Back pain is as much a part of the human condition as the common cold. In fact, 8 out of 10 adults will experience an acute episode of back pain at some point in their lifetime. Back pain is the second most common cause of missed workdays due to illness and the most common cause of disability.
Fortunately, most episodes of back pain resolve with time: approximately 50% of patients will experience back pain relief within two weeks and 90% within three months.
While most episodes of back pain are self-limited, 5% to 10% of cases will become chronic (i.e., long-lasting and recurrent). Chronic back pain accounts for 90% of the healthcare expenditures for back pain and amounts to $50 to $80 billion dollars annually.
Many different structures in the back and neck are capable of producing pain. There are the large nerve roots that go to the legs and smaller nerves that innervate (supply the nerves to) the spine itself. The large paired back muscles may be strained, and the bones, ligaments and joints may be injured.
In general, pain does not mean that there is actual tissue damage. Even if the pain is severe, there rarely is ongoing tissue damage. Most pain syndromes are due to inflammation, especially in the acute phase, which typically lasts for two weeks to three months.
There are two instances in which acute back pain is an indicator of nerve damage:
- Bowel and/or bladder incontinence
- Progressive weakness in the legs.
These symptoms constitute a medical emergency and medical treatment should be sought immediately. The symptoms may be due to nerve pinching, and if not treated immediately, the damage maybe permanent. Fortunately, this condition is extremely rare.
Typically, younger individuals (30 to 60 year olds) are more likely to experience back pain from the disc space itself (e.g. lumbar disc herniation or degenerative disc disease). Older adults (e.g. 60 year olds and above) tend to suffer from degeneration of the joints in the back (e.g. facet joint osteoarthritis).