Pain Management

Low Back Pain

About four out of every five adults has low back (lumbar) pain at some point in their lives. As we live more sedentary lifestyles, it is becoming even more common. Not everyone experiences lumbar pain in the same way. It can start with a dull ache or a sudden sharp pain. It can begin after an accident or lifting something or it can develop over time as your spine ages. Low back pain affects men and women equally. Most of the time, the pain lasts a few days to a few weeks. If you’re feeling severe pain in your lower back, it’s probably time to see an expert.

Causes of Low Back Pain

Most of the time, low back pain comes from general stress and strain in the joints, discs, and bones of the spine as we age. Sometimes, though, it signals an underlying condition. Mechanical causes include the following:

  • Arthritis of the spine or spinal arthritis, is a condition where the small joints between each vertebra in the spine shrink or wear thin, causing bone spurs or enlargement of the joint. This, in turn, leads to the pain and inflammation of arthritis. The pain can also be due to inflammation of the nerves that supply lumbar facets. Often, arthritis of the spine is difficult to treat and may require spine surgery. Our expert approach can help you avoid surgery and allow you to return to a more functional life
  • Herniated discs develop when the discs become compressed and bulge out (hernia) or burst (rupture). Herniated discs happen to you at any age and can cause severe pain that happens all of a sudden. Our targeted treatment regimens for herniated discs involve a multi-disciplinary strengthening and anti-inflammatory approach. If your herniation is recent, you may even experience freedom from pain at your first visit
  • Intervertebral disc degeneration is a normal part of aging. Discs cushion your back and keep the bones of your spine from pressing on each other, resulting in pain. As the disc degenerates, so does its ability to cushion your spine. This lack of cushioning may cause severe pain  
  • Radiculopathy happens when your spinal nerve root becomes compressed, inflamed, or injured. It can cause pain, numbness, or tingling. The sensation can spread throughout the body, not just in your low back. This condition is due to a pinched or inflamed nerve in the back that can create a wide constellation of symptoms including severe back pain, groin pain, leg pain, and foot pain. The condition commonly known as “sciatica” is included in this category.  Sometimes radiculopathy is caused by a tumor or cyst pressing on the nerve root. We can often provide quick diagnosis and long-lasting relief for this condition using our multi-disciplinary toolkit 
  • Sacroiliac joint pain. If you have a dull pain in your lower back, it could be sacroiliac joint pain. This joint connects the spine to the pelvis; you have sacroiliac joints on both sides of your spine. It helps with forward and backward bending and absorbs pressure. Pain in this joint may eventually radiate out to your buttocks, thighs, groin, or upper back. You may have sacroiliac joint pain due to injury, arthritis, or even pregnancy. We can stop your pain and strengthen your muscles to prevent this condition from recurring
  • Sciatica is a type of radiculopathy. Sciatica affects the sciatic nerve, which is the nerve that goes from your buttocks down the back of the leg. This condition, too, can be caused by pressure from a tumor or cyst
  • Spondylolisthesis happens when one of the vertebra in your lower spine slips out of place and pinches the nerve
  • Traumatic injury due to sports or an accident can hurt your tendons, ligaments, or muscle, or can cause our spine to become compressed, causing pain 
  • Scoliosis and other skeletal irregularities stem from abnormal curves in the spine. Scoliosis often doesn’t cause pain until middle age
  • Spinal stenosis happens when the vertebrae of your spine become narrow and press on your spinal cord causing pain, weakness, and loss of sensation
  • Sprains/strains are stretched or torn ligaments, muscles, or tendons. This is the most common cause of low back pain. You can get a sprain or strain from twisting or lifting something or overstretching. Physical therapy, acupuncture, and targeted muscle relaxation and strengthening can provide rapid, long-lasting relief 

The key to successfully treating low back pain is determining the precise cause. At Mount Sinai, we start by taking a complete medical history and conducting a physical exam. We might also use imaging tests to provide additional information. These tests can include X-rays, computed tomography (CT) scans, myelograms, discography, magnetic resonance imaging (MRI), electrodiagnostics, bone scans, ultrasounds, and bone density tests.

Treatments We Offer

You can start by trying to treat your own low back pain. Hot or cold packs can ease pain and inflammation. You should limit bed rest, as that can backfire and make your pain worse. You can also take over-the-counter pain relievers such as acetaminophen (Tylenol) and aspirin. If none of this helps you feel better, you may need to see a specialist.

At Mount Sinai, we use a variety of treatments, depending on your diagnosis and any underlying conditions. The most common approaches are the following:

  • Acupuncture: This approach involves insertion of thin needles into specific points (meridians) to enhance the flow of energy (chi) into the back. This approach helps relieve chronic low back pain
  • Medications: Pain-relievers, nonsteroidal anti-inflammatory drugs, anticonvulsants, antidepressants, and counter-irritants can all help. We rarely if ever use opioids
  • Physical therapy: These techniques are very useful for arthritis and back strengthening, allowing your body to adapt to your condition, relieve pain and keep it from coming back. In combination with our other treatments, a well-developed physical therapy regimen can allow you to effectively participate in getting better. A physical therapist can teach you stretches and exercises to strengthen your core muscles, reduce pain, and increase your range of motion
  • Radiofrequency Ablation: This is a targeted approach that allows us to quickly diagnosis specific arthritic pain generators in your back. After diagnosis, we can treat those generators with carefully applied heated needles, often providing pain relief from back arthritis for up to a year 
  • Spinal Cord Stimulation: This technique can treat the type of pain that nothing else has worked for. Spinal cord stimulation is for patients have severe back pain that has not responded to any other treatment approach and may have had multiple unsuccessful surgeries.
  • Targeted Anti-Inflammatory Injections: These can target the specific nerve in your back that is causing your pain. They treat a wide range of back pain, are often very successful and can take away your pain quickly. Often, these injections let you return to your normal life and avoid surgery.