Dorsalgia: What Is It and How Do I Treat It?

The word dorsalgia comes from the words “dorsal,” which means back, and “algia,” which means pain. Dorsalgia generally refers to back or spine pain (1). However, while dorsalgia includes spinal-related pain like lower back pain, mid back pain, and sciatica pain, it does not include pain from conditions like scoliosis or lordosis. Dorsalgia includes back pain that begins in the back muscles, nerves, and joints (2).

Bulging or herniated discs can cause dorsalgia. Dorsalgia may also occur after an injury or be the result of overuse, such as in the case of extensive manual labor (3, 4). Stress-related disorders can also result in dorsalgia (5).

Physical Examination

Your healthcare provider will likely begin with a physical examination. They may ask you to sit, stand, walk, and pick your legs up off the floor. You should try to describe your pain in detail to your healthcare provider throughout the examination process. Does your back ache? Burn? Feel like it’s being stabbed? Does the pain radiate? Is it dull, sharp, or pulsing (6)?

You can also aid your doctor in forming a diagnosis by providing the answers to questions like: 

• Does your back hurt when sitting, standing, lying down, or some combination?
• What time of day does your back tend to hurt the most?
• Is your pain consistent throughout the day or does it ebb and flow? 
• Does your pain limit your ability to perform normal tasks? If so, which tasks? 
• Have any at-home remedies or over-the-counter medications relieved your pain?
• What other health conditions do you have?
• Do you have a family history of back problems or spinal conditions?
• Have you suffered any injuries, even in childhood, that could affect your back? If so, what are they?‍

Neurological Testing

Neurological testing such an EMG may be necessary, especially if a nerve-related cause is suspected. Tests that may signal the need for neurological testing include:

• Straight Leg Test: For this common test, your doctor will have you lay on your back on an exam table  You’ll relax your outstretched, affected leg. Your doctor will then gently lift your leg 30-60 degrees. If this causes pain in the back or pain that radiates in the leg, your condition may have a nerve-related origin (7).
• Stork Test: This test requires you to stand on the floor while your healthcare provider examines your lower back. When you’re comfortable and feel ready to balance, your healthcare provider will have you lift your knee toward the ceiling (8).
• Adam’s Forward Bend Test: During this test, you’ll stand with both feet on the floor then bend forward at the waist. Your healthcare provider will watch for abnormalities or signs of larger conditions (9).‍

Imaging

In more complex cases of dorsalgia, imaging may be necessary. MRIs can be useful in diagnosing dorsalgia (10). You may also want to ask your doctor about the potential of X-rays or a CT scan helping you find a diagnosis and successful treatment plan.

In this section, we’ll walk you through your range of options for treating dorsalgia pain. Depending on the intensity and longevity of your dorsalgia, your healthcare provider will likely recommend starting out with conservative treatments like physical therapy, at-home remedies, and medication. If those treatments fail to relieve your pain, then slightly more invasive treatments like dry needling or injections could help you. If your pain still persists, then surgery may be necessary.

Physical Therapy

Physical therapy is a first-line treatment for responding to backache associated with dorsalgia. If your primary healthcare provider determines that you do not have a serious condition, then a physical therapist will likely able to provide a treatment plan that relieves your pain and helps you perform normal activities. In some cases of chronic back pain, physical therapy can be more effective than surgery.

Generally, physical therapists want to see patients anywhere from once to a few times a week for several weeks or months. Regular appointments have a direct correlation to pain relief, so think through the following questions before you select a physical therapist or agree to a treatment plan:

• Where is the physical therapist’s office located?
• Do their office hours work for your schedule?
• Are you comfortable talking to and being touched by this physical therapist? 
• Does your insurance provider cover their services? 
• How long does the physical therapist estimate your treatment plan will take? 
• Do they recommend any exercises you can do at home to supplement the exercises performed at physical therapy?
• What are the additional treatments – such as ice therapy, heat therapy, chiropractic care, over-the-counter pain relievers, or acupuncture – that could enhance the effects of physical therapy?

While rest can be an important part of healing from back pain, supervised exercise therapy prescribed by a physical therapist can accelerate your healing and help prevent future injuries (11).‍

NSAIDs

Non-steroidal anti-inflammatory drugs are commonly recommended for back ache and acute back pain. They are available over-the-counter and via prescription, and can be taken as pills, capsules, topical creams and gels. Popular NSAIDs include aspirin, ibuprofen (Motrin, Advil), Naproxen (Aleve), and indomethacin (Indocin). Diclofenac, a prescription NSAID often applied in topical form, effectively relieves joint pain (12).

