Internist Questions Low Back Pain

What causes lower back pain?

What causes a dull ache in the lower back? I spend a lot of time on my feet and I get this pain all the time. Do I need to see a doctor? Or will it go on its own?

1 Answer

The pain of back pain often seems worse than it is. The most worrisome causes of back pain rarely cause severe pain, and many common problems (like slipped discs) are usually much less serious than people fear. Only a very small percentage (1% or so) of back pain is potentially serious, and even then it’s often treatable. Many of the 1% are due to cancer, autoimmune disease, or spinal cord damage.

Back pain doesn't usually need to be medically investigated until it’s met at least three criteria: (1) it’s been bothering you for more than about 6 weeks; (2) it’s severe and/or not improving, or actually getting worse; and (3) there’s at least one other “red flag” (age over 55 or under 20, painful to light tapping, fever/malaise, weight loss, slow urination, incontinence, groin numbness, a dragging toe, or symptoms in both legs like numbness and/or tingling and/or weakness).

Red flags do *not* confirm that something horrible is going on, just that it’s time to talk to a doctor. And the absence of red flags is not remotely a guarantee that you’re in the clear, but often does

Dr. Prieve DO
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