Low back pain is extremely common. It affects millions of individuals each year, and hundreds of millions of dollars are spent on lost work and medical care. Almost everyone has at least one episode of back pain sometime in their life. The good news is the vast majority never requires formal treatment and get better.

The causes of back pain are vast. They include the common low back strain of the muscles in the back that help to support the spine. Often rest, ice, and later heat can be helpful. Modification of activities and proper body mechanics along with weight reduction are the mainstays of treatment. Anti-inflammatory drugs can be helpful for both pain and inflammation. Sometimes muscle-relaxant drugs are prescribed to help with acute spasm. Physical therapy is often prescribed after the acute phase to help teach specific core or trunk muscle exercises as well as general conditioning and body mechanics. Usually muscle strains are self limited and recovery is full. The goal is to prevent further episodes.

Other causes of low back pain include lumbar degenerative disc disease, degenerative joint disease, herniated disc, spondylolisthesis, spinal stenosis, and scoliosis. All of these have been described in more detail in other areas specific to that particular disease.

Further causes of low back pain may be more serious in nature. Sometimes tumors or metastatic cancer can present as low back pain. Anyone with a history of cancer with new onset back pain should be evaluated for possible spread of the cancer.

Aortic aneurysms may present as knife like pain from the abdominal area to the back and may mimic acute low back pain. These usually occur in older individuals with vascular disease but can occur in younger people as well. Any new severe low back pain of this type, without a history of trauma or lifting, should also be urgently evaluated for vascular problems.

Sometimes kidney infections will present as a dull or sharp lateral back pain similar to a muscle strain. This may or may not be accompanied by urinary symptoms of burning, frequency, and cloudy urine. This should be evaluated as well, especially if fever is present.