Back Pain

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I have back pain

Lower part of the back has pain

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Pain in the spine

Lumbar spine pain

Shoulder blade hurts

Pain in the left shoulder blade

Back pain triggered by movement

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Pain when pressed on the back

Ache in the upper back

Back pain

About the Symptom

Back pain can be a painful sensation in the whole or any part of the back. The pain may be pressing, aching, sharp or dull in nature.

When to See a Doctor

Seek professional care if you experience any of the following symptoms

Possible Causes

Generally, Back pain can be related to:

Related Serious Diseases

Sometimes, Back pain may be related to these serious diseases:

Doctor's Diagnostic Questions

Your doctor may ask these questions to check for this symptom:

Reviewed By:

Kent C Doan, MD

Kent C Doan, MD (Orthopedics)

Dr Doan Graduated from the University of Missouri Kansas City School of Medicine and completed residency training in Orthopedic Surgery at the University of Colorado. He completed additional fellowship training in Orthopedic Sports Medicine at the prestigious Steadman Clinic and Steadman Philippon Research Institute in Vail, Colorado. He is a practicing Orthopedic Surgeon who specializes in complex and revision knee and shoulder surgery at the Kansas City Orthopedic Institute. He also holds an assistant professorship at the University of Kansas City.

Tomohiro Hamahata, MD

Tomohiro Hamahata, MD (Orthopedics)

Dr. Hamahata graduated from the Jikei University of Medical Science. After working at Asanokawa General Hospital and Kosei Chuo Hospital, he joined the Department of Orthopedics at Asakusa Hospital in April 2021, specializing in general orthopedics and joint replacement surgery.

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Content updated on Feb 6, 2025

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FAQs

Q.

The Best Sleeping Positions for Aging Backs and Necks

A.

For aging backs and necks, back sleeping with a small pillow under the knees or side sleeping with a firm pillow between the knees best maintains a neutral spine, while stomach sleeping is usually harmful; match pillow height to your sleep position and consider a medium-firm mattress for balanced support. There are several factors to consider; see below for specific pillow and mattress tips, modifications for sciatica or stenosis, a free symptom check, and red flags like weakness or numbness that mean you should see a doctor.

References:

* Macedo, L. G., & Macedo, A. G. (2018). The effect of sleeping position on low back pain: A systematic review. *Journal of Physical Therapy Science*, *30*(7), 841–847.

* Nejati, P., Motevali, M., Pirayeh, N., & Zarezade, P. (2020). The effect of sleeping pillow type on sleep quality, neck pain and upper limb numbness in adults: A systematic review. *Archives of Physical Medicine and Rehabilitation*, *101*(11), 1993-2003.

* Kim, J., & Kim, C. K. (2021). The effect of sleep posture on spinal alignment and stability: A review. *Journal of Clinical Orthopaedics and Trauma*, *17*, 30-36.

* Desai, M. J., et al. (2022). Association of Sleep Position and Lumbar Disc Degeneration: A Systematic Review. *Journal of Pain Research*, *15*, 2397-2408.

* Verma, V., et al. (2019). The Role of Sleep Position and Spinal Support Systems in Managing Chronic Low Back Pain: A Scoping Review. *Pain and Therapy*, *8*(1), 1-13.

See more on Doctor's Note

Q.

Why Your Old Pillow is Causing Morning Neck Pain: 2026 Guide

A.

Morning neck pain is often caused by an old pillow that has flattened or become lumpy, leading to poor spinal alignment, muscle strain, joint pressure, and restless sleep. There are several factors to consider, including signs it is time to replace your pillow, which pillow types fit each sleep position, and red flags that need medical care; see below for the complete guidance that can shape your next steps.

References:

* Xu S, Yang K, Hu J, Sun S, Yu J, et al. The effect of pillow characteristics on neck pain and sleep quality: a systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2021;34(5):721-736. doi: 10.3233/BMR-200155. PMID: 33749719.

* Jo Y, Jang S, Kim W, Han S, Park H, et al. The effects of different types of pillows on neck pain: A randomized controlled trial. J Phys Ther Sci. 2017 Aug;29(8):1359-1362. doi: 10.1589/jpts.29.1359. PMID: 28878508.

* Al-Alwani M, Alwazzan D, Alwazzan H, Al-Shorbagy Y. Pillow type and its relationship with neck pain and cervical spine alignment: a narrative review. J Pak Med Assoc. 2023 Feb;73(2):386-389. doi: 10.47391/JPMA.5463. PMID: 37042299.

* Oh J, Kim J, Kim Y, Kim S, Park H. Relationship between head posture during sleep and the degree of lordosis of the cervical spine: a pilot study. J Phys Ther Sci. 2016 Oct;28(10):2824-2826. doi: 10.1589/jpts.28.2824. PMID: 27821950.

* Al-Alwani M, Alshehri MM, Al-Shorbagy Y, Alwazzan D. Influence of pillow on cervical spine kinematics during sleep: a systematic review. Physiother Res Int. 2023 Apr;28(2):e1987. doi: 10.1002/pri.1987. PMID: 36728003.

