Back pain refers to discomfort or debilitating suffering caused by an injury or affliction of the back, the area from the shoulders to the hips. It is a common complaint and a leading cause of disability worldwide. Back pain is classified by location (neck, upper, or lower back, with the lower back being most common) and duration: acute (lasting days to weeks), subacute (lasting weeks to months), or chronic (lasting over three months). A common cause of low back pain is a herniated disk , in which the soft center of a spinal disk is displaced, possibly compressing a nerve. Another cause is spinal stenosis, a narrowing of the spinal canal that causes nerve compression. Other potential sources include spinal deformities, fractures, infections, and tumors.

What are some common causes of back pain?

Back pain can arise from various sources, with a herniated disk being a common cause. This occurs when the soft center of a spinal disk is displaced, potentially compressing a nerve root. Spinal stenosis , especially in older individuals, involves the narrowing of the spinal canal, leading to nerve compression. Other causes include spinal deformities, fractures, infections, and tumors. Spondyloarthropathies like ankylosing spondylitis and psoriatic arthritis can also lead to back pain. Symptoms like fever, weight loss, or bowel irregularities alongside back pain require immediate medical attention.

How can injury or disease affect the spine and lead to back pain?

Various injuries or diseases can affect the spine, leading to back pain. A common cause is a herniated disk , where the soft center of a spinal disk is displaced, potentially compressing a nerve root. This compression can cause radiating pain and neurological symptoms. Spinal stenosis , often seen in older adults, involves the narrowing of the spinal canal, which compresses nerves and obstructs their blood supply, leading to pain and weakness. Other sources of back pain include spinal deformities, fractures, infections like brucellosis spondylitis , and tumors. Degenerative conditions, such as spondylosis, and trauma can also cause back pain by narrowing the spinal canal or compressing nerve roots. Additionally, disorders like spondylolisthesis, infections, and bone diseases can damage the spinal roots and cord, resulting in pain.

What is the difference between acute and chronic back pain?

Back pain is classified based on its duration. Acute back pain is severe but lasts only days or weeks. Chronic back pain is frequent and lasts for more than three months. Subacute back pain falls between these categories. Most back pain is benign and responds to treatments like stopping activities that worsen the pain. However, specific symptoms may suggest a more serious issue, requiring prompt evaluation and treatment.

How do doctors diagnose the cause of back pain?

To diagnose the cause of back pain, doctors rely on a combination of methods, starting with a thorough medical history and physical examination. The patient's age, pain characteristics (location, duration, nature), and preceding events are key factors. Physical exams include neurological function assessment in the lower extremities. Imaging studies like X-rays may be used. Identifying "red flag" symptoms such as fever, weight loss, or bowel irregularities is crucial for detecting aggressive pathologies requiring urgent intervention. Pinched nerves from a herniated disk are a common cause, as is spinal stenosis, especially in older adults.

What are some possible treatments for different types of back pain?

Back pain is classified by location (neck, upper, or lower back) and duration (acute, subacute, or chronic). Most back pain is benign and responds to treatments like modified activity. However, specific symptoms may indicate the need for urgent intervention. Possible treatments include: * Medications Opiates are prescribed for severe pain, while nonnarcotic anti-inflammatory analgesics are used for mild pain. Psychotropic medications can help patients with psychological conditions. * Physical Therapies Physical therapy, exercise, acupuncture, compresses, and heat treatment. * Invasive Procedures Injections or surgery may be needed if other treatments don't provide relief. * Alternative Therapies Cognitive behavioral therapy may benefit some patients.

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Also known as: dorsopathy

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Classification and diagnosis of back pain

To facilitate diagnosis, back pain can be considered by anatomical location, with pain occurring in the neck, the upper back, or the lower back. The most-common site is the lower back, which encompasses the lumbar region. Back pain may be further characterized as acute, with pain being relatively severe but lasting only a few days or weeks; chronic, with frequent pain over more than three months; or subacute, with mild or bothersome pain of a duration somewhere between acute and chronic. Most back pain is benign in nature and responds to conservative treatment, such as temporary cessation of activities that aggravate the pain. However, in the presence of certain symptoms, an aggressive pathology may be suspected, necessitating urgent evaluation and intervention.

A thorough history and careful physical exam are essential for determining the etiology of the back pain. A significant challenge is identifying when further urgent evaluation and treatment are needed. The patient’s age and the duration, location, and nature of the pain (e.g., radiating or localized) are important factors in the diagnosis of back pain. Events preceding the onset of pain, occupation, related symptoms, and even psychological disturbances may also be considered. Physical exams for back pain typically include a thorough systematic assessment of the neurological function of the lower extremities. In some cases, imaging studies, such as conventional radiography (X-rays) or more-advanced radiographic studies, may be employed.

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Causes and treatment of back pain

A common source of low back pain is a herniated disk, in which the soft centre, or nucleus, of one of the cartilaginous disks in the spinal column has become displaced. A herniated disk may be caused by an acute traumatic event, a repetitive-use injury, a postural problem, or a degenerative process. The displacement of a disk can result in the compression of a nerve root (pinched nerve).

Symptoms associated with a herniated disk typically include radiating back pain and paresthesias (burning or prickling sensations) that follow the course of anatomical areas supplied by the compressed nerve. Physical activities or maneuvers that increase the pressure on the disk, such as coughing, sneezing, or sitting forward, can worsen the pain. First-line treatments include anti-inflammatory drugs, activity modifications, and physical therapy. An individual who does not respond to those treatments may be a candidate for epidural steroid injection or disk surgery.

Another cause of back pain is spinal stenosis, which is especially common among older persons. Spinal stenosis is the narrowing of the spinal canal (the opening in the vertebrae that accommodates the spinal cord). The narrowing may be congenital (present at birth) or may be acquired, such as from degenerative arthritis. The narrowing causes nerve compression and ischemia (obstruction of the nerve’s blood supply). Individuals with spinal stenosis experience onset of pain, paresthesias, and weakness with walking or standing. Unlike disk herniation, the symptoms in spinal stenosis usually improve with bending or sitting forward, which increases the diameter of the spinal canal and area of the neural foramina (the openings through which nerves pass from the spinal cord). Initial treatment is with physical therapy and anti-inflammatory drugs. Surgery to widen the canal and decompress the nerve may be indicated for patients who do not obtain relief from noninvasive measures.

Other potential sources of back pain include spinal deformities, fractures, infections, and tumours. Such causes may be associated with symptoms of fever, night sweats, significant weight loss, and bowel or bladder irregularities; those “red flag” symptoms warrant special awareness and immediate medical attention.

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