Low back pain is the most common pain complaint in the United States. There are a number of causes for back pain. Today, I would like to focus on nonspecific/mechanical low back pain. This type of pain is focused in the back and is not like sciatica which means pain radiating down the leg to the foot. Low back pain can occur spontaneously or may be related to a patient’s specific activity or exercise. A patient may complain about the onset of back pain with activities such as bending, twisting, or lifting objects.
There are certain categories of patients who are at higher risk for developing low back pain. These categories include: Patients with a previous episode of low back pain, patient’s older than 40 years of age, female sex, asthma, headaches, diabetes and certain genetic factors. There are certain risk factors, which if addressed can lower the chance for back pain, these factors include: Obesity, smoking, physical inactivity and poor sleep.
The first thing a patient needs to understand is that with the sudden onset of back pain they should remain active. The pain usually resolves within 6-12 weeks. Lying in bed or sitting in a chair all day is not recommended. Treatment of low back pain may include: Over-the-counter anti-inflammatory medications such as Motrin or Naprosyn, spinal manipulation, physical therapy with a home exercise program, and acupuncture. Other medications such as muscle relaxants are commonly used for muscle spasms or tightness in the back. The problem with many of the muscle relaxants is difficulty with tolerating these medications during the day because they can make you sleepy. In my practice, I typically only prescribe muscle relaxants for patients to take at night.
Another common source of treatment for back pain is the use of heating pads. Heating pads should be used for 20 minutes per session, and a patient can apply the heating pad several times a day. Heating pads used for longer periods of time can cause thermal or heat damage to the skin. There are also continuous low-level heat wraps that can be used for several hours at a time.
When a patient goes to a physician for an initial consultation for low back pain, plain x-rays may be ordered. This allows the physician to look at the bony anatomy of the spine. Arthritis in the joints and degeneration of the discs in the back (discs are the padding between the bones or vertebral bodies) can be seen. In the older population, a spinal fracture can be identified on an x-ray. More advanced radiological studies such as MRIs, which give a very detailed look at the discs and nerve roots, are not commonly ordered when the patient initially presents to a physician’s office with back pain. The insurance carriers, in general, will not approve an MRI study until the patient has had at least a month or more of some form of physical therapy or chiropractic care. The insurance carrier may also deny the request for an MRI if the patient does not have pain or numbness radiating into the leg(s) or lack of physical findings of improper nerve function on physical examination. The insurance carriers are well aware that most of the time back pain will resolve within 6-12 weeks.
In the coming weeks, we will discuss a variety of other common causes of back pain such as lumbar disc herniations, sacroiliac joint pain, facet joint pain etc. I will also discuss the role of interventional or injection therapy for treatment of various spinal ailments.
Dr. Harris Bram is a fellowship trained interventional pain management physician with over 25 years of experience. Dr. Bram has had a presence in Ocean County for over 25 years. Dr. Bram is expanding his services with the opening of his new office in Toms River starting July 2026. The office will be located at 601 NJ-37 suite 101. In addition to pain management services, the new expanded office space will also provide access to both a fellowship trained orthopedic surgeon and a spinal surgeon.
Dr. Bram specializes in personal injury cases such as motor vehicle accidents and Worker’s Compensation injuries. He also participates in many commercial health plans.