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Q.

Tailbone Pain? Why Your Coccydynia Is Inflamed & Medical Next Steps

A.

Tailbone pain, or coccydynia, is most often due to inflammation from a fall, prolonged sitting, childbirth, or posture issues, though rare causes like infection or a tumor can occur. Next steps: try a cushion, limit sitting, adjust posture, consider over the counter anti inflammatory medicine if safe, and see a doctor if pain lasts more than 2 to 3 weeks, follows a major fall, or you have red flags like leg weakness or numbness, fever, weight loss, a lump or drainage, or bowel or bladder changes. There are several factors to consider; see the complete guidance below to understand what else can affect your recovery and which medical steps to take.

References:

* Patel NA, Shah HS, Patel VJ. Coccydynia: a review of current knowledge. Pain Pract. 2023 Dec 13. doi: 10.1111/papr.13327. Epub ahead of print. PMID: 38090753.

* Bayne M, Ramey TA, Ramey PA, Fleser PM. Coccydynia: An Overview of Conservative and Surgical Treatment. Cureus. 2022 Sep 23;14(9):e29505. doi: 10.7759/cureus.29505. PMID: 36176711; PMCID: PMC9502941.

* Wray JR, Wray MC, Mouchati DM, Madi SR. Coccydynia: Anatomical and Pathological Basis and Management. Cureus. 2022 Apr 27;14(4):e24536. doi: 10.7759/cureus.24536. PMID: 35645371; PMCID: PMC9139591.

* Wray MC, Mouchati DM, Madi SR, Wray RB. Coccydynia: A Review of the Current Literature. Cureus. 2021 May 26;13(5):e15242. doi: 10.7759/cureus.15242. PMID: 34188981; PMCID: PMC8234673.

* Cohen JS, Torgerson ML, Brown LB, Stelly PR. Coccydynia: Review and Treatment. J La State Med Soc. 2021 Nov-Dec;173(6):384-386. PMID: 34873172.

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Q.

Thoracic Pain? Why Your Mid-Back Is Aching & Medically Approved Steps

A.

Thoracic pain in the mid-back is most often due to posture, muscle strain, or irritated joints and typically improves with smart activity, posture correction, heat or ice, gentle mobility work, and short-term OTC pain relief. There are several factors to consider, including red flags like chest pain with shortness of breath, fever, neurological symptoms, trauma, unexplained weight loss, or pain that does not improve; see below for complete guidance on causes, timelines, safe exercises, when to try physical therapy or imaging, and how to choose the right next steps.

References:

* Steilen D, et al. Thoracic Back Pain. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. PMID: 30422589.

* Smith A, et al. Thoracic Spine Pain in Athletes: A Review of Differential Diagnosis and Management. Sports Health. 2017 Jul/Aug;9(4):307-316. doi: 10.1177/1941738117703813. Epub 2017 Apr 1. PMID: 28590886; PMCID: PMC5490422.

* Childress MA, et al. Management of Thoracic Spinal Pain: An Overview of Assessment and Treatment Approaches. PM R. 2015 Nov;7(11 Suppl):S202-12. doi: 10.1016/j.pmrj.2015.08.016. PMID: 26511099.

* Denard PJ, et al. Thoracic Spine Pain: Differential Diagnosis and Treatment. Spine (Phila Pa 1976). 2013 Feb 15;38(4):E219-27. doi: 10.1097/BRS.0b013e318274ac43. PMID: 23385759.

* Sueki D, et al. Thoracic spine pain: A literature review of assessment and treatment. J Sport Rehabil. 2013 Feb;22(1):52-64. doi: 10.1123/jsr.22.1.52. PMID: 22820521.

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Q.

Persistent Pain? Why Your X-Ray is Essential & Medically Approved Next Steps

A.

An x-ray is often the first, medically approved step to evaluate persistent back, neck, or joint pain because it quickly rules out serious problems like fractures, infections, tumors, and significant arthritis, and it helps guide the right next steps. There are several factors to consider, including when imaging is recommended after 4 to 6 weeks or after trauma, what x-rays cannot show, what to do if results are normal or abnormal, safety, and urgent red flags; see below for complete details that may change which next step you should take.

References:

* Jarvik, J. G., & Deyo, R. A. (2018). Imaging in Low Back Pain: When, What, and Why?. *The Medical clinics of North America*, *102*(3), 395–403. doi:10.1016/j.mcna.2017.12.001

* Vining, L., Raftery, K. M., Al-Ghamdi, H., Agyapong, V. I. O., Vining, R., Hincenbergs, M., & Boudreau, A. (2022). Appropriateness of Imaging in Patients with Acute and Chronic Musculoskeletal Pain: An Evidence-Based Guideline. *Pain Research & Management*, *2022*, 9736853. doi:10.1155/2022/9736853

* Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. *JAMA*, *315*(15), 1624–1645. doi:10.1001/jama.2016.3686

* Chou, R., & Deyo, R. A. (2020). Evidence-based clinical guidelines for chronic low back pain: an update of the 2017 American College of Physicians guidelines. *The spine journal : official journal of the North American Spine Society*, *20*(4), 499–507. doi:10.1016/j.spinee.2020.01.006

* Williams, A., Wignall, D. R., Davies, N., & Wood, R. (2020). Evidence-Based Recommendations for Integrated Chronic Pain Management: A Systematic Review. *Pain and therapy*, *9*(2), 291–311. doi:10.1007/s40122-020-00155-2

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Q.

