Back pain can be devastating. Just ask my wife. 

Prior to our wedding day 38 years ago, my then-fiancée decided she wanted to get in shape.  She joined a gym and, in her zeal, repeated the same weight routine three days in a row. On the fourth day, she suffered severe low-back pain that has besieged her for the past three decades.

Guess who’s been the designated luggage shlepper and grocery shopper in our marriage?

My wife is not alone in her ongoing battle with back pain. An estimated 80 percent of adults suffer back pain at some point during their lifetime.

Pain in the lower back can be triggered by repeated straining (such as what caused my wife’s pain), by a fall or accident, or by a sudden action such as lifting a heavy weight or twisting abruptly. Oddly, a herniated disc can happen spontaneously without a specific injury. 

In older adults, the most common cause of lower back pain is spinal stenosis, a narrowing of the spaces of the spine. With aging, some people develop spurs in their vertebrae, and ligaments around the spine may thicken, which in tandem cause narrowing (stenosis) where the nerves exit the spine. This typically results in pain while standing and walking, and relief by sitting.

Red flags

While most causes of back pain are not life-threatening, there are some warning signs that call for immediate attention. These “red flags” include a history of trauma, fever, incontinence, unexplained weight loss, long-term steroid use, and intense localized pain with the inability to find a comfortable position. The latter typifies a patient with an abdominal aortic aneurysm.   

A patient with a history of cancer is another red flag, even if the cancer occurred decades prior. A patient who has a history of cancer, especially when coupled with recent weight loss, deserves an X-ray evaluation.

(The problem with MRIs is that even without back pain, most people will show an abnormality. Falsely alarming MRI results may explain why back surgery in the United States is more than twice as common as in other countries. Yes, surgery can correct the problem seen on the MRI, but this may be unrelated to the cause of a patient’s pain.) 

Treatment

Treatment of low-back pain depends on whether the pain is acute or chronic (lasting longer than three months). There are no hard rules, but generally ice packs are advised for pain within two to three days of injury. Heat can help ease subacute or chronic pain. 

Contrary to the common assumption, bed rest after an acute injury tends to delay recovery, not hasten it. For this reason, it’s important to resume normal activity as soon as possible. Physical therapy can help strengthen core muscles that support the spine, though an interesting study from UCLA a few years ago showed that walking three hours a week was more effective than three hours a week of physical therapy. 

Epidural steroid injections can be given for low-back pain associated with sciatica, but a recent  study by the National Institutes of Health showed that patients with spinal stenosis who received epidural injections had worse long-term outcomes than those who did not receive them.

Surgery may be considered in serious injury situations or if there is progressive neurological deterioration. While there appears to be a short-term benefit in patients who have undergone surgery, long-term studies appear to show no clear advantage for surgery over nonsurgical methods.

Prevention

Regular exercise is the best way to keep one’s back healthy. My wife has found that walking at least 60 minutes a day helps, as does stretching and using a lumbar support called a Sacro-Ease or an inflatable travel pillow for sitting. She avoids high-heeled shoes and heavy lifting. If she does lift something, she lifts with bent knees, carries the object close to her, and does not twist.  

Personally, I find that running, biking and yoga keep my back in shape, but everyone has to find a regimen that works best for them.

There’s no doubt that back pain can be disabling, but with awareness and regular activity, you can help prevent further damage.

Jerry Saliman, M.D., is a volunteer internist at Samaritan House Medical Clinic in San Mateo and a contributing medical blogger for the Peninsula JCC (www.pjcc.org) in Foster City.  He retired from Kaiser South San Francisco after a 30-year career. To learn more about low back pain, visit http://tinyurl.com/78yea.