About Back Pain
Back pain is the most common symptom, experienced by approximately 85% of Japanese people at least once in their lifetime. The causes are diverse, ranging from muscle fatigue and poor posture to disc herniation, spinal canal stenosis, internal organ diseases, and bone metastases from cancer.
Most back pain is non-specific low back pain that resolves naturally within a few weeks. However, some cases hide serious conditions that require early treatment, so it is crucial to identify red flags.
Our Clinic's Role
As an internal medicine clinic, we focus on not overlooking back pain originating from internal organs and provide conservative treatment for common back pain. We refer patients requiring detailed MRI examinations, neurological symptom evaluations, and surgical eligibility assessments to orthopedic or neurosurgical departments.
Classification of Back Pain
Classification by Acute/Chronic
| Category | Duration | Main Causes |
|---|---|---|
| Acute Low Back Pain | Within 4 weeks | Acute lumbago, myofascial low back pain, acute stage of disc herniation |
| Subacute Low Back Pain | 4 to 12 weeks | Delayed treatment, repetitive strain |
| Chronic Low Back Pain | 12 weeks or more | Spinal canal stenosis, degenerative spondylosis, psychogenic |
Classification by Cause
| Category | Example Diseases |
|---|---|
| Muscular/Myofascial | Myofascial low back pain, acute lumbago (lumbar sprain) |
| Discogenic | Disc herniation, degenerative disc disease |
| Spinal Degeneration | Degenerative spondylosis, spinal canal stenosis, spondylolysis |
| Inflammatory | Ankylosing spondylitis, polymyalgia rheumatica |
| Osteoporotic | Vertebral compression fracture (elderly) |
| Visceral Origin | Urolithiasis, pyelonephritis, pancreatitis, dissecting aortic aneurysm, gynecological diseases |
| Tumor | Bone metastasis, multiple myeloma, spinal tumor |
| Infection | Pyogenic spondylitis, tuberculous spondylitis |
| Psychogenic | Stress, depression, chronic pain syndrome |
Red Flags (Warning Signs)
Back pain accompanied by the following symptoms may indicate a serious condition.
Prompt medical attention is necessary for early diagnosis and treatment.
- Back pain accompanied by fever (infectious spondylitis)
- History of cancer or accompanied by weight loss
- First onset of back pain at age 50 or older
- Pain that worsens at rest or at night
- Symptoms suggestive of cauda equina syndrome: perineal numbness, bladder/bowel dysfunction, weakness in both lower limbs
- Severe back pain after trauma (suspected fracture)
- Long-term steroid use or history of osteoporosis
- Sudden paralysis or difficulty walking
- Pain that rapidly worsens
- Accompanied by pulsating abdominal pain (dissecting aortic aneurysm)
Characteristics of Major Back Pain Conditions
Acute Lumbago (Acute Low Back Pain)
- Acute onset when lifting a heavy object or in a forward-bent position
- Injury to muscles and ligaments around the lumbar spine
- Often improves within a few days to 2 weeks
- Cooling in the acute phase, then heat application
Disc Herniation
- Part of the intervertebral disc protrudes and compresses a nerve
- Back pain + unilateral leg pain/numbness (sciatica)
- Worsens with forward bending, coughing, sneezing
- Most cases improve with conservative treatment within 3 months
- Surgery may be considered for severe neurological symptoms
Spinal Canal Stenosis
- Common in middle-aged and elderly individuals, spinal canal narrows and compresses nerves
- Intermittent claudication: Leg numbness and pain when walking, improves with rest
- Relieved by forward-bent posture (cycling is relatively easier)
- Worsens with backward extension
- Conservative treatment, nerve blocks, surgery for severe cases
Vertebral Compression Fracture
- Common in elderly individuals and those with osteoporosis
- Can occur with minor trauma (sneeze, fall on buttocks)
- Severe pain with turning over or getting up
- Diagnosed by X-ray, MRI for determining acute or chronic
- Osteoporosis treatment is important
Do Not Overlook Back Pain of Visceral Origin
The following conditions fall under internal medicine, urology, or gynecology, but can manifest as back pain.