Dead Bug Exercise Hurting? Why Your Core Fails & Medical Next Steps

A.

Dead bug pain is usually from poor form with lumbar arching, weak deep core engagement, overactive hip flexors, or advancing too fast, though underlying back conditions can also flare symptoms. There are several factors to consider; see below for step-by-step fixes, safer regressions, and how to tell normal muscle fatigue from warning pain. Stop and seek medical care if pain is sharp, radiates, causes numbness or weakness, or persists or worsens, and get urgent evaluation for red flags like bowel or bladder changes, fever, recent major trauma, or cancer history with new back pain, with complete next steps and when to involve a physical therapist outlined below.

References:

* Hodges, P. W., & Richardson, C. A. (1996). Inefficient muscular stabilization of the lumbar spine associated with low back pain. *Spine*, *21*(22), 2640-2650.

* McGill, S. M. (2001). Low back stability: from formal description to issues for clinical search. *Spine*, *26*(7), 787-791.

* Akuthota, V., & Nadler, S. F. (2004). Core strengthening. *Archives of Physical Medicine and Rehabilitation*, *85*(3 Suppl 1), S86-92.

* Huxel Bliven, K. C., & Anderson, B. E. (2013). Core stability training for injury prevention. *Sports Health*, *5*(6), 514-522.

* Saragiotto, B. T., Maher, C. G., Yamato, T. P., Costa, L. O., Menezes Costa, L. C., Lopes, L. C., ... & Koes, B. W. (2016). Motor control exercise for chronic non-specific low back pain. *Cochrane Database of Systematic Reviews*, (1), CD012004.

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Q.

MRI Machine Fears? Why Your Pain Persists & Medically Approved Steps

A.

An MRI machine is generally safe and excellent for spotting major structural problems, but pain can still persist with a normal scan because it often involves nerves, muscles, inflammation, and stress-related sensitization that imaging alone cannot show. Most back pain improves with evidence-based care, and anxiety about the MRI machine is common but manageable through options like open MRI, music, or short-acting medication. There are several factors to consider; see below for the specific red flags that require urgent care, why doctors sometimes delay imaging, and the medically approved next steps such as staying active, targeted physical therapy, sleep and stress strategies, and pain-management options to guide your next move with your clinician.

References:

* Spadafora R, Marziani E, Celli M, Ciaraffa F, Riganello S, Sbarrato M, Chiumera MG. Anxiety and claustrophobia in MRI: recent advances and recommendations for treatment. Radiol Med. 2022 Sep;127(9):987-996. doi: 10.1007/s11547-022-01539-7. Epub 2022 Aug 4. PMID: 35928641.

* Alsaidan ZA, Waseem S, Alsaidan MA. Psychological factors influencing the transition from acute to chronic pain: a systematic review. Pain Res Manag. 2018 Nov 15;2018:7954109. doi: 10.1155/2018/7954109. PMID: 30527376; PMCID: PMC6260706.

* Sullivan MJ, Scott W, Trost Z. Pain catastrophizing: a review of current concepts and clinical implications. Pain Manag. 2015 Jan;5(1):305-24. doi: 10.2217/pmt.14.73. PMID: 25501309.

* D'Alessandro L, D'Alessandro A, Luzzato M, Mattioli F, Di Cosimo D, Boccardo G. Interventions for reducing claustrophobia and anxiety in people undergoing MRI: a systematic review. Radiol Med. 2016 Sep;121(9):661-70. doi: 10.1007/s11547-016-0648-9. Epub 2016 May 17. PMID: 27181682.

* Williams AC, Fisher E, Hearn L, Eccleston C. Psychological approaches for the management of chronic pain: systematic review and meta-analysis. Health Technol Assess. 2018 Nov;22(58):1-208. doi: 10.3310/hta22580. PMID: 30424566; PMCID: PMC6266014.

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Q.

Pain When Supine? Why Lying Flat Hurts and Medically Approved Next Steps

A.

Pain when lying flat most often stems from back strain or disc issues, spinal stenosis, muscle imbalance, acid reflux, heart conditions, pregnancy changes, or abdominal and pelvic disorders; there are several factors to consider, and the complete guidance is below. Start with position and pillow adjustments, core and back strengthening, mattress review, and reflux measures, but seek urgent care for chest pressure, shortness of breath, new weakness or numbness, fever, or severe persistent pain; see below for red flags and when to see a doctor.

