Sudden Onset (Acute) Low Back Pain

The term “acute low back pain” is often used for back pains with sudden onset or experienced within the last six weeks. This pain can be strong and severe, or sometimes patients describe it as feeling the burning or stabbing. The severity can vary between mild and severe, and go up and down. The pain can spread into either of the hips, or femoral area.

The low back pain can begin after an activity or trauma, or present without a specific cause. The surveys conducted across the world show that 80% of people suffer from low back pain at least once throughout their life. Those who have jobs that they don’t move much and sedentary life style, those who lift heavy objects and involve in wrong bending, and those who are long term drivers (drivers, riders, etc.), overweight, smoke and consume alcohol, have a posture disorder, poor lumbar and stomach muscles, those who are in the last months of pregnancy, those who engage in high risk sports (e.g. weight lifting), and experience mental and emotional stress are included in the group at risk of low back pain.

It is often difficult to identify the exact source of acute low back pain.

The first thing that comes into mind of people suffering from low back pain is the possibility of herniated disc. Lumbar disc hernia is caused by protruding of disc content between the vertebrae towards the canal of spinal cord, or over the nerve roots. In fact, many causes can lead to a lower back pain and the most common type is mechanical low back pain. It is a term to describe low back pains which increase with physical activities and reduce with resting, and are usually caused by overuse of the body, damage and deformity. Mechanical low back pain is often developed by overstraining of lumbar muscles, muscle fibers and ligaments, or by stress. Structures other than disc such as the muscles around the spine, ligaments, and joints between the vertebrae are the cause in most of the acute low back pains. Little ruptures on the outer layer of the disc, apart from hernia, can also result in severe pain.

No matter from what tissue it is initially resulted, the pain is as a result of a chain of incidents. Many chemical substances are released from the tissue activated in response to tissue irritation. These substances induce pain-sensitive nerve fibers around and result in pain. Finally, an inflammation process is produced and this cycle can continue for days or even for weeks. The tissues surrounding the spine have muscle strain (spasm) due to pain. This can cause balance disorder which is defined as shifting of the body to one side.
The good news is that although the exact source of pain cannot be identified, the acute pain is spontaneously reduced in time. This is due to recovery of tissue irritation. The pain completely disappears within approx 2 weeks in 50% of the patients. Unfortunately, how long the pain will last cannot be determined by its location and initial severity. One should know that 30% of individuals will have recurrence pain attacks.

The severity of acute low back pain varies from person to person.

The low back pain is rarely due to a fracture, infection, or more serious diseases such as cancer. Pain caused by a more serious disease occurs most commonly in those who are over 50 years old, have a cancer history and excessive use of alcohol or drugs, and long-term use of corticosteroids, and those who have an underlying medical problem such as diabetes or osteoporosis, and in patients who suffer from severe pain even while resting. In case the pain radiates down the legs, emergency medical evaluation must be performed when problems with bowel or bladder control are present. A medical evaluation is recommended for any type of pain lasts longer than six weeks.
The best recommendation for acute low back pain is to tolerate the pain and continue daily activities. The common tendency of patients is to take a bed rest and wait for the pain to diminish. In fact, muscle movements increase the blood flow so that inflammation and muscle tension reduces. If the pain is strong, more difficult or uncontrolled activities should be avoided, e.g. weight lifting or contact sports. Stretching exercises to the legs and back should be carefully performed not to aggravate the pain. Heat or cold application on painful area can be effective in reducing the pain.


Paracetamol and nonsteroid anti-inflammatory (NSAID) drugs are commonly used to diminish the severity of acute low back pain. NSAIDs also suppress the inflammation process producing the pain. Such drugs must be prescribed by a physician before use. NSAIDs can produce various side effects in some persons in case of long-term use. Overuse of such drugs can cause renal and liver problems. Even a single dose could cause heartburn and even gastrointestinal bleeding especially in those with stomach diseases.

Muscle relaxants are often useful to eliminate the pain. However, remember that some of these drugs could produce feeling of sleep and dizziness and must be used under the supervision of a physician.

Narcotic analgesics (also called opioids) are strong pain killers and their use in acute low back pain is restricted. Narcotics can help reducing the symptoms and promoting sleep during several nights since they are sedative. Long-term use of narcotics can cause undesirable adverse effects including physical addiction, sedation, depression, constipation, increased susceptibility in sensitive pain fibers, and interruption of sleep cycle. They should not be used uncontrolled.

Various physical therapies (deep or surface heating, TENS etc. electrical stimulation), strengthening exercises and massage therapies can provide a temporary relief of pain; however, their long-term effects have not been proven yet.

If the pain is strong, performing daily activities can become difficult.

It will be useful to organize activities, sleeping position or working way of an individual by a physician or physical therapist. For those with permanent or recurrent low back pain, an exercise program under the supervision of a physical therapist should be recommended after a medical evaluation. Patient education is one important part of the treatment of low back pain.

A spinal injection is not considered an appropriate treatment for acute and self-limiting low back pains. In case of recurrent pains, following an extensive medical evaluation, epidural steroid, facet joint and trigger point injections can be applied if required, after the source of pain has been identified.

Classically, radiological diagnostic tests are not required for most patients for acute low back pain. Radiological diagnostic tests can be recommended in case of health problems such as serious trauma, history of cancer, presence of fever, diabetes, and addiction and for patients who are over 50 years old and diagnosed with osteoporosis. Imagining tests include radiography, bone scintigraphy, computerized tomography (CT) and magnetic resonance imaging (MRI). Selecting a test depends on your doctor and possible cause of pain considered after the examination.

Although acute low back pain can be a painful experience to patients, rapid elimination of pain is possible in most cases. An extensive medical check is a must in case the pain lasts longer than six weeks in particular. The purpose of the treatment should be elimination of acute pain as well as prevention of recurrence. For this reason, patient education, starting exercise programs at early stages and maintaining them are very important.

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