Last updated: Apr 10, 2008
Finding the source of chronic back pain requires patience and perseverance.
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."

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More about low back pain
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.

You'll need to be patient
This all means that back-pain sufferers need to muster some patience and look for doctors who will approach their pain with a comprehensive examination, a full history, and then proceed to X-rays or MRIs only if they suspect a specific cause. The strategy for chronic back pain involves a careful elimination process that—barring early discovery of an urgent problem such as tumor or nerve damage—moves very slowly to the most aggressive treatment: surgery.

Patience may be difficult when you're in severe pain. But in the past things were worse. "Thirty years ago it was common practice to operate first, and look during the operation to see what was wrong," says Richard Derby, MD, an anesthesiologist based in Daly City, Calif. That led to low cure rates and painful recovery times. Now that surgery is seen as a last resort, patients have the opportunity to first look for relief with fewer risks.