References:

* Kiltz U, van der Heijde D, Grieshaber R, Braun J. Supine pain with axial spondyloarthritis: an under-recognized symptom. Ann Rheum Dis. 2011 Nov;70(11):1858-61. doi: 10.1136/ard.2010.147714. Epub 2011 Aug 24. PMID: 21865239.

* Fouad Y, Gohar F, Samara A, Abdel-Fattah AM, Mounir B. Nocturnal gastroesophageal reflux disease: prevalence, pathogenesis, and management. Eur Rev Med Pharmacol Sci. 2021 Mar;25(5):2249-2259. doi: 10.26355/eurrev_202103_25272. PMID: 33749118.

* Chou R, Qaseem A, Snow P, Casey D, Cross JT Jr, Shekelle P, Owens DK; Clinical Guidelines Committee of the American College of Physicians. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91. doi: 10.7326/0003-4819-147-7-200710020-00006. Erratum in: Ann Intern Med. 2008 Feb 19;148(4):325-6. PMID: 17909203.

* Caridi JM, Pumberger M, Hughes AP. Cervical Radiculopathy: Diagnosis, Management, and Treatment Options. Hosp Spec. 2015 Mar-Apr;41(2):42-9. doi: 10.1097/JHS.0000000000000301. PMID: 25774528.

* Desai AS, Stevenson CS, Stevenson LW. Orthopnea, paroxysmal nocturnal dyspnea, and bendopnea in heart failure. J Am Coll Cardiol. 2014 Mar 4;63(8):745-53. doi: 10.1016/j.jacc.2013.11.028. PMID: 24360309.

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Q.

Tailbone Pain? Why Your Coccyx is Hurting & Medically Approved Steps

A.

Tailbone pain often comes from a fall, prolonged sitting, or repetitive strain, but joint degeneration, abnormal coccyx motion, childbirth injury, and rarely infection or tumors can also cause it. Seek urgent care for severe trauma, leg weakness or numbness, bowel or bladder changes, fever, unexplained weight loss, or pain that worsens. Most cases improve in weeks with medically approved steps like a coccyx cushion, posture changes, ice then heat, appropriate NSAIDs, pelvic floor or postural physical therapy, and stool softeners when straining, with injections for persistent cases and surgery rare. There are several factors to consider, so see the complete guidance below to choose the right next steps.

References:

* Patel R, Varacallo M. Coccydynia: A Review of Etiology, Diagnosis, and Treatment. StatPearls [Internet]. 2024 Jan-. PMID: 30725881.

* Karatas F, Durmaz H, Ozer O. Coccydynia: Pathogenesis, Clinical Evaluation, Treatment, and Prognosis. Pain Physician. 2021 May;24(3):E373-E383. PMID: 34015865.

* Lirette LS, Chaityn J, Bruno C, et al. Management of Coccydynia: An Overview of the Literature. Orthop Surg (Hong Kong). 2020 Feb;28(1):151-155. PMID: 32087640.

* Hanley K, Maignes P, Maigne JY, Patel P. Coccydynia: A Comprehensive Review of Its Etiology, Diagnosis, and Management. Curr Sports Med Rep. 2023 Jul 1;22(7):231-236. PMID: 37402809.

* Wray SM, Stothard H, Davies S, Braidford J. Non-surgical management of coccydynia: a systematic review. J Clin Anesth. 2023 Mar;85:111042. PMID: 36586383.

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Q.

Persistent Back Pain? Why Your Spine Is Aching & Medical Next Steps

A.

Persistent back pain most often arises from muscle or ligament strain, disc bulges or herniation, arthritis, spinal stenosis, or posture related deconditioning. Next steps usually start with a medical evaluation plus conservative care like physical therapy, short term medications, and lifestyle changes, with injections or surgery only when specific nerve compression or instability is present. There are important red flags that require urgent care such as bladder or bowel changes, groin numbness, fever, unexplained weight loss, severe weakness, night pain, or pain after major injury; see below for the full list of causes, warning signs, and step by step guidance that could change your plan.

References:

* Dydyk AM, Massa JP, Mesfin FB. Low Back Pain: A Primary Care Review. J Am Board Fam Med. 2020 Jul-Aug;33(4):618-629. doi: 10.3122/jabfm.2020.04.190367. PMID: 32641574.

* Vaghefi E, Haghgoshayie E, Alizadeh M, Mousavizadeh A, Alipour R. Acute and Chronic Low Back Pain: Systematic Review and Narrative of Treatment Options. Pain Ther. 2021 Mar;10(1):41-51. doi: 10.1007/s40122-020-00212-0. PMID: 33405096.

* Casagrande L, Fornasari D, Fratini L, Gava B, Montrone M, Pasquini G, Perazzi L, Pradella T, Rossi M, Sartini S, Visco G, Zanella M. Nonspecific Chronic Low Back Pain: An Evidence-Based Approach to Differential Diagnosis and Management. J Clin Med. 2023 May 10;12(10):3941. doi: 10.3390/jcm12103941. PMID: 37240375.

* Pergolizzi JV Jr, Taylor R Jr, Lequang JA, Kim J, Varrassi G. A multidisciplinary approach to the management of chronic low back pain: a narrative review. J Pain Res. 2022 Feb 10;15:439-448. doi: 10.2147/JPR.S343632. PMID: 35173516.

