Back Pain: Causes and Symptoms

Back pain is one of the most common complaints bringing a person to meet a physician. It is also responsible for missed work days. Almost everyone experiences some form of back pain at least once during their lives. Acute pain is experienced most commonly and lasts less than 6 weeks. Pain lasting more than 3 months is termed chronic back pain. Chronic lower back pain causes extensive disability and affects about 12% of the population.

Risk Factors for Low Back Pain

• Aging: Increasing age weakens the bone and also leaves us less agile with performing tasks.
• Obesity: Increased weight can place stress on the back and lead to pain\
• Absence of physical exercise: Poor muscle strength results from sedentary lifestyles increasing the risk for muscle strains
• Occupation: Work that involves lifting heavy objects can place strain on the back
• Smoking: Smoking can weaken the soft tissue around the spine and also prevent healing in case of strains and fractures thus worsening any back pain.

Causes of Low Back Pain

There are numerous causes for back pain. The majority are due to acute muscle strains and resolve within in a few weeks. The following are the major causes of back pain

• Muscle or Ligament Strain: sudden strains or excessive use of the muscle and surrounding soft tissue can cause pain.
• Compression fractures from Osteoporosis: With aging, the bones weaken from loss of mineral density and have an increased risk of fracture.
• Spinal deformities: Certain defects in the skeletal structure of the spine can lead to back pain. Scoliosis is the abnormal curving of the spine to the side which is likely to cause pain in severe cases.
• Damage or displacement of the vertebral discs: The vertebral discs are flattened structures that sit like cushions between the vertebrae. The content within is soft and can sometimes bulge out or rupture. This can cause pain due to local inflammation and compression of a nerve.
• Arthritis: Any form of inflammation of the joints can cause pain. Several types of arthritis can also cause deformity of the spine which can compress and damage the spinal cord.
• Cancers: Cancers of the breast, lung and prostate are among the most common cancers that spread to the spine and can present with back pain and even fractures. Certain bone cancers like myeloma may also present with pain in the back.
• Infections: In many parts of the world, tuberculosis of the spine is still quite prevalent. Other infections of the spine can also occur in patients with immune deficiencies and other risk factors.

Symptoms of Back Pain

The pain in the back may occur anywhere along the spine but is most common in the lower back. Along with the back pain, the patient may experience additional symptoms

• Sharp shooting pain along the legs
• Pain and stiffness during movements of the back like turning or bending
• Tenderness on touching the site of pain
• Inability to lie down on the back
• Poor sleep due to pain

Diagnosis of Back Pain

Back pain is an extremely common symptoms with a large list of possible underlying causes. In a patient with a clear history of muscle strain which occurred following any form of strenuous exercise, physical examination alone is adequate and additional tests are usually not be needed. But if the history is unclear, the following tests may be performed

• X rays of the spine focussed to the exact site of pain. X ray of the lumbar region is most commonly done to evaluate lower back pain. Fractures can be seen on an X ray. Several spine deformities can also be visualised.
• MRI and CT spine: Imaging of the back is performed to look at the vertebral discs and nerves. It can also detect tumors, infective collections and inflammation
• Blood tests: Infections in the blood stream and markers for inflammation may be detected.
• Bone scan: This is a special scan to look at the bone density, It can also detect fractures I the spine
• Nerve conduction studies: These are done to evaluate for nay nerve compression by vertebral discs as the cause of the pain.

Treatment of Back Pain

The treatment of the pain depends on the underlying cause of the pain.

Management of Acute Back Pain

These are generally due to muscle strains and the treatment is supportive.

• Pain killers such as Tylenol, ibuprofen may be tried
• Local application of hot and cold packs may soothe the pain
• Rest from strenuous activities
• Performance of usual level of movement to avoid stiffness of the back

Management of Chronic Back Pain

Various different options are available for the treatment of chronic back pain. These are:

• Medications
• Pain killers
• Muscle relaxants
• Anti-depressants
• Steroids
• Exercise on recommendation of doctor
• Local application of hot or cold compresses
• Traction or other forms of manipulation by a trained specialist
• Smoking cessation

Surgical Treatment of Back Pain

Certain conditions may require surgical correction for pain relief. Structural deformity, cancers and infection often benefit from a procedure. Very severe back pain which has not responded to therapy may resolve with surgery. This can be discussed with the treating physician to  decide on treatment options.

Prognosis of Back Pain

Acute back pain with an identified cause resolves on tis own and with supportive care. Chronic back pain is however more challenging to address. Several patients have recurrence of the pain and most continue to have a dull pain for an extended period of time.

References:

• Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012 Jun;64(6):2028–37.
• Nancy Garrick DD. Back Pain [Internet]. National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2017 [cited 2018 Jul 22]
• Low Back Pain – OrthoInfo – AAOS [Internet]. [cited 2018 Jul 22]