Back Pain Causes, Diagnosis, and Treatment

More than 80% of people experience back pain at some point in their life. In the past 3 months, 1 in 3 people has had back pain. Zacharia Isaac, MD, a Mass General Brigham spine care and pain management specialist, discusses back pain causes, treatment and prevention tips. Dr. Isaac is chief of spine care and pain management at Spaulding Rehabilitation Hospital and associate chairman of physical medicine and rehabilitation at Brigham and Women’s Hospital.

Back pain causes

Most people have experienced back pain at some point in their life. Common causes of chronic back pain include:

• Aging discs and disc herniations
• Arthritis in the joints
• Sprains or ligament strains
• Other processes in the central nervous system

“It's very rare that patients with back pain have concerning things like tumors or infections, and even fractures are not that common,” explains Dr. Isaac.

Back pain diagnosis

It can be difficult to diagnose the specific cause of back pain. “It’s so common that doctors call it nonspecific back pain, because it doesn’t always have a structural cause,” Dr. Isaac explains. "MRIs can show various findings, but they're often seen in people without any pain whatsoever."

However, if your symptoms last for more than 3 months, and if you have any other concerning medical conditions, it's worth talking to your primary care provider (PCP).

Back pain treatments

When treating patients with back pain, Dr. Isaac often makes 3 recommendations:

1. Have healthy cognitive practices around pain.
2. Exercise regularly and consistently.
3. Reduce inflammation.

“Back pain is very treatable, and even with setbacks, it can be managed and improve very quickly,” Dr. Isaac says.

Cognitive therapies for pain

Back pain can make patients feel vulnerable, less independent, and negatively impact sleep. These cognitive therapies can help patients deal with pain and encourage recovery:

• Mindfulness meditation
• Cognitive behavioral therapy (CBT)
• Pain reprocessing therapy (PRT)

Regular and consistent exercise

Strengthening your muscles can improve your endurance and function so you can do the activities you enjoy in life. Exercises for back pain include:

• Functional weight training
• Stretching
• Foam rolling
• Walking programs
• Low-impact cardio
• Yoga
• Pilates

Patients may experience something called delayed onset muscle soreness, which is normal after exercise, but people with back pain are often concerned they've re-injured themselves. Dr. Isaac recommends trying these exercises again, gently, to see how your endurance improves over time. “Pick a workout you find interesting enough to keep doing it regularly, and want to implement it into your life," he says.

Reduce inflammation

Sometimes back pain can be caused by inflammation, which can be reduced by diet and weight loss. “Different diets work for different people. Some people do well with a plant-based diet, some people do well with intermittent fasting. But most importantly, you should limit processed carbohydrates,” says Dr. Isaac.