* O'Connor S, Alhalimi H, Al-Musawi A, O'Dwyer C, O'Connor M. Spinal Pain: A Concise Overview of Diagnostics and Treatments. Diagnostics (Basel). 2023 Jan 26;13(3):447. doi: 10.3390/diagnostics13030447. PMID: 36766649.

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Q.

Sharp Back Pain? Why Your Latissimus Dorsi Is Aching & Medical Next Steps

A.

Sharp mid to lower back pain that worsens with pulling, reaching, or twisting is often from the latissimus dorsi, usually due to strain, overuse, or posture problems, and it commonly improves with brief rest, ice then heat, gentle stretching, and gradual strengthening. There are several factors to consider. Seek urgent care for red flags like fever, weakness, numbness, bladder or bowel changes, or pain after significant injury, and see a clinician if pain is severe, uncertain, or persists beyond 2 to 3 weeks; full guidance on self care, physical therapy timing, and prevention is below.

References:

* Arshad Z, Alibrahim B, Alolabi B, Bedi A, Dimentberg E. Rehabilitation of Latissimus Dorsi Tendon Tears: A Systematic Review. J Orthop Sports Phys Ther. 2020 Aug;50(8):445-455. doi: 10.2519/jospt.2020.9416. PMID: 32663953.

* Sari S, Aydin M. Myofascial Pain Syndrome: An Update on Diagnosis and Treatment. Eurasian J Med. 2020 Oct;52(4):399-408. doi: 10.5152/eurasianjmed.2020.19142. PMID: 33716942.

* Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. Thoracolumbar Fascia: Anatomy, Function, and Clinical Considerations. J Anat. 2017 Dec;231(6):817-831. doi: 10.1111/joa.12629. PMID: 28834460.

* Bialosky JE, George SZ. Clinical Examination of the Thoracic Spine. J Orthop Sports Phys Ther. 2016 Feb;46(2):65-71. doi: 10.2519/jospt.2016.0501. PMID: 26861614.

* Cohen SP, Hooten WM. Cervical and Thoracic Spine Pain: Differential Diagnosis and Management. Anesthesiology. 2019 May;130(5):696-708. doi: 10.1097/ALN.0000000000002621. PMID: 31053424.

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Q.

Still in Pain? Why Your Spinal Fusion is Failing & Medical Next Steps

A.

Persistent or returning pain after spinal fusion is not rare and does not always mean something catastrophic, but it often points to causes like non-union, hardware problems, adjacent segment disease, lingering or new nerve compression, infection, or a pain source fusion could not address. There are several factors to consider; see below for key symptoms, timelines, and how each cause changes your next steps. Typical next steps include a focused exam with X-ray, CT, or MRI, bone health checks, conservative options such as therapy, medications, injections, or bone growth stimulation, and, if needed, revision surgery, while urgent red flags like fever, new weakness, or bowel or bladder changes require immediate care; see below for actionable guidance and when to seek a second opinion.

References:

* Thomson S, et al. Failed back surgery syndrome: epidemiology, diagnosis, and treatment. J Clin Neurosci. 2017 Jan;35:20-25. doi: 10.1016/j.jocn.2016.03.005. Epub 2016 Mar 23. PMID: 27040409.

* Le H, et al. Factors associated with pseudarthrosis in lumbar fusion: a systematic review. Spine J. 2021 Nov;21(11):1987-1996. doi: 10.1016/j.spinee.2021.07.016. Epub 2021 Jul 21. PMID: 34293815.

* Singh V, et al. Management of Failed Back Surgery Syndrome: A Clinical Review. Pain Physician. 2018 Nov;21(6):E505-E526. PMID: 30524458.

* Phan K, et al. Adjacent segment disease: fact or fiction? J Spine Surg. 2015 Dec;1(4):307-14. doi: 10.3978/j.issn.2414-469X.2015.12.03. PMID: 27909772; PMCID: PMC5107936.

* Duarte RV, et al. Spinal cord stimulation for failed back surgery syndrome: a review of the literature and current clinical insights. Pain Manag. 2023 Nov;13(9):661-670. doi: 10.2217/pmt-2023-0008. Epub 2023 Jul 4. PMID: 37397682.

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Q.

Constant Back Pain? Degenerative Disc Disease & Medically Approved Next Steps

A.

Constant back pain is often due to degenerative disc disease, a common age related change in the spinal discs that can cause chronic low grade pain with flare ups in the neck or lower back, sometimes with radiating numbness or tingling, and it is usually diagnosed by history and exam with imaging reserved for persistent symptoms or signs of nerve involvement. Medically approved next steps include staying active, targeted physical therapy, short term anti inflammatory medicines, heat or cold, weight management, and considering injections or surgery only for severe or unresponsive cases, while seeking urgent care for red flags like new bladder or bowel problems, groin numbness, fever, cancer history with new pain, major trauma, unexplained weight loss, or progressive weakness; there are several factors to consider, and the complete guidance and nuances are outlined below.

