Lower back pain?

Originally Published: October 1, 1993 - Last Updated / Reviewed On: November 29, 2013
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Dear Alice,

I have been having a bad lower back pain since the start of summer. It's been getting worse, and now it’s REALLY bad because it starts hurting when I sit for more than one to 30 minutes (depends on the chair). At the beginning of the summer I noticed that my lower back started feeling stiff. At the present moment, the pain has shifted to the area above the right buttock. A recent change is that when my back hurts, my right ankle usually bothers me as well. I have been to a specialist, and have been to physical therapy, and it has not helped. X-rays have shown to be negative, and so far there has been no sign of a nerve impingement. But this pain is driving me nuts! I look to you as a last hope. Please help! Thanks.

Signed,
Aching Back

Dear Aching Back,

What a pain in the …er, back. As frustrating and as painful as it may be to experience lower back pain even after undergoing diagnostic tests and treatment, all is not lost. A second (or third) opinion from a health care provider may be able to provide you with a diagnosis, and hopefully, with an effective treatment. Although its causes vary, chronic back pain may result from repeated bouts of physical strain on the back, perhaps due to changes in how the nerves in the back respond to pain stimuli. Medical conditions that may also contribute to back pain include:

  • Sciatica (sharp pain going through buttocks and back of leg, due to a herniated disk that hits the sciatic nerve)
  • Herniated or bulging disk (FYI — this condition may not always cause pain, even though it may require surgery. See Disk is slipped, bulging, and herniated... Help! for more information)
  • Injury
  • Cancerous tumor in the spine
  • Infection of the spine (marked by fever and a tender, warm area on back)
  • Arthritis

List adapted from Back Pain from the Mayo Clinic.

In some cases, stress may contribute to back pain by causing tension in the back muscles. If you suspect that this may be the case (and this is confirmed by a health care provider), you may want to try some of the de-stressing tips in Stress, anxiety, and learning to cope and Number one cause of stress in the Go Ask Alice! Emotional Health archives. Also keep in mind that sometimes the cause of back pain cannot always be determined, although pain management techniques — under the supervision of a health care provider — may be effective in alleviating the pain.

Additionally, X-rays, which are sometimes used to determine a potential diagnosis for back pain, may not always show problems with the spinal cord, muscles, fibrous tissues, nerves, or disks. Other diagnostic tests include: CT scans, magnetic resonance imaging — MRI, bone scans, and motion and reflex tests. A health care provider can determine which test(s) to use.

You seem to feel unsatisfied with the physical therapy that you were receiving for your back pain. Keep in mind that a number of different options to treat back pain exist. Some people find that visiting a chiropractor or trying acupuncture is helpful. Others may find relief by using hot and cold packs, exercising, resting at home, or taking pain-relievers (such as acetaminophen, aspirin, or ibuprofen) when you feel pain. It is always advisable to discuss treatment options with a health care provider beforehand.

You may consider seeing a health care provider (perhaps a different one) for another opinion or for another referral to a specialist. If you are a student at Columbia, you can make an appointment to see a health care provider by contacting Medical Services (Morningside) or the Student Health Center (CUMC).

Even though your back pain may be driving you nuts, seeking other opinions from health care providers may help take the pain off the proverbial back-burner.

Alice