Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine.

Most low back pain can be treated without surgery. Treatment involves using over-the-counter pain relievers to reduce discomfort and anti-inflammatory drugs to reduce inflammation. The goal of treatment is to restore proper function and strength to the back, and prevent recurrence of the injury. Medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Although the use of cold and hot compresses has never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals. Bed rest is recommended for only 1–2 days at most. Individuals should resume activities as soon as possible. Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries.

Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. Engaging in exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, vibration, repetitive motion, and awkward posture. Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.

National Institute of Neurological Disorders and Stroke

T04-45
October 26, 2004
FDA Approves Artificial Disc; Another Alternative to Treat Low Back Pain The Food and Drug Administration (FDA) has approved an artificial spinal disc for use in treating pain associated with degenerative disc disease (DDD). The device is intended to replace a diseased or damaged intervertebral disc. The device--the first of its kind--is the Charité artificial disc manufactured by DePuy Spine, Inc., of Raynham, Mass. It was approved for use in patients who have DDD at one level in the lumbar spine (from L4-S1) and who have had no relief from low back pain after at least six months of non-surgical treatment. Currently, patients with DDD who get no relief from pain after several weeks of non-invasive therapy may have surgery to implant a variety of devices intended to stabilize the spine while bone grafts fuse together the two vertebrae surrounding the diseased or damaged disc. The artificial disc provides another alternative for these patients. The Charité artificial disc is made up of a plastic core sandwiched between two metal endplates. The device helps restore the natural distance between the two vertebrae, which can allow movement at the level where it is implanted. However, it may not necessarily allow movement, or may allow too much movement, which can over-stress the device. The new system is placed in the spine through a small incision just below the belly button. The diseased or damaged disc is removed and the artificial disc is placed in the space. Patients require general anesthesia. FDA approved the device based on a review of a clinical study of safety and effectiveness conducted by DePuy at 16 medical centers. The objective of the study was to determine whether the Charité artificial disc was any less safe and effective than a commercially available spinal fusion cage using bone graft. The firm studied the use of the artificial disc in 205 patients who had been diagnosed with DDD and had failed to have their pain relieved after six months of non-surgical therapy and compared them to 99 patients who received the control device. Additional safety information was obtained from another 71 patients when doctors in the study were being trained to use the Charité artificial disc. The study showed that two years after surgery, patients treated with the artificial disc did no worse than patients treated with intervertebral body fusion. The rates of adverse events from use of the artificial disc were similar to those from treatment with fusion. In addition, the study showed that there was no statistically significant relationship between motion at the level where the disc was implanted and the patient's relief from pain. FDA is requiring DePuy Spine to conduct a post-approval study to assess the product's long-term safety and effectiveness, including its impact on other discs and on the bony structures on the back of the spine.