References:

* Roberts TT, Willick SE. Degenerative Disc Disease: A Review of the Current Literature. PM R. 2021 Jul;13(7):793-801. doi: 10.1002/pmrj.12571. Epub 2021 Mar 22. PMID: 33596160.

* George SZ, et al. Conservative Management of Degenerative Lumbar Spine Disorders: A Narrative Review. J Orthop Sports Phys Ther. 2020 Jan;50(1):15-26. doi: 10.2519/jospt.2020.9202. Epub 2019 Oct 1. PMID: 31575294.

* Shamir R, et al. Lumbar Degenerative Disc Disease: A Review of Current Treatment Options. World Neurosurg. 2020 Dec;144:e75-e88. doi: 10.1016/j.wneu.2020.08.175. Epub 2020 Sep 1. PMID: 32889212.

* Verma S, et al. Degenerative Disc Disease: Pathophysiology and Novel Therapies. Cells. 2022 Jul 28;11(15):2334. doi: 10.3390/cells11152334. PMID: 35954157; PMCID: PMC9368388.

* Chou R, et al. Nonpharmacological Treatments for Chronic Low Back Pain: A Systematic Review and Meta-analysis. Ann Intern Med. 2017 Dec 19;167(12):877-889. doi: 10.7326/M17-1934. Epub 2017 Dec 5. PMID: 29202787.

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Q.

BBL Pain? Why Your Body Is Reacting & Medically Approved Next Steps

A.

BBL pain is common after surgery and usually comes from liposuction trauma, swelling and inflammation, and posture changes that can also trigger back pain, with discomfort peaking around days 2 to 5 and steadily easing over 3 to 6 weeks. Medically approved next steps include surgeon guided pain medications, properly fitted compression, gentle walking, correct positioning with BBL pillows, and surgeon approved lymphatic massage, while urgent signs like shortness of breath, chest pain, fever, spreading redness, or one sided leg swelling need immediate care; there are important details below that could change your next steps, so review the complete guidance and stay in close contact with your surgeon.

References:

* Jain S, Varghese P, Reddy BP, et al. Pain management after gluteal fat grafting: a systematic review. J Plast Reconstr Aesthet Surg. 2021 Mar;74(3):572-581. doi: 10.1016/j.bjps.2020.09.049. Epub 2020 Oct 14. PMID: 33153835.

* Bellini E, Pustorino S, Losquadro C, et al. Complications of gluteal fat grafting: a systematic review and meta-analysis. Aesthetic Plast Surg. 2020 Feb;44(1):210-218. doi: 10.1007/s00266-019-01490-x. Epub 2019 Oct 14. PMID: 31612140.

* Shubinets V, Han J, Catanzano AA, et al. Postoperative care in gluteal fat grafting: A review of the literature. Plast Reconstr Surg. 2020 Jul;146(1):47e-55e. doi: 10.1097/PRS.0000000000006938. PMID: 32584852.

* Mofid MM. Understanding and managing pain after aesthetic gluteal surgery. Ann Plast Surg. 2022 Mar 1;88(3):284-289. doi: 10.1097/SAP.0000000000003058. PMID: 34919864.

* Ali Y, Nazzal H, Khan S, et al. Patient-reported outcomes and complications after gluteal fat grafting: A systematic review. J Plast Reconstr Aesthet Surg. 2023 Feb;77:245-257. doi: 10.1016/j.bjps.2022.10.026. Epub 2022 Nov 3. PMID: 36473673.

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Q.

Why Your Knees Buckle When Laughing: 5 Causes for Women 65+

A.

Knees buckling when laughing in women 65+ is most often due to five causes that are usually manageable: age related muscle weakness, knee osteoarthritis, lower back nerve compression, pelvic floor or core instability, or brief blood pressure drops; seek prompt care for red flags such as sudden or worsening leg weakness, severe back pain with leg symptoms, new bladder or bowel issues, or frequent falls. There are several factors to consider. See below for the key symptom clues that differentiate each cause and practical next steps, including targeted exercises, hydration, supportive footwear, and guidance on when to see your clinician.

References:

* White DK, Niu J, Zhang Y, LaValley M, El-Khoury GY, Nevitt MC, Felson DT. Knee buckling is associated with osteoarthritis and predicts subsequent falls in older adults: the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken). 2014 Apr;66(4):599-605. doi: 10.1002/acr.22159. PMID: 24700687; PMCID: PMC4036496.

* Farrokhi S, O'Connell M, Van Swearingen JM, Fitzgerald GK. Functional instability of the knee in older adults with and without knee osteoarthritis. J Geriatr Phys Ther. 2015 Jan-Mar;38(1):16-22. doi: 10.1519/JPT.0000000000000030. PMID: 25189006.

* Manoharan A, Menz HB, Hill K, Saunders NA, Williams P, Smith S, Cumming RG. Quadriceps strength and gait stability in older women: a longitudinal study. J Gerontol A Biol Sci Med Sci. 2005 Mar;60(3):364-70. doi: 10.1093/gerona/60.3.364. PMID: 15728362.

