Back Pain

What Is It?

Back pain can be a symptom of many different illnesses and conditions. The main cause of the pain can be a problem with the back itself or by a problem in another part of the body. In many cases, doctors can't find a cause for the pain. When a cause is found, common explanations include:

  • Stress or injury involving the back muscles, including back sprain or strain; chronic overload of back muscles caused by obesity; and short term overload of back muscles caused by any unusual stress, such as lifting or pregnancy

  • Disease or injury involving the back bones (vertebrae), including fracture from an accident or as a result of the bone-thinning disease osteoporosis

  • Degenerative arthritis, a "wear and tear" process that may be related to age, injury and genetic predisposition.

  • Disease or injury involving the spinal nerves, including nerve injury caused by a protruding disk (a fibrous cushion between vertebrae) or spinal stenosis (a narrowing of the spinal canal)

  • Kidney stones or a kidney infection (pyelonephritis)

Rarer causes include:

  • Inflammatory arthritis, including ankylosing spondylitis and related conditions

  • A spinal tumor or a cancer that has spread (metastasized) to the spine from elsewhere in the body

  • Infection, which may be in the disk space, bone (osteomyelitis), abdomen, pelvis or bloodstream

Symptoms

Back pain varies widely. Some symptoms may suggest that the back pain has a more serious cause. These include fever, recent trauma, weight loss, a history of cancer and neurological symptoms, such as numbness, weakness or incontinence (involuntary loss of urine). Back pain usually is accompanied by other symptoms that may help point to its cause. For example:

  • Back sprain or strain – Back pain typically begins on the day after heavy exertion. Muscles in the back, buttocks and thighs are often sore and stiff. The back may have areas that are sore when touched or pressed.

  • Fibromyalgia – In addition to back pain, there are usually other areas of pain and stiffness in the trunk, neck, shoulders, knees and elbows. Pain may be either a general soreness or a gnawing ache, and stiffness is often worst in the morning. People usually complain of feeling abnormally tired, especially of waking up tired, and they have specific areas that are painful to touch, called tender points.

  • Degenerative arthritis of the spine – Together with back pain, there is stiffness and trouble bending over, which usually develops over many years.

  • Inflammatory arthritis, including ankylosing spondylitis and related conditions – In these disorders, there is pain in the lower back, together with morning stiffness in the back, hips or both. There also can be pain and stiffness in the neck or chest or an extremely tired feeling. Other features may include psoriasis, eye pain and redness, or diarrhea, depending on the specific disorder causing back pain. This group of diseases is a relatively rare cause of back pain.

  • Osteoporosis – This common condition is characterized by thinned, weakened bones that fracture easily. It is most common in postmenopausal women. When vertebrae become compressed because of fracture, posture may become stooped over or hunched along with back pain. Osteoporosis is not painful unless a bone fractures.

  • Cancer in the spinal bones or nearby structures – Back pain is consistent and may become worse when you are lying down. Numbness, weakness or tingling of the legs that continues to get worse. If cancer spreads to spinal nerves that control the bladder and bowel, there may be bowel or bladder incontinence (loss of control).

  • Protruding disk – People with significant disk disease sometimes have severe pain in the lower back. If a disk compresses a nerve, the pain may spread down one leg. The pain gets worse during bending or twisting.

  • Spinal stenosis – Pain, numbness and weakness affect the back and legs. Symptoms get worse when you are standing or walking, but are relieved by sitting or leaning forward.

  • Pyelonephritis – People with a kidney infection typically develop sudden, intense pain just beneath the ribs in the back that may travel around the side toward the lower abdomen or sometimes down to the groin. There also can be a high fever, shaking chills and nausea and vomiting. The urine may be cloudy, tinged with blood or unusually strong or foul-smelling. There may be additional bladder related symptoms, such as the need to urinate more often than normal or pain or discomfort during urination.

Diagnosis

Your doctor will ask about your symptoms and your medical history. He or she will examine your back muscles and spine and will move you certain ways to check for pain, muscle tenderness or weakness, stiffness, numbness or abnormal reflexes. For example, if you have a disk problem, you may have pain in your lower back when the doctor raises your straightened leg.

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