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Low Back Pain

The Journal of the American Medical Association

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115 views1 page

Low Back Pain

The Journal of the American Medical Association

Uploaded by

qwerrty123987
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Low Back Pain

our back is made up of bones (the vertebrae, or spinal column, which


protects your spinal cord) and muscles. The vertebrae are stacked
like blocks; the spinal cord runs down the middle, and between the
vertebrae nerves extend from the spinal cord to the left and right. The disks
lie between the vertebrae and form spongy shock absorbers between each
Lumbar
bone. Several layers of muscle cover the back, and ligaments and tendons
spine
vertebrae
support the vertebrae, supporting posture and giving the body flexibility.
Back pain can be caused by problems with the muscles, the bones, or the
nerves in the back.

Nerves at
the end of the
spinal cord
1
2
3
4

Healthy disk
Spinal
nerve root

Nucleus

CAUSES OF LOW BACK PAIN AND SYMPTOMS

Annulus

Often, the cause of back pain is unknown. Back pain can be caused by a strain
of the muscle. This type of back pain can vary; it can be dull or sharp and may
get worse with sitting, standing, walking, or other movement. Lying down often
helps. Muscle pain does not extend down your leg toward your foot.
Sometimes the disk can bulge out, putting pressure on the nerve that
is exiting between the vertebrae. Signs of a pinched nerve may include
pain that radiates down your leg, numbness, or tingling. More rarely,
it can cause problems with controlling your bowels or bladder. Signs
of underlying disease requiring immediate medical attention include
back pain accompanied by unexplained weight loss or fever.
Arthritis or degeneration of the bony vertebrae can also cause back pain.

V E RT E B R A

Bulging disk
compressing
nerve root

DIAGNOSIS

FOR MORE INFORMATION

Most back pain is uncomplicated and self-limited. If your pain does not get better in a
few days or weeks, if you have fever or weight loss, or if you have signs of nerve
involvement, you should call your doctor. A medical history and physical examination
will allow the doctor to make appropriate treatment recommendations. Imaging
(x-rays, magnetic resonance imaging [MRI], or computed tomography [CT]) is not
recommended for uncomplicated low back pain. Imaging is used if you have had
trauma, evidence of nerve involvement, sometimes for those older than 70 years, or if
symptoms are very prolonged. It is also used if your doctor suspects another disease,
such as infection or cancer.

TREATMENT
Many treatments are available for low back pain. Often exercises and physical therapy
can help. Some people benefit from chiropractic therapy or acupuncture. Sometimes
medications are needed, including analgesics (painkillers) or medications that reduce
inflammation. Surgery is not usually needed but may be considered if other therapies
have failed.

PREVENTION
Exercise and good posture can maintain good back health. Your back and abdominal
muscles work to maintain posture and need exercise. It is important to use proper
technique with strenuous activities such as lifting heavy objects and shoveling snow.
This includes bending your knees so you use your legs and buttocks as well as your
back to lift, and turning your whole body so you dont twist just your back.
Sources: Agency for Healthcare Research and Quality, American College of Physicians, National Institute
of Neurological Disorders and Stroke, American Academy of Orthopaedic Surgeons
Chou R, Qaseem A, Owens DK, et al. Diagnostic imaging for low back pain: advice for high-value health care from
the American College of Physicians. Ann Intern Med. 2011;154(3):181-189
Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from
the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491

Denise M. Goodman, MD, MS, Writer


Alison E. Burke, MA, Illustrator
Edward H. Livingston, MD, Editor
1738

JAMA, April 24, 2013Vol 309, No. 16

Downloaded From: http://jama.jamanetwork.com/ on 07/16/2014

BACK PAIN

The Journal of the American Medical Association

JAMA PATIENT PAGE

Agency for Healthcare Research and


Quality
www.guidelines.gov/content.aspx?id
=35145
American College of Physicians
www.acponline.org/clinical
_information/guidelines/guidelines/
National Institute of Neurological
Disorders and Stroke
www.ninds.nih.gov/disorders
/backpain/detail_backpain.htm
American Academy of Orthopaedic
Surgeons
orthoinfo.aaos.org/topic.cfm?topic
=a00311

INFORM YOURSELF
To find this and previous JAMA
Patient Pages, go to the Patient Page
index on JAMAs website at
www.jama.com. Many are available in
English and Spanish. A Patient Page
on coping with back pain was
published in the December 6, 2000,
issue and one on steroid injections to
treat back pain was published in the
November 21, 2012, issue.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical
condition, JAMA suggests that you consult your physician. This page may be photocopied
noncommercially by physicians and other health care professionals to share with patients.
To purchase bulk reprints, call 312/464-0776.

2013 American Medical Association. All rights reserved.

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