August 01, 2014
What to Do About Low Back Pain

What to Do About Low Back Pain

by Berkeley Wellness  |  

Four out of every five people will experience low back pain at some point in their lives, and many will contend with repeated episodes of debilitating pain on and off, sometimes for years. Low back pain is the second most common medical complaint after headache. It’s a leading cause of doctor visits and missed days from work, second only to the common cold.

The annual bill for aching backs, including medical care and disability compensation, may run as high as $50 billion in the U.S. alone. Over the years, the cost of treating back pain has gone up and up—and yet there is no indication that this extra expense is resulting in healthier, happier people. In addition to the discomfort and the expense, back pain compromises people’s overall quality of life, making it hard to work, exercise, and travel.

Every year, many articles and books about back pain are published, espousing new and old theories about its causes and how to treat it. However, there’s lots of room for controversy because the back is such a complicated, sophisticated structure. While we can name all of the bones, joints, nerves, muscles, and ligaments, the sum total remains something of a mystery.

The following interview with William Pereira, M.D., M.P.H., is adapted from our Wellness ReportHow to Manage Back Pain, of which he is the co-author. Dr. Pereira is Associate Chair of the Editorial Board of the UC Berkeley Wellness Letter and is board-certified in occupational and environmental medicine. He has over 30 years of clinical experience in occupational, preventive, primary care, physical and emergency medicine.

Q. When should someone with back pain see a doctor?

A. If you have simple low back pain and you have adequate control of the pain, you don’t need to see a doctor. But if over-the-counter pain relievers don’t help enough, or if there are symptoms such as lower-extremity pain, numbness, tingling, or weakness in the lower extremities, loss of bladder or bowel control, or fever, you should see a doctor.

There’s no hard line with simple low back pain, which is defined as pain that is nonradiating or radiates just a bit into the buttocks or thigh, without any of the other symptoms I just mentioned. I myself have chronic low back pain and chose not to seek medical attention for about a year and a half.

Q. If a person has gone to a primary care doctor for back pain and that hasn’t helped, who should he/she consult next?