Low back pain can have many causes, treatments

Q. I have low back pain. A friend of mine with back pain had surgery, but I want to avoid that. What are my options?

A. There are many different causes of low back pain, and therefore many different treatments. So the first step is to diagnose the cause. Your primary care doctor probably will be able to do that, just based on your symptoms and the physical examination. Sometimes the diagnosis may not be straightforward, and the primary care doctor either will order tests or refer you to a back pain specialist, or both.

Back pain is quite common. The U.S. government conducted a survey (the National Health Interview Survey) of 30,000 randomly selected people, asking if they had suffered from back pain that lasted at least a whole day in the prior three months; 26 percent said they had. Many people with low back pain don't even seek medical care, as the symptom either comes and goes, or is not very severe.

Fortunately, very few of the millions of people like you with back pain require surgery. Simpler treatments are not only available; they're much more likely to relieve the pain. A common cause of low back pain is injury to the muscles and ligaments around the spine, something that doesn't benefit from surgery. There are disks between the bones of the spine, and if they rupture, they can pinch nerves that lead to the buttocks and legs. Only occasionally is surgery necessary to fix this condition.

If your back pain is so severe that it interferes with simple activities, call your doctor. If the pain has been going on for several weeks, call your doctor. If, along with your low back pain, you have certain worrisome “red flag” symptoms, you definitely should see your doctor. Each of these symptoms increases your risk of a more serious cause of low back pain, including kinds that might benefit from surgery:

Ÿ You have a persistent fever and loss of energy.

Ÿ You sometimes lose control of your bowel movements or urine.

Ÿ Your legs seem weak.

Ÿ Your legs are numb.

Ÿ You have had cancer.

Ÿ You have thin bones (osteoporosis).

Ÿ You are on a medicine that can thin the bones, such as corticosteroids (the most commonly prescribed type is prednisone) or thyroid pills.

The treatment of low back pain often requires more than your primary care doctor. It can “take a village” — or at least a group of health professionals. The types of doctors who most often consult in the care of people with low back pain are rheumatologists, orthopedists, neurosurgeons and physiatrists (rehabilitation specialists).

Physical therapists also can be helpful. I've put a chart listing specialists you may see, along with their specific areas of expertise, on my website, AskDoctorK.com.

Ÿ Dr. Komaroff is a physician and professor at Harvard Medical School. Send questions to AskDoctorK.com.