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Another possible cause of chronic back pain in people with otherwise normal scans is central sensitization, where an initial injury or infection causes a longer-lasting state of heightened sensitivity to pain. This persistent state maintains pain even after the initial injury has healed.[15] Treatment of sensitization typically involves low doses of anti-depressants.[16]

What does that mean for you – especially if your back hurts? It means that just because a certain practitioner claims a certain cause is your problem, and they have the perfect treatment, their cause may not be the real cause. Their cure may not be what ultimately makes your pain go away. In some cases, paying a lot of money for these treatments may not be the best option.

Low back pain results in large economic costs. In the United States, it is the most common type of pain in adults, responsible for a large number of missed work days, and is the most common musculoskeletal complaint seen in the emergency department.[25] In 1998, it was estimated to be responsible for $90 billion in annual health care costs, with 5% of individuals incurring most (75%) of the costs.[25] Between 1990 and 2001 there was a more than twofold increase in spinal fusion surgeries in the US, despite the fact that there were no changes to the indications for surgery or new evidence of greater usefulness.[11] Further costs occur in the form of lost income and productivity, with low back pain responsible for 40% of all missed work days in the United States.[98] Low back pain causes disability in a larger percentage of the workforce in Canada, Great Britain, the Netherlands and Sweden than in the US or Germany.[98]

Strained muscles and ligaments often cause back pain. Strain commonly occurs with incorrect lifting of heavy objects and sudden awkward movements. Strain can also result from over-activity. An example is the sore feeling and stiffness that occurs after a few hours of yard work or playing a sport.

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Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is directly irritated), often due to a herniation (or bulging) of the disc between the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, affecting a specific area, and associated with numbness in the area of the leg that the affected nerve supplies.

Of course, not all incidences of back pain are injury or trauma-related. Many back problems are congenital (found at birth), degenerative, age-related, disease-related, and may be linked to poor posture, obesity or an unhealthy lifestyle such as smoking. Sometimes the back pain is worse than the severity of the injury or disorder. That statement raises the question, “When should I seek medical attention for back pain?”

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Approximately 98 percent of people with back pain are diagnosed with nonspecific acute back pain in which there is no serious underlying pathology.[12] Nearly 2 percent are comprised by metastatic cancers, while serious infections such as spinal osteomyelitis and epidural abscesses account for fewer than 1 percent.[13]

Scientific American is part of Springer Nature, which owns or has commercial relations with thousands of scientific publications (many of them can be found at www.springernature.com/us). Scientific American maintains a strict policy of editorial independence in reporting developments in science to our readers.

Back rehabilitation is achieved through specific low back pain exercises known as core stability exercises. These exercises improve spinal stability and posture. A back support or back brace helps to prevent slouching and bad posture. Good posture relies upon a forward curve in the lower back, which is known as the lordosis. If the lordosis is maintained during sitting and activities then the upper part of the spine will be in the best position to deal with the loads that are placed on the back.

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Some people seem to benefit from the use of ice or heat. Their use, although not proven effective, is not considered to be harmful. Take care: Do not use a heating pad on high or place ice directly on the skin.

About 50% of women experience low back pain during pregnancy.[43] Some studies have suggested women who have experienced back pain before pregnancy are at a higher risk of having back pain during pregnancy.[44] It may be severe enough to cause significant pain and disability in up to a third of pregnant women.[45][46] Back pain typically begins at around 18 weeks gestation, and peaks between 24 and 36 weeks gestation.[46] Approximately 16% of women who experienced back pain during pregnancy report continued back pain years after pregnancy, indicating those with significant back pain are at greater risk of back pain following pregnancy.[45][46]

Research suggests that topical medications may be just as effective as oral ones. Many of them worked significantly better than placebo. These medications can come in the form of gels, creams, patches, and more. One study also saw decrease in pain when people applied lavender essential oil or ointments prepared with cayenne peppers with acupressure.

Spinal stenosis causes back pain in the aging population. As we age, the spinal canal can become constricted, due in part to arthritis and other conditions. If the spinal canal becomes too tight, back pain can be the result.

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