Back pain is one of the most common medical problems, affecting 8 out 10 people at some point in their lives. Symptoms can vary in severity and duration depending on the underlying cause. Since there are many potential causes of back pain, it is important to see a medical specialist for a proper diagnosis and ideal treatment plan.
Causes of Back Pain
Causes of back pain are often grouped into broad categories such as:
- Traumatic – the result of an injury
- Degenerative – caused by wear and tear
- Other causes – which include tumors, infection, and autoimmune disorders
A traumatic cause of back pain is the result of an injury. An injury is perhaps the most common cause of back pain. Some injuries are minor and resolve spontaneously on their own and others require medical attention and a prolonged recovery.
- Muscle strain: also known as a pulled muscle, a muscle strain refers to damage to the muscle or its connecting tendons. This can be caused by lifting a heavy object or twisting awkwardly. These are typically minor injuries that heal with rest and medications.
- Fracture: a fracture is a broken bone and may be the result of a fall, or high impact injury like a car accident. In older people with osteoporosis (decreased bone density) fractures can occur with minimal trauma. Depending on where the vertebrae is broken, a fracture can be treated with rest alone, bracing, but can sometimes require surgery.
Degenerative causes of back pain refer to wear and tear on the spine. This is often age related, or due to overuse and repetitive injury. Chronic back pain is often caused by degenerative changes.
- Canal Stenosis (narrowing) – the spinal cord and spinal nerves pass through canals within the spine. These can narrow due to bony overgrowth (osteophytes), thickening of ligaments (ligamentum flavum hypertrophy), or because of a herniated intervertebral disc.
- Herniated disc – The intervertebral discs can slip, protrude, or rupture which can result in canal narrowing and compression of the spinal cord or nerve roots
- Degenerative disc disease – refers to wear and tear on the intervertebral disc. The disc can be thought of as a gel filled sac (nucleus pulposus) with a fibrous outer layer (annulus pulposus) that acts as a shock absorber. Overtime, the gel-like center can dry out and the outer layer may break down leading to pain.
- Spondylosis – is a general term that refers to age related wear and tear, or degeneration, of the spine
- Spondylolisthesis – is when one of the bones of the spine, called a vertebrae, slips forward or backwards from its normal position.
There are other causes of back pain that are neither due to injury or degenerative changes in the spine.
- Tumor – An abnormal growth that may be benign or cancerous. Treatment may be surgery, radiation, chemotherapy, or a combination.
- Infection – An infection can affect the bones (osteomyelitis), the discs (discitis), or the space surrounding the spinal cord (epidural abscess).
- Auto-immune disorders – Autoimmune disorders occur when your immune system misidentifies healthy cells as foreign and attacks them by mistake. Example disorders are rheumatoid arthritis and ankylosing spondylitis.
Sometimes, the sensation of back pain is actually unrelated to a disorder of the spine. Examples include:
- Kidney stone or kidney infection (pyelonephritis)
- Aortic dissection or aortic aneurysm – life threatening conditions affecting the aorta, which is the large blood vessel that transports blood away from your heart.
An evaluation by a medical professional is highly recommended to ensure a proper diagnosis
Back Pain Symptoms
Pain can be isolated to the back or can cause additional symptoms if nerves are compressed. Symptoms commonly experienced include:
- Back pain
- Leg pain
- Leg numbness
- Leg weakness
The following symptoms require immediate attention by a medical professional as they are signs of potential emergency such as spinal cord compression or Cauda Equina Syndrome (CES). Cauda equina syndrome is a result of compression of nerve roots that split off from the bottom of the spinal cord. Spinal cord compression and CES may result in permanent neurological damage including paralysis.
- Numbness in your private area (saddle anesthesia)
- Bowel or bladder incontinence
- Weakness or numbness affecting both of your legs
A proper diagnosis should be made by a medical professional. Often the diagnosis can be made clinically, meaning based on detailed interview and a careful physical examination. However, sometimes more studies are needed based on the assessment or if symptoms do not improve after initial visits.
Imaging studies such as x-ray, CT scan, and MRI, are commonly used to make diagnosis. Each visualizes different body parts and has it’s own strengths and weaknesses.
- X-ray – uses the passage of electromagnetic waves to create shadow like images of bones and some organs. X-rays are quick and accessible but do a poor job evaluating soft tissues such as muscles and nerves. X-rays also result in a small amount of radiation.
- CT scan – also known as Computed Tomography, uses a series of x-rays along with computer processing to create detailed cross-sectional images. CT scans produce higher quality images that can also see organs and blood vessels. However, they are associated with more radiation exposure.
- MRI -which stands for Magnetic Resonance Imaging, uses a magnetic field and radio waves to create images of the body. MRI does a great job of visualizing tendons, ligaments, nerves, and intervertebral discs. Another benefit is that there is no radiation exposure. Unfortunately, MRI’s often are associated with longer wait times and higher cost.
Back Pain Treatments
Treatment for back pain should take into consideration the underlying cause. Typically a stepwise approach to treatments is taken, starting with the least invasive treatments (medications and physical therapy) to the most invasive (surgery).
- Medications – Medications can either be taken orally (by mouth) or applied topically (on the skin). Non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, are common first line treatments. More severe pain may be treated with opioids or muscle relaxants with extreme caution. Topical medications, which can be applied on the skin, include capsaicin cream or lidocaine patches.
- Physical Medicine & Rehabilitation – Some common treatments in this category include heat application, McKenzie exercises, physical therapy, and spinal manipulation therapy (SMT).
- Invasive but non-surgical – These treatments include steroid injections and nerve ablation therapy.
- Surgical – Often considered a treatment of “last resort”, surgeries can either decompress pressure on the cord or nerves (such as a discectomy or laminectomy) or stabilize the spine (fusion).
A more comprehensive discussion of the various treatment options can be found in the “treatments” section.