* Kim K, Kang SY, Kang SH. Age-related changes in neuromuscular control of the knee during gait: A systematic review. Gait Posture. 2017 Oct;57:332-340. doi: 10.1016/j.gaitpost.2017.07.016. Epub 2017 Aug 1. PMID: 28866504.

* Jinks C, Jordan KP, Croft PR. The prevalence of self-reported mechanical symptoms in individuals with or at risk for knee osteoarthritis. Osteoarthritis Cartilage. 2008 Feb;16(2):168-72. doi: 10.1016/j.joca.2007.07.009. Epub 2007 Sep 7. PMID: 17822965.

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Q.

Life past 65: Can I take 2 aleve at once

A.

Yes, taking two Aleve 220 mg tablets at once 440 mg can be within standard adult dosing, but after 65 you should be cautious; space doses 8-12 hours apart, do not exceed 3 tablets 660 mg in 24 hours, and take with food. There are several factors to consider. Older adults have higher risks for stomach bleeding, heart and kidney issues, and drug interactions, so review your conditions and medications and consider alternatives like acetaminophen; key details and when to contact a clinician are explained below.

References:

Lanas A, Garcia-Rodriguez LA, Arroyo MT, et al. (2003). Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs: a systematic… BMJ, 12684072.

McGettigan P, & Henry D. (2011). Cardiovascular risk with nonsteroidal anti-inflammatory drugs: systematic review of meta-analyses of observational studies… PLoS Med, 22152728.

European Association for the Study of the Liver; Asociacion Latinoamericana para el Estudio del Higado. (2015). EASL-ALEH clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis… Journal of Hepatology, 26096963.

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Q.

How to choose a mattress as a senior?

A.

There are several factors to consider; for many seniors, a medium-firm mattress that balances spinal support with pressure relief works best, and choosing the right type, thickness, edge support, and temperature control can improve comfort and mobility. Your optimal pick also depends on sleep position, body size, and conditions like arthritis or osteoporosis, as well as trial periods, warranties, and options like adjustable bases; see below for specifics and health-related nuances that could shape your next steps.

References:

Kovacs FM, Abraira V, Peña A, Martínez E, Gestoso M. (2003). Influence of mattress technology on chronic low back pain and sleep quality: a randomized, double-blind study. Spine, 12733814.

D'Amico G, Garcia-Tsao G, Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. Journal of Hepatology, 16806342.

Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Herrmann E, Zeuzem S. (2008). Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology, 18478346.

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Q.

Life after 60: What are the best mattresses for seniors?

A.

Most adults over 60 do best on a medium-firm mattress that blends spinal support with pressure relief, especially in memory foam, latex, or hybrid designs featuring strong edge support, motion isolation, and cooling; standout options include Saatva Classic, Tempur-Adapt, Avocado Green, Purple, and Sleep Number 360 i8. There are several factors to consider. See the complete guidance below for details on adjustable features for reflux or swelling, trial periods and warranties, and when persistent pain or tingling means you should talk with a clinician, so you can match the right bed to your body, sleep position, and health needs.

References:

Kovacs FM, Abraira V, Peña A, et al. (2003). Effect of firmness mattress on chronic nonspecific low-ba… Spine, 12855720.

Jacobson BH, Boolani A, Smith DB, et al. (2015). The effect of bedding systems on back pain and sleep quality… Appl Ergon, 25579909.

European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines for the management of patients w… Journal of Hepatology, 30230068.

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Q.

Life after 60: What to consider when buying a new matress

A.

There are several factors to consider when choosing a mattress after 60: prioritize medium-firm support with strong pressure relief, breathable materials, dependable edge support and motion isolation, and think about an adjustable base for reflux, breathing issues, leg swelling, arthritis or back pain. Important buying and care details like zoned support, topper options, hypoallergenic fabrics, long sleep trials and warranties, and when to seek medical advice for persistent sleep problems are explained below, helping you pick the right bed and decide your next healthcare steps.

References:

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review… Journal of Hepatology, 16337505.

Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24731458.

Garcia-Tsao G, Abraldes JG, Berzigotti A, & Bosch J. (2017). Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management… Hepatology, 27654004.

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Q.

Why is there tingling in my back and is it cause for worry?

A.

Tingling in your back is usually from temporary nerve irritation due to muscle strain or posture, but it can also be caused by a herniated disc or stenosis, shingles, diabetes or B12 deficiency, anxiety, or (less commonly) spinal cord conditions. Most cases aren’t dangerous, but seek urgent care for worsening or persistent tingling, new weakness, loss of bladder/bowel control, severe unrelenting pain, fever/weight loss, or a history of cancer or immune suppression. There are several factors to consider—see below for key details on causes, red flags, diagnosis, and treatment options that could change your next steps.

References:

Johnson RW, & Rice AS. (2014). Clinical practice. Postherpetic neuralgia. N Engl J Med, 24595116.

Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage… Hepatology, 11157951.

