Acute, Subacute or Chronic: When Back Pain Needs a Specialist

Back pain is one of the most common medical problems in the United States. The National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that almost everyone has it at some point. Most episodes get better on their own. Some don't. Knowing the difference can help you decide when to rest and wait, and when to get your back evaluated.

Acute, subacute and chronic back pain

Doctors usually group back pain by how long it has lasted:

• Acute back pain comes on suddenly and usually lasts a few days to a few weeks.
• Subacute back pain may start suddenly or gradually and lasts 4 to 12 weeks.
• Chronic back pain lasts longer than 12 weeks and occurs daily.

These labels matter because the causes, and the right next steps, often change as pain persists.

Symptoms that should not wait

According to NIAMS, you should see a doctor if your back pain has not improved after a few weeks, or if it comes with any of the following:

• Numbness and tingling
• Severe pain that does not improve with medication
• Pain after a fall or injury
• Trouble urinating
• Weakness, pain or numbness in your legs
• Fever
• Weight loss you did not intend

If you have sudden loss of bladder or bowel control, or rapidly worsening weakness in your legs, seek emergency care right away.

What can cause back pain

Back pain often has more than one contributing factor, and sometimes no single cause can be found. Common sources include:

• Mechanical or structural problems, such as sprains and strains, herniated discs, degenerative disc disease, spinal stenosis, spondylolisthesis and vertebral fractures
• Inflammatory conditions, such as ankylosing spondylitis
• Other medical conditions, such as osteoporosis, fibromyalgia, kidney stones or infections, and, rarely, tumors

Pain that travels from the back into the buttock or leg can point to an irritated nerve, as in sciatica.

What an evaluation involves

A specialist evaluation starts with a conversation. Expect questions about where the pain is, what it feels like, when it started, and what makes it better or worse. A physical exam usually follows: checking your posture and spine, seeing how movement affects the pain, and testing your reflexes, strength and sensation.

Most people do not need additional tests. If your doctor needs to confirm or rule out a specific cause, they may order X-rays, an MRI or CT scan, nerve studies such as EMG, or blood work.

Treatment is matched to the cause

NIAMS describes a range of options that are often combined:

• Activity, not bed rest. Limit activities that cause pain, then increase activity gradually as you tolerate it.
• Physical therapy to strengthen the muscles that support the spine. Check with your doctor or physical therapist before starting any exercise routine.
• Medications, including over-the-counter and anti-inflammatory medicines, and, for some patients, prescription options
• Injections for certain kinds of pain, such as pain that travels down the leg because a nerve is compressed or irritated. See injections and nerve blocks.
• Interventional procedures such as radiofrequency ablation and spinal cord stimulation, for selected patients whose pain persists
• Surgery, which may be considered when other treatments have not helped, although not everyone is a candidate

The right plan depends on your diagnosis, your medical history and your goals.

Everyday habits that can help

While you recover, these habits from NIAMS may make your back more comfortable:

• If you sit for long stretches, get up, move around and change positions often.
• On long drives, add support behind your back and stop often to walk around.
• Sleep on your side with a small pillow between your knees. If you sleep on your back, put a pillow under your knees.
• Carry less at once, and lift with your legs and abdominal muscles rather than your back.

A note on your care

This article is for general education. It is not a diagnosis or a substitute for medical advice. Consult your physician about your symptoms before starting or changing any treatment, medication or exercise program.

Talk with our team

If your back pain has lasted more than a few weeks or keeps coming back, you can request an appointment at HTx Pain Institute. We'll start by working out where the pain is coming from.