Millions of Americans are affected by acute or chronic back pain. Acute back pain usually suddenly and the trigger is often identified – either an injury or another cause. It resolves in a few days to weeks. Chronic pain on the other hand develops gradually over time and may worsen over time.
Let’s review in this article the differences and similarities between these two conditions. Whether you have acute or chronic low back pain, it is important to get medical treatment and back pain relief as soon as possible.
Acute vs chronic low back pain. Differences
The duration. Acute low back pain means that the symptoms last less than 6 weeks, while chronic low back pain is defined as pain in the lower back that lasts for more than 12 weeks. There is a subacute form described in those who have symptoms between 6-12 weeks, and typically has the same causes and treatments with the acute form.
The underlying causes. Acute low back pain is commonly caused by a sudden injury to the muscle or ligaments of the lower back like a sprains or strains. Other causes include herniated disk, sciatica, osteoarthritis, spinal stenosis, abnormal spine curvature like scoliosis or kyphosis, or a compression fracture (i.e. due to osteoporosis). Up to 20% of individuals who have acute back pain develop chronic low back pain, with symptoms experienced for more than a year. The underlying cause of chronic back pain is often unknown. In other cases, this chronic pain may be due to arthritis, past injuries, wear and tear from sports or work conditions, surgery of the lower back, herniated disk, spinal stenosis, scoliosis and kyphosis, and fractures. There are also non-spine sources of low back pain. For example kidney stones, pregnancy (mostly causing acute back pain), as well as endometriosis, fibromyalgia, tumors that may pores on the spine or the nerves. All these causes should be considered if imaging tests do not show a problem involving the spine, and muscle or ligaments of the lower back.
The treatment. Acute back pain often better on its own with simple measures like heat or ice packs, over the counter non steroid antiinflammatory drugs and muscle relaxants. Gentle stretching exercises recommended by a physiotherapist can also help. More treatment options in this article. Vigorous exercise, bed rest and surgery are usually not indicated for acute back pain. Chronic back pain on the other hand can be harder to treat. The same treatments used for acute pain can all be used, but those with chronic pain tend to respond less to simple measures. In addition to anti-inflammatory drugs, opioid drugs, anticonvulsants and antidepressants may be prescribed. Special exercises targeting core and abdominal muscles can help promote quicker recovery. Acupuncture, spinal manipulation, biofeedback and spinal injections with steroid or painkillers are other treatment options. Surgery is recommended If conservative measures do not help manage the pain enough. While surgery is successful in many cases, some individuals experience worsening of the back pain after a surgery. It is important to discuss with the doctor the pros and cons of the surgery, and which procedure is the best option for your condition.
Acute vs chronic low back pain. Similarities
Diagnostic tests. Although those with chronic low back pain usually undergo more testing to identify the underlying cause, there are tests that can be used in both acute and chronic low back pain. All testing starts with a complete medical history and physical examination. Special neurologic tests may help identify the cause of pain, while imaging tests like X rays, CTs or MRIs further confirm the diagnosis. Blood tests do not diagnose the back pain directly, but may show signs of inflammation or infections. Electrodiagnostics can help identify issues related to the nerves of the back and legs. Electromyography ( or EMG) can identify if the muscle weakness may be due to the nerve that controls the muscle. Evoked potential studies record the speed of the nerve signals to the brain. Nerve conduction studies can detect nerve damage by recording the nerve’s electrical signals.
Risk factors for low back pain. The first episode of low back pain usually is experienced between ages 30 and 50, and later on becomes more common. This is because muscles and ligaments are less flexible, the disks between vertebrae lose fluid and flexibility. The risk of arthritis or spinal stenosis also increases with age. Genetics may play a role in some cases. Excess weight, certain jobs (ie from those requiring heavy lifting and pushing to desk jobs that lead to poor posture) and smoking are all considered risk factors for low back pain. When it comes to fitness, back pain is more common in those who lead a sedentary life and also those who work out during the weekends and are inactive during the week. Stress, anxiety and depression all correlate with increased risk for low back pain.
While some risk factors can not be modified, some can be changed to prevent low back pain. Maintain a healthy weight, exercise regularly, and practice stress management techniques. If the treatment does not improve the symptoms, work with the doctor and explore all the options that may help you.