Effective treatment without surgery is available for the great majority of patients suffering from back pain and related disorders, such as neck, arm, or leg pain caused by intervertebral disc disease. Prior to treatment proper diagnosis of the underlying condition is required. Consultation with a physician is recommended for all patients experiencing significant back pain. The information in this website is not designed to be a substitute for consultation with your own physician; rather it is designed as a guide to allow the patient to gain a more thorough understanding of the medical issues involved in both diagnosis and treatment.

Acute back pain caused by non-musculoskeletal diseases requires prompt diagnosis and treatment of the underlying condition. The following discussion is directed to patients with chronic back pain caused by one of the musculoskeletal disorders in Category A in Table 1.

Treatment of acute musculoskeletal pain involves the common remedies of avoidance of exertion; physical modalities such as ice, and later heat; non-steroidal anti-inflammatory and analgesic medication such as acetaminophen, aspirin, ibuprofen, or related medications; and gradual resumption of activity after symptomatic improvement. Consultation with a physician is recommended when pain is severe, associated with other symptoms, such as headache or fever, or in cases where fracture of a bone or other internal injuries is a possibility.

Proper diagnosis of the underlying condition is imperative, since chronic pain can be caused by a variety of different medical condtions, often with symptoms which overlap. Therefore consultation with a physician is imperative, especially when pain persists. Patients failing to respond to treatment merit further investigation to rule out the possibility of a less common, but more serious cause of their pain, such as cancer.

NSAIDS are a mainstay of treatment for patients with chronic musculoskeletal pain. The reason for this is that they are generally well tolerated, have a rapid onset of action, are widely available, may be taken orally and therefore can be self-administered, and have a low cost per dose. Despite these considerations, NSAIDS are not without their drawbacks.

First, these medications do not affect the underlying nature of the disorder. In other words they do not help to cure the disorder, or shorten its course. These are purely used to mask the symptoms of the disease.

Second, these medications, allow generally well-tolerated in the short term, are being used to treat a chronic condition, and therefore are usually used for a prolonged period of time. When used this way there are additional medical risks due to cumulative and repetitive dosing. The greatest risk over the long term is gastrointestinal bleeding. GI bleeding from these agents can be catastrophic and life-threatening. Several thousand deaths per year occur in the U.S. attributed to this, particularly in elderly patients. Caution is therefore necessary when using these agents on a chronic basis, particularly in those who are elderly, who have a history of previous GI bleeding, or in those using other agents which promote bleeding, such as coumadin or aspirin. The newer NSAIDS which selectively inhibit COX-2 may have a lower incidence of GI bleeding than the COX-1 active drugs, but there may be other cardiovascular risk factors associated with some of these agents. These issues are currently being investigated.

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