Back pain is a very common complaint. According to the Mayo Clinic, approximately 80% of all Americans will have low back pain at least once in their lives.
Back pain is a common reason for absence from work and doctor visits. Although back pain may be painful and uncomfortable, it is not usually serious.
back pain can affect people of any age, it is significantly more common among adults aged between 35 and 55 years. Experts say that back pain is associated with the way our bones, muscles and ligaments in our backs work and connect together.
Pain in the lower back may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdomen and pelvic internal organs, and the skin around the lumbar area. Pain in the upper back may be due to disorders of the aorta, tumours in the chest, and spine inflammation.
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You will also see introductions at the end of some sections to any recent developments that have been covered by MNT’s news stories. Also, look out for links to information about related conditions.
Causes of back pain
The human back is composed of a complex structure of muscles, ligaments, tendons, disks and bones – the segments of our spine are cushioned with cartilage-like pads called disks. Problems with any of these components can lead to back pain. In some cases of back pain, its cause is never found.
Problems with the spine such as osteoporosis can lead to back pain.
Strain – the most common causes of back pain are:
- Strained muscles
- Strained ligaments
- A muscle spasm
Things that can lead to strains or spasms include:
- Lifting something improperly
- Lifting something that is too heavy
- The result of an abrupt and awkward movement
Structural problems – the following structural problems may also result in back pain:
- Ruptured disks – each vertebra in our spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.
- Bulging disks – in much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
- Sciatica – a sharp and shooting pain that travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.
- Arthritis – patients with osteoarthritis commonly experience problems with the joints in the hips, lower back, knees and hands. In some cases spinal stenosis can develop, which is the term used to describe when the space around the spinal cord narrows.
- Abnormal curvature of the spine – if the spine curves in an unusual way the patient is more likely to experience back pain. An example is scoliosis, a condition in which the spine curves to the side.
- Osteoporosis – bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
Below are some other causes of back pain:
- Cauda equina syndrome – the cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. People with cauda equine syndrome feel a dull pain in the lower back and upper buttocks, as well as analgesia (lack of feeling) in the buttocks, genitalia and thigh. There are sometimes bowel and bladder function disturbances.
- Cancer of the spine – a tumour located on the spine may press against a nerve, resulting in back pain.
- Infection of the spine – if the patient has an elevated body temperature (fever) as well as a tender warm area on the back, it could be caused by an infection of the spine.
- Other infections – pelvic inflammatory disease (females), bladder, or kidney infections may also lead to back pain.
- Sleep disorders – individuals with sleep disorders are more likely to experience back pain, compared to others.
- Shingles – an infection that can affect the nerves may lead to back pain, depending on the nerves affected.
- Bad mattress – if a mattress does not support specific parts of the body and keep the spine straight, there is a greater risk of developing back pain.
Everyday activities or poor posture.
Back pain can also be the result of some everyday activity or poor posture. Examples include:
Adopting a very hunched sitting position when using computers can result in increased back and shoulder problems over time.
- Bending awkwardly
- Pushing something
- Pulling something
- Carrying something
- Lifting something
- Standing for long periods
- Bending down for long periods
- Muscle tension
- Straining the neck forward, such as when driving or using a computer
- Long driving sessions without a break, even when not hunched
The following factors are linked to a higher risk of developing low back pain:
- A mentally stressful job
- Pregnancy – pregnant women are much more likely to get back pain
- A sedentary lifestyle
- Age – older adults are more susceptible than young adults or children
- Gender – back pain is more common among females than males
- Obesity and overweight
- Strenuous physical exercise (especially if not done properly)
- Strenuous physical work.
Signs and symptoms
A symptom is something that the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
The main symptom of back pain is, as the name suggests, an ache or pain anywhere on the back, and sometimes all the way down to the buttocks and legs. Some back issues can cause pain in other parts of the body, depending on the nerves affected.
In most cases, signs and symptoms clear up on their own within a short period.
If any of the following signs or symptoms accompanies a back pain, people should see their doctor:
- Weight loss
- Elevated body temperature (fever)
- Inflammation (swelling) on the back
- Persistent back pain – lying down or resting does not help
- Pain down the legs
- Pain reaches below the knees
- A recent injury, blow or trauma to your back
- Urinary incontinence – you pee unintentionally (even small amounts)
- Difficulty urinating – passing urine is hard
- Faecal incontinence – you lose your bowel control (you poo unintentionally)
- Numbness around the genitals
- Numbness around the anus
- Numbness around the buttocks
According to the British National Health Service (NHS), the following groups of people should seek medical advice if they experience back pain:
- People aged less than 20 and more than 55 years
- Patients who have been taking steroids for a few months
- Drug abusers
- Patients with cancer
- Patients who have had cancer
- Patients with depressed immune systems
Most GPs (general practitioners, primary care physicians) will be able to diagnose back pain after carrying out a physical examination, and interviewing the patient. In the majority of cases imaging scans are not required.
If the doctor or patient suspects some injury to the back, tests may be ordered. Also, if the doctor suspects the back pain might be due to an underlying cause, or if the pain persists for too long, further tests may be recommended.
Suspected disk, nerve, tendon, and other problems – X-rays or some other imaging scan, such as a CT (computerized tomography) or MRI (magnetic resonance imaging) scan may be used to get a better view of the state of the soft tissues in the patient’s back.
- X-rays can show the alignment of the bones and whether the patient has arthritis or broken bones. They are not ideal for detecting problems with muscles, the spinal cord, nerves or disks.
- MRI or CT scans – these are good for revealing herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles and bones.
- Bone scan – a bone scan may be used for detecting bone tumours or compression fractures caused by brittle bones (osteoporosis). The patient receives an injection of a tracer (a radioactive substance) into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
- Electromyography or EMG – the electrical impulses produced by nerves in response to muscles is measured. This study can confirm nerve compression which may occur with a herniated disk or spinal stenosis (narrowing of the spinal canal).
In the vast majority of cases back pain resolves itself without medical help – just with careful attention and home treatment.
Usually back pain is categorized into two types:
- Acute – back pain comes on suddenly and persists for a maximum of three months.
- Chronic – the pain gradually develops over a longer period, lasts for over three months, and causes long-term problems.
If home treatments do not give the desired results, a doctor may recommend the following:
- physical therapy
In Our Pain Management Center, our pain physicians/doctors perform Caudal ESI, nerve root block & other procedures.
CBT (cognitive behavioural therapy) – CBT can help patients manage chronic back pain. The therapy is based on the principle that the way a person feels is, in part, dependent on the way they think about things.
People who can be taught to train themselves to react in a different way to pain may experience less perceived pain. CBT may use relaxation techniques as well as strategies to maintain a positive attitude. Studies have found that patients with CBT tend to become more active and do exercise, resulting in a lower risk of back pain recurrence.