[6 MIN READ 

In this article: 

• Back pain is common among adults, but its causes vary. It’s important to find a provider who takes the time to listen to you and identify the cause of your discomfort.
• Sometimes back pain can be treated at home, but severe and sudden pain along with other specific symptoms may require a trip to the ER. 
• Not all back pain requires an MRI in order to obtain a diagnosis and treatment. The medical spine team at Providence Swedish is skilled at diagnosing pain without an MRI. 

Back pain: What all adults need to know 

According to The Lancet Rheumatology, the global epidemic of low back pain is escalating, with a reported 619 people worldwide suffering from the condition in 2020, and is on track to reach a staggering 843 million by 2050. It’s common to have a lot of questions about it. Is it just a muscle strain or something more serious? Should you rest and take anti-inflammatory medications? Or will you need an MRI, physical therapy or prescription pain medications?

“At Swedish, we see patients every day who are dealing with new or recurring back pain,” says James Babington, M.D., the program medical director for medical spine at Providence Swedish Edmonds. “Most of them have already tried to manage their symptoms on their own, but when those first-line strategies don’t work, they turn to us.”

“Medical spine” is a term Dr. Babington’s team uses to describe the treatment of spinal disease that does not involve surgery. They help patients navigate a wide range of treatments, including physical therapy, chiropractic care, injections and medications. The goal is to help people find relief, stay active and avoid unnecessary imaging, procedures or fear.

What causes back pain?

Back pain can stem from many different sources. Sometimes, it has a clear cause, such as lifting something heavy or sitting for extended periods of time. Other times, it can come out of nowhere. 

“We see people who’ve had back pain come and go for 20 years and others who just wake up and suddenly can’t stand up straight,” says Dr. Babington. “In some cases, the pain has a mechanical cause, such as joint degeneration or disc issues, but often there is no obvious structural issue.” 

Dr. Babington and his team consider each patient’s overall health when diagnosing and developing a treatment plan for back pain. A young, active person with sudden pain after lifting something heavy is usually less concerning than an older adult experiencing unexplained weight loss, fevers or pain after a fall, which are symptoms that could point to more serious underlying conditions like infection or cancer.

“Even if someone can’t stand up straight because of back pain, we want to look at that in light of their overall health,” he says.

When pain strikes, these should be your first steps

What should you do if you have back pain? If you’ve had an accident or injury, or the pain is so intense that you cannot move, you should head to the emergency room. But, if you can stand up and walk around, the first step is to try over-the-counter medications and self-care.

“Relative rest is important,” says Dr. Babington. “That means staying active but within reason. Try walking. Avoid extreme bending forward or backward. Gentle stretches can help.”

Anti-inflammatory medications, such as acetaminophen and ibuprofen, can help reduce back pain. Some patients find that heat therapy in the form of a heating pad or warm baths can also provide relief. However, prolonged bed rest is discouraged. 

“Bed rest can make nerve pain worse, so we encourage people to stay active and to keep moving,” Dr. Babington says.

When to go to the ER

While most back pain can be treated at home, certain signs warrant immediate medical attention. Go to the emergency room if you experience: 

• Pain so severe that you cannot stand or walk
• Tingling or numbness around the genitals or anus
• Loss of bladder or bowel control
• Significant leg weakness, especially foot drop

“These are serious symptoms that could point to a condition like cauda equina syndrome, which requires emergency care,” says Dr. Babington.

Take action against chronic and recurrent pain

Not all back pain is sudden or extreme. Many people live with a dull, nagging ache that comes and goes for years. It might not feel like an emergency, but it shouldn’t be ignored.

“Anything your body is telling you through pain is worth paying attention to,” says Dr. Babington. “It doesn’t always need urgent care, but it should be evaluated if it persists.”

He says that if your back pain is ongoing, the best place to start is with your primary care doctor, who may suggest lifestyle changes, ergonomic adjustments or medications to help manage your condition. They may also refer you to physical therapy.

Most people don't need an MRI

Many patients are surprised to learn that imaging tests like MRIs are not typically recommended in the first six weeks of back pain unless there are red flags like trauma, infection or cancer. That’s because MRIs often reveal abnormalities that may not be causing the pain. Disc bulges, small tears or joint changes are common as we age and may not always indicate a problem.

“There’s strong evidence that early imaging doesn’t change the treatment plan,” says Dr. Babington. “With or without an MRI, most patients will hear the same advice: stay active, use anti-inflammatories if appropriate and go to physical therapy. We place a significant emphasis on the physical exam and the patient’s health history. What makes the pain worse? What brings relief? These clues often tell us more than what an MRI finds.”

During a physical exam, the medical spine team at Providence Swedish assesses posture, flexibility, nerve function and which factors exacerbate or alleviate the pain. Dr. Babington emphasizes that this is why patients need to look for providers who listen carefully and conduct thorough physical examinations. 

Relief is possible, even without surgery

Injections and surgery are sometimes necessary, but they’re not the first step.

“If you’re getting a spinal injection or considering surgery, we need a clear picture of what’s going on,” says Dr. Babington. “But for everyone else, the goal is to avoid those things and get better anyway.”

Most patients improve with conservative care. Physical therapy, activity modifications, medications and sometimes complementary treatments can help people return to everyday life without invasive procedures.

Ask your provider about alternative therapies

Patients often ask about acupuncture, chiropractic care or even cannabis products. Providers at Providence Swedish are open to discussing these options and encourage evidence-based care that supports mobility and function. 

“For chronic pain, I have seen acupuncture be very effective,” says Dr. Babington. “Chiropractic can be helpful for some patients, too.” 

He is more cautious about cannabis.

“There’s a lot of buzz, but we still don’t have strong data on the role medical marijuana may play in back pain relief,” says Dr. Babington. “Some people do find that topical CBD creams help, though.”

Massage and acupuncture aren’t offered at Providence Swedish but may be recommended when appropriate.

Opioids play a specific role in treatment

Opioids are not the first-line treatment for back pain. 

“For the majority of patients, we try very hard to avoid opioids,” says Dr. Babington. “They’re considered a last resort after other options have been tried and haven't worked.” 

If used, they are prescribed for short periods and under close supervision.

“We always frame that around restoring function, not just managing pain.”

Learn more and find a provider

Whether your back pain started today or has been going on for years, help is available. The key is knowing when to seek care, understanding your options and trusting that even stubborn back pain can improve with the proper support. 

“We may not always have a perfect label for your pain,” says Dr. Babington, “but we can help you understand how your body's working and manage your pain so you can improve your quality of life.”

If you or someone you love is struggling with back pain, the experts on the medical spine team at the Providence Swedish Edmonds Specialty Clinic can help. Whether you require an in-person visit or want to consult a doctor virtually, you have options.  

You can also contact Swedish Primary Care to schedule an appointment with a primary care physician. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections, and more. You can use our provider directory to find a specialist or primary care physician near you.

Information for patients and visitors

Related resources

Keep moving! Maintain mobility as you age.

Swedish experts can help ease the burden of overwhelming chronic pain

Dink, rally and repeat: How to play pickleball without the pain

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

Providence Swedish experts in the media

Follow us on Facebook, Instagram and X.