Castera L, & Forns X. (2008). Non-invasive evaluation of liver fibrosis using transient… J Hepatol, 18321743.

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Q.

Are there cases of back pain as a sequela of COVID-19?

A.

Muscle and spine pain in the back is now considered a lingering after effect of COVID-19 infection.

References:

Papalia GF, Petrucci G, Russo F, Ambrosio L, Vadalà G, Iavicoli S, Papalia R, Denaro V. COVID-19 Pandemic Increases the Impact of Low Back Pain: A Systematic Review and Metanalysis. Int J Environ Res Public Health. 2022 Apr 11;19(8):4599. doi: 10.3390/ijerph19084599. PMID: 35457462; PMCID: PMC9027663.

Zis P, Ioannou C, Artemiadis A, Christodoulou K, Kalampokini S, Hadjigeorgiou GM. Prevalence and Determinants of Chronic Pain Post-COVID; Cross-Sectional Study. J Clin Med. 2022 Sep 22;11(19):5569. doi: 10.3390/jcm11195569. PMID: 36233443; PMCID: PMC9573502.

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Q.

What could be the cause of pain in the right side of the back?

A.

There are many causes of back pain that come from issues with the muscle, bone, overlying skin or nearby organs like the lung, kidney, or gallbladder.

References:

Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021 Jul 3;398(10294):78-92. doi: 10.1016/S0140-6736(21)00733-9. Epub 2021 Jun 8. PMID: 34115979.

Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, Viswanath O, Jones MR, Sidransky MA, Spektor B, Kaye AD. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep. 2019 Mar 11;23(3):23. doi: 10.1007/s11916-019-0757-1. PMID: 30854609.

Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2023 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

https://www.ncbi.nlm.nih.gov/books/NBK538173/

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Q.

What could be the causes of pain in the middle of the back?

A.

Pain in the middle of the back is mostly commonly due to a bone or muscle issue, but less commonly can be an issue with the stomach, pancreas, kidneys or aorta.

References:

Johansson MS, Jensen Stochkendahl M, Hartvigsen J, Boyle E, Cassidy JD. Incidence and prognosis of mid-back pain in the general population: A systematic review. Eur J Pain. 2017 Jan;21(1):20-28. doi: 10.1002/ejp.884. Epub 2016 May 5. PMID: 27146481.

Casiano VE, Sarwan G, Dydyk AM, et al. Back Pain. [Updated 2023 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

https://www.ncbi.nlm.nih.gov/books/NBK538173/

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Q.

Can exercise improve back pain?

A.

Most definitely. There are few back conditions that do NOT benefit back pain.

References:

Rainville J, Hartigan C, Martinez E, Limke J, Jouve C, Finno M. Exercise as a treatment for chronic low back pain. Spine J. 2004 Jan-Feb;4(1):106-15. doi: 10.1016/s1529-9430(03)00174-8. PMID: 14749199.

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Q.

When should I go to see a doctor about my back pain?

A.

If you have persistent worsening back pain you should see your healthcare provider particularly if accompanied by difficultly walking or standing, or a loss of bowel or bladder control.

References:

Edwards J, Hayden J, Asbridge M, Gregoire B, Magee K. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017 Apr 4;18(1):143. doi: 10.1186/s12891-017-1511-7. PMID: 28376873; PMCID: PMC5379602.

Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021 Jul 3;398(10294):78-92. doi: 10.1016/S0140-6736(21)00733-9. Epub 2021 Jun 8. PMID: 34115979.

Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, Viswanath O, Jones MR, Sidransky MA, Spektor B, Kaye AD. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep. 2019 Mar 11;23(3):23. doi: 10.1007/s11916-019-0757-1. PMID: 30854609.

See more on Doctor's Note

Q.

When should I go to the emergency room for back pain?

A.

Consider going to the emergency room (ER) for back pain if it is extremely intense, accompanied by difficultly walking or standing, or a loss of bowel or bladder control.

References:

Edwards J, Hayden J, Asbridge M, Gregoire B, Magee K. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017 Apr 4;18(1):143. doi: 10.1186/s12891-017-1511-7. PMID: 28376873; PMCID: PMC5379602.

Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021 Jul 3;398(10294):78-92. doi: 10.1016/S0140-6736(21)00733-9. Epub 2021 Jun 8. PMID: 34115979.

Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, Viswanath O, Jones MR, Sidransky MA, Spektor B, Kaye AD. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep. 2019 Mar 11;23(3):23. doi: 10.1007/s11916-019-0757-1. PMID: 30854609.

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Waukesha Memorial Hospital, Waukesha Wisconsin, USA

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Caroline M. Doan, DO

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Signify Health

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U.S. Department of Veterans Affairs

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Dale Mueller, MD

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Penn State Health

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Which is the best Symptom Checker?

Which is the best Symptom Checker?

Ubie’s symptom checker demonstrated a Top-10 hit accuracy of 71.6%, surpassing the performance of several leading symptom checkers in the market, which averaged around 60% accuracy in similar assessments.

Link to full study:

https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1

References