Medical Considerations - Treatment Choices And Considerations: Back Pain

Content provided by the Faculty of the Harvard Medical School

Medical considerations

Ultimately the particular management strategy or treatment you choose to ease your back pain will depend on an assessment of several factors. Chief among these are medical considerations, such as your back problem's natural history and whether the problem is acute or chronic, as well as your personal situation and preferences (see "Personal considerations"). Taking all these factors into consideration will help you and your physician determine which of the available options are right for you.

Natural history

When used in a medical context, natural history is a term that refers to how long the problem would persist if it were left untreated. Based on scientific research, physicians can now predict the natural histories of various types of back pain. This information is very helpful, especially if you're considering a surgical option. If the natural history is relatively short, you might decide to hold off on surgery. If it isn't, that might tip the balance in favor of surgery.

Acute or chronic?

Acute low back pain strikes swiftly. It may follow something you did at work or at play. It can also be caused by a pinched nerve or a degenerative condition such as arthritis. Fortunately studies suggest that one-third of people with low back pain will be much improved in as little as one week after the start of their symptoms, and two-thirds will experience improvement within seven weeks.

But the problem tends to recur: About 40% of people who develop low back pain will experience another bout of symptoms within six months. So after the initial acute attack retreats, prevention is the name of the game.

Chronic low back pain is a very different story. This is pain that shows little or no improvement after three months. Often the precise cause of the pain is difficult to pinpoint, and it gets progressively worse.

In general, chronic back pain responds best to a management program that includes several different types of approaches — for example, a combination of pain-relieving medication, physical activity, and a complementary therapy such as acupuncture. If your pain persists, your doctor may refer you to a pain clinic. These centers use a variety of approaches — including education, cognitive behavioral therapy, exercise programs, biofeedback, relaxation techniques, and selective nerve blocks — to ease the pain or minimize its effect on your daily routine. The primary goal is to help people return to a more active life.

Last updated:	January 23, 2007