Getting to the Bottom of Your Chronic Back Pain

For a condition as common as back pain (one survey found that almost twenty percent of Americans suffer a month-long bout of back pain each year) it's remarkably hard to find the actual cause in individual patients. According to the American Pain Society and the American College of Physicians, it's impossible to say precisely why a person's back hurts in more than 85 percent of cases. Cure, not surprisingly, can also be elusive.

"Unless you have leg pain, which usually means there's a pinched nerve, it's very hard for physicians to figure out where it comes from," says Richard Guyer, MD, a past president of the North American Spine Society. "We have many structures: we have muscles, we have ligaments, we have the joints, we have the disk and we have the nerve," says Guyer. "All of those can give you problems."

Most often, the cause is overuse or muscle injury. That kind of pain will often go away, untreated, over a few weeks. But in a structure as complex as the back, disks between your vertebrae can also bulge, rupture, or wear out. Vertebrae can slip out of place. The spinal canal can narrow, putting pressure on nerves (a condition known as stenosis, a problem related to aging). The facet joints that hold the spine in alignment can become inflamed due to arthritis or injury. And that doesn't include poor posture, stress, tumors, osteoporosis, spinal deformities…and the list goes on.