Acetaminophen

Acetaminophen, also called paracetamol, is a pain reliever and fever reducer. It does not have anti-inflammatory properties, so if you suspect that inflammation is linked to your pain, it may not be the best choice for you. However, in cases where inflammation isn’t present, acetaminophen is a good first-line treatment. You can find acetaminophen in over-the-counter medications like Tylenol, Excedrin, Benadryl, and Dayquil.

Muscle Relaxants

If your pain is persistent and doesn’t respond to first-line, over-the-counter treatments, you may want to talk to your doctor about muscle relaxants. Cyclobenzaprine is a muscle relaxant that effectively treats neck pain and related muscle spasms (13). Muscle relaxants have also been shown to provide relief for non-specific back pain, especially acute pain (14).‍

Dry Needling

Dry needling can be used to treat pain in the thoracic spine (the spine in the upper back and abdomen) (15). Often used in sports medicine, physical therapists perform dry needling to relieve muscle pain. By inserting a small needle into a muscle’s trigger point, the therapist relaxes the muscles and increases blood flow in the painful area (16).

‍Facet Injections of Lidocaine or Steroids‍

Especially in the case of acute lumbar back pain, facet injections of lidocaine and steroids have demonstrated therapeutic effects (17). Cortisone, a steroid, can relieve pain for months, but you may not feel pain relief until several days after the injection. Lidocaine, on the other hand, acts quickly but will only relieve pain for a couple of hours (18).

If your health care provider recommends facet injections, ask a few questions to help you feel as relaxed and confident going into the procedure: 

• Which facet joints do they want to inject? Why those?
• Will the injections be intraarticular (injected directly into the joint) or nerve blocks (blocking the nerves connected to the joint)? 
• What the eating and drinking restrictions prior to the injections?
• Will you be able to drive yourself home after the injections? 
• When should you become aware of pain relief from the injections?
• How many rounds of injections will it take to experience maximum effects?
• What are the activity restrictions after injections? 
• What are the possible side effects‍

TENS

Transcutaneous electrical nerve stimulation (TENS) is a possible therapy for middle back pain. TENS units are small, handheld, battery-operated devices that block nerve impulses (19). They’re available over-the-counter and online, though you may want to ask a healthcare provider if a certain type of TENS unit is best suited to the pain you’re experiencing.

Surgery

In cases of severe back pain, surgery may be required in order for you to find optimal pain relief. There are a few surgery options that you can discuss with a doctor: 

• Discectomy: Quite literally, discectomy means “cutting out the disc.” For this procedure, a surgeon removes one or more damaged discs. The success rate is 80-90% (20).
• Disc arthroplasty: This relatively new form of spinal surgery allows surgeons to replace damaged discs with artificial disc implants. The technology is still quite new for this surgery, but the results thus far seem to be positive (21).
• Spinal fusion: Thanks to recent medical advancements, surgeons can now perform spinal fusion surgeries via small incisions. Spinal fusion eliminates movement between two or more vertebrae in the spine by fusing them together (22, 23).

If your healthcare provider suggests surgery, ensure that they are aware of former procedures you’ve undergone or any family history of surgical complications.

NSAIDs carry a risk of gastrointestinal (stomach) and cardiovascular (heart) problems. Acetaminophen has been linked to nausea and potentially to liver effects. Some patients experience fatigue due to muscle relaxants, while others suffer from blurred vision or dry mouth (24).

The side effects of dry needling tend to be minor and include bleeding at the site of needle insertion, bruising, and fainting (25). Similarly, facet injections have a low risk of side effects, the most common being temporary pain, though the rare patient may experience infection or negative responses to cortisone like weight-gain or water retention (26). TENS Units are considered generally quite safe when used properly. Turning the impulse up too high or placing the electrodes on sensitive skin could lead to burning or irritation. Pregnant women, patients with heart problems, and people who have implanted devices should not use TENS units (27).

All surgeries carry a risk of infection and reaction to anesthesia. Discectomies carry a risk of excessive bleeding and blood clots (28). In the case of spinal fusion surgery, talk to your surgeon about the risk of the bone failing to fuse and spinal cord injury (29).

The list of conditions that can be labeled “dorsalgia” is quite long. In order to determine your underlying condition and find an effective pain management plan, work with a trusted healthcare provider to find the pathology that’s causing your pain.

Standard, first-line treatments for dorsalgia start conservatively with NSAIDs and physical therapy. Stronger prescription medications, such as muscle relaxants, can be used if the pain persists. Injections or surgeries may be necessary for the most severe cases of dorsalgia.