| Condition | Characteristics |
|---|---|
| Urolithiasis | Severe pain, hematuria, nausea, renal colic |
| Pyelonephritis | Fever, painful urination, costovertebral angle tenderness |
| Acute Pancreatitis | Upper abdominal pain radiating to the back, vomiting |
| Abdominal Aortic Aneurysm/Dissection | Pulsating severe pain, emergency |
| Endometriosis/Uterine Fibroids | Linked to women's menstrual cycles |
| Ovarian Cyst Torsion | Sudden lower abdominal to back pain, vomiting |
| Gallstones/Cholecystitis | Upper right abdominal to right back pain |
Consultation and Examination
Key Points for Medical Interview
- Onset time, trigger, mode of onset
- Nature of pain, location, presence of radiation
- Aggravating factors (forward bending, backward extension, coughing, weight-bearing)
- Leg symptoms (numbness, weakness, radiating pain)
- Bladder/bowel dysfunction
- Systemic symptoms (fever, weight loss)
- Medical history, medications
Examinations Available at Our Clinic
| Examination | Purpose |
|---|---|
| Blood test (CRP, CBC, LDH) | Inflammation, infection, tumor markers |
| Urine test | Urolithiasis, pyelonephritis |
| X-ray (spine, chest) | Vertebral compression fracture, deformity |
| Abdominal ultrasound (if necessary) | Exclusion of visceral diseases |
| Rheumatoid-related markers | Inflammatory spinal diseases |
Cases Requiring Referral to an Orthopedic Specialist or Specialist
- Requires detailed examination with MRI/CT
- Severe neurological symptoms (sciatica, weakness)
- Suspected cauda equina syndrome (emergency)
- Evaluation for spinal surgery eligibility
- Nerve blocks, rehabilitation
- Suspected visceral disease is referred to the relevant department
Treatment Options
Pharmacotherapy
| Category | Representative Drugs | Usage Scenario |
|---|---|---|
| NSAIDs | Loxoprofen, Celecoxib | Acute to subacute low back pain, consider stomach/kidney health |
| Acetaminophen | Calonal | When NSAIDs cannot be used |
| Muscle Relaxants | Eperisone, Tizanidine | Low back pain with severe muscle tension |
| Neuropathic Pain Medications | Pregabalin, Mirogabalin, Duloxetine | Numbness, sciatica |
| Weak Opioids | Tramadol | Severe pain not relieved by NSAIDs |
| Herbal Medicine | Hachimijiogan, Goshajinkigan, Keishikajutsubuto | Chronic low back pain, elderly |
| Topical Medications | NSAID gels, patches | Local treatment |
Non-pharmacological Therapy
- Moderate exercise therapy (walking, aquatic exercise)
- Stretching, core muscle strengthening
- Heat therapy (chronic stage), cooling (acute stage)
- Corset (short-term use in acute stage)
- Posture improvement, ergonomic approach
- Nerve blocks and rehabilitation at an orthopedic clinic
Dealing with Acute Lumbago (Acute Low Back Pain)
Immediately After Onset (Acute Stage: 48-72 hours)
- Rest in a comfortable position (often easier lying on your side with knees bent)
- Cooling (ice pack for 15 minutes, several times/day)
- Oral and topical NSAIDs
- Temporary support with a corset
- Prolonged absolute bed rest is counterproductive (start moving within 2 days)
Subacute Stage (3 days - 2 weeks)
- Gradually return to normal activities
- Switch to heat therapy
- Light stretching, walking
- Avoid lifting heavy objects or bending over
- If pain persists, consult an orthopedic specialist
Avoid "Absolute Bed Rest"
In the past, it was said that bed rest for a week would cure it, but it is now known that prolonged rest actually delays recovery. The key to faster recovery is to start moving early within the limits of your pain.
Self-Care for Chronic Back Pain
Exercise
- Walking 30 minutes/day (walking is effective for back pain)
- Aquatic walking/swimming (less strain on the back)
- Core training (plank, bird-dog)
- Stretching (hamstrings, quadriceps, glutes)
- Continue within a reasonable range
Lifestyle Habits
- Maintain a healthy weight (obesity puts significant strain on the back)
- Quit smoking (improves blood flow to the intervertebral discs)
- Improve sleep quality and review bedding
- Stress management (aggravating factor for chronic pain)
- Correct way to lift heavy objects (bend your knees)
- Posture during desk work (stand up every hour)
Key Points for Back Pain Prevention
- When lifting heavy objects, bend your knees and squat down
- Do not twist your body while holding an object
- Avoid prolonged static postures
- Practice correct posture habitually (tilt your pelvis forward)
- Regularly strengthen core muscles
- Maintain hamstring flexibility
- Prevent and treat osteoporosis
- Stress management
Characteristics of Our Clinic's Back Pain Treatment
- As an internal medicine clinic, evaluation not to overlook visceral, infectious, or tumor-related causes
- Blood tests, urine tests, chest X-rays are available on the same day
- Prescription of NSAIDs, muscle relaxants, neuropathic pain medications, and herbal medicines tailored to symptoms
- Guidance on stretching, exercises, and posture improvement
- Evaluation and treatment of osteoporosis
- Referral for MRI, nerve blocks, and surgical eligibility to orthopedic or neurosurgical departments
- Prompt referral for emergency conditions such as cauda equina syndrome and dissecting aortic aneurysm
- No appointment needed, same-day consultation OK / Open daily 9 am - 9 pm / 1-minute walk from Jujo Station
Early intervention to prevent chronicity
Back pain can be prevented from becoming chronic with early appropriate treatment and lifestyle improvements. Do not leave it untreated assuming it will get better on its own. Please feel free to consult us if you have any concerning symptoms.
