Most of us have (or will have) experienced an acute lower back pain. Sometimes the cause is obvious – you unloaded six bags of loam from the trunk of your car – while other times “I just bent over to pick up a pencil.” Our back muscles extend over a long distance and stretching them just the wrong way may be all it takes.
Whatever the cause, it can make for a very uncomfortable time. What should you do?
First, what you should not do is go to the emergency room. Unless you have one of the “red flags” I list below, you do not need X-rays or CT scans. What you need is pain relief and a short period of rest.
Pain relief for acute onset back pain takes many forms, no one of which works for everybody. Getting flat with your knees bent and some pillows under your knees may be all you need. Both heat and cold can be very helpful. For acute pain, I tend to start with ice rather than heat, but if you have found a heating pad works, stick with it.
Note that you should only spend an hour or two lying down. After that, gentle movement such as walking is fine.
Get some over-the-counter pain relievers: acetaminophen, ibuprofen or naproxen are equally likely to help but each of us has a favorite. If one anti-inflammatory does not work, try a different one.
When might you need an imaging test? If the pain extends down the back of one leg towards the ankle you might have a ruptured disk, a condition that can be suspected based on clinical exam and confirmed with a CT scan. If you have known osteoporosis or cancer, or have been on long-term cortisone-type medication or the pain comes after a serious fall, you may be dealing with a fracture of one or more vertebra. This can be proven with a plain X-ray.
Cancer, an unexplained fever, IV drug use or a depressed immune system raise worry about an infection near the spine and suggest you seek early medical attention.
Assuming none of these uncommon situations fits, your pain should subside within a day or two with rest, pain relievers and ice or heat. Don’t try to ignore it and push through or the pain will last longer.
Next week: what about back pain that does not go away?
Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.
What Does The Doctor Say?
By Dr. Edward Hoffer