Your Age

A patient’s age is the first thing many doctors use to decipher the cause of back pain, says Robert Napoles, M.D., an internal and sports medicine physician with Sutter Pacific Medical Foundation.

“If a young person knows they did something and developed back pain immediately following, that falls into the category of mechanical back pain, which is caused by stress or strain on the back muscles,” he says. “Back pain in the elderly, on the other hand, raises the question of a more serious diagnosis, and I’d want to rule out cancer or other more systemic causes.”

People in middle-age tend to have more disc-related back injuries, whereas seniors have increased risk for degenerative or progressive conditions such as osteoporosis and arthritis.

How Pain Started

Doctors call this your “history,” but essentially they just mean how the back pain developed. You might have played a tough game of basketball yesterday or helped a friend move. Or, maybe you woke up in the night with a sharp pain in your back.

“I call this giving the story of what’s going on,” Dr. Napoles says.

If the pain occurred suddenly and is localized, it is most likely a back spasm that will heal with rest, ice and medication. If the pain has gradually radiated into the buttock and legs, it is probably injury to the disc or vertebrae that is pressing on a nerve. More systemic issues, such as fever, lack of appetite, weight loss or problem with bowels, deserve immediate attention, since these could be signs of a serious problem like an infection or tumor. Sudden, abrupt pain that moves location with time could be a kidney stone, especially if you’ve had one in the past.

“Depending on the history, we may want to get an x-ray or diagnostic imaging study to confirm the diagnosis,” Dr. Napoles says.

Your Response to Pain

Many people experience one of two kinds of back pain. The first type makes you want to be still because it feels worse with movement. The other is more colicky, meaning it starts and stops and sometimes moves abruptly. This type of pain typically prompts you to move constantly because it’s hard to find a comfortable position. The first type mostly likely comes from a back sprain or strain that will resolve with home care. However, sharp pain that comes and goes, interrupts your sleep or moves with time could indicate the need for medical care.

What to Do Next

Once you’ve cracked the code on your back pain, you can choose from the following options to get help:

• Take care of yourself. Most back pain resolves within a few weeks without medical treatment. To treat your back pain at home, rest and refrain from unnecessary bending or twisting. Apply ice every hour during the first few days, and then begin alternating ice and hot pads or a warm bath. Take nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen) to promote healing and improve comfort. Gradually, begin taking walks and gently stretching to loosen muscles and increase circulation.

• Visit your primary care physician. If you do not see improvement after several weeks of home care, or if the back pain interferes with daily functioning, visit your doctor for a thorough evaluation.

• Work with a physical therapist. A physical therapist can help you learn exercises and back care strategies that can reduce pain and protect your back from further injury. Talk to your doctor if you need a referral to a physical therapist.
• See a back specialist. Your primary care doctor may recommend you see an orthopedic or neurological specialist if you need pain management injections or specialized procedures.

• Take symptoms seriously. In rare cases of back pain with accompanying symptoms such as fever, abdominal discomfort, bowel problems or sharp, stabbing pain, go directly to the emergency room. These could be signs of a problem that requires immediate medical attention.

Trust your instincts, and recognize that your doctor probably won’t pursue testing or treatment for most cases of back pain.

“Most of the time, back pain just needs time to resolve,” Dr. Napoles says. “Do your home care, try a physical therapist or back exercise program and, if that doesn’t help, ask your doctor to pursue a diagnostic study.”