Ask The Doctor

Dear Ask The Doctor: I've been having middle back pain (slightly to the left of the middle). It is most pronounced when sitting and leaning forward like when eating in a restaurant. When standing or leaning back sitting there is almost no pain. It's been going on for close to 2 months, but hasn't gotten worse/better. The pain itself isn't very much (2-3/10), so it hasn't caused me any real issues. I originally thought it was a herniated disc, but I wanted to see if you had any thoughts on what it might be.

Dear John: The pain in the middle and low back is a common concern, and it affects roughly up to 90% of Americans at some point in their lifetime. According with the medical literature, up to 50% will have more than one episode. Back pain is not a specific disease but it is a symptom that may happen from a wide array of different processes. In up to 85% of people with back pain, despite a thorough medical examination and imaging tests (X rays, MRI, CT scans), no specific cause of the pain can be identified and we call it: mechanical back pain.

Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine as follows: disc herniation that produces irritation of the nerve (i.e.: sciatica), spinal stenosis, deformities of the spine (i.e.: scoliosis, kyphosis), fibromyalgia, amongst the most common.

The suggested strategy to treat a back pain that has persisted for more than 1 month is as follows: evaluation by a physician to rule out other possible causes than just mechanic or postural and start a physical therapy program aimed to control pain, stretching and strengthening exercises, correct posture, and teach the patient an exercise routine that he/she can follow at home, also the use of anti-inflammatory drugs (i.e: “motrin”, “advil”, “aleve”) can be beneficial to manage the pain. Nearly everyone improves within a month following this conservative measures if it is a mechanical back pain.