Back pain in the lower back or low back pain is a common concern, affecting up to 90% of Americans at some point in their lifetime. Up to 50% will have more than one episode. Low back pain is not a specific disease. Rather, it is a symptom that may occur from a variety of different processes. In up to 85% of people with low back pain, despite a thorough medical examination, no specific cause of the pain can be identified.



Back pain can affect anyone, of any age, but it is more common in people between the ages of 35-55 years. In the majority of cases, the cause of pain can be linked to the way the bones, muscles and ligaments in the back, work together.

The nerves of the spinal cord, which connect the brain to the rest of the body, run down a hollow channel in the spine (the spinal canal). Where the nerves pass out from the spinal column on their way to the muscles of the arms and legs they are known as nerve roots (see Figure 2). The bones of the back are also held together by tough bands called ligaments which, together with the spinal muscles, give the back its strength. The main muscles at the front and the back of the body are shown in Figures 3 and 4.

Medication for Back Pain

Two types of over-the-counter medications, acetaminophen and non-steroidal anti-inflammatory drugs (NSAID's), are commonly recommended to alleviate low back pain. Acetaminophen and NSAID's work differently and therefore may be taken at the same time. For short periods of time, prescription medications (such as narcotic pain medications and muscle relaxants) may be helpful to alleviate pain or related complications.

Narcotic Pain Medications

Narcotic pain medications are excellent at relieving pain, but these can be dangerous, addictive medications. These medications include Percocet, Vicoden, Oxycontin, and others. Using narcotic medications must be under close supervision, and only for a limited period of time. prolonged use of narcotic medication can be dangerous.

Muscle Relaxes

Muscle relaxing medications can be very helpful in the treatment of some types of back pain. Muscle relaxes are sold under the trade names of Flexeril, Soma, Valium, and others. These medications help to relieve muscle spasm, but may also make patients quite drowsy.

Opioids are appropriate only in the most severe cases of back pain; they are morphine derivatives and extremely addictive. But for those who have chronic, untreatable back pain, the may be a last resort back pain medication. They must be prescribed by a doctor.

Most episodes of back pain are caused by muscle strain. The large paired muscles in the low back (erector spine) help hold up the spine, and with an injury the muscles can become inflamed and spasm, causing low back pain and significant stiffness.

As with all pain relief treatments, there are some cautions with applying ice and using ice massage therapy. Never apply ice directly to the skin. Instead, be sure that there is a protective barrier between the ice and skin, such as a towel. Limit the ice application to no more than fifteen or twenty minutes. Additionally, ice should also not be used for patients who have rheumatoid arthritis, Reynard's Syndrome, cold allergic conditions, paralysis, or areas of impaired sensation.