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Back Pain

Overview

Back pain is a very common condition that causes severe discomfort and disrupts your day-to-day work. Initially, it was considered that back pain only occurs in old age, but studies have shown that young adults can be affected by it as well. Mild to moderate back pain is manageable, but severe back pain can severely affect your physiological and mental health. Back pain can occur in any region of your back, including the neck, middle back, and lower back. Pain originating from the back can also radiate to other body parts.

Causes

There are multiple causes of back pain. It can occur due to mechanical, degenerative, inflammatory, infectious, or oncological reasons. In certain cases, the exact cause of back cannot be identified as it can be due to more than one factor. Mechanical injury of the spinal cord, muscle spasms, or rupture of the ligaments in the back can cause mild to moderate back pain. Irregular sitting posture is also another cause of back pain. Traumatic injury of the spinal cord or back muscles can cause long-lasting back pain even after the damage has been repaired. Pregnancy can also cause severe back pain, especially in older mothers.
Degenerative disk disease is a major cause of back pain which occurs a soft gel-like pad between the disks of your spinal cord ruptures. This leads to compression of the spinal nerves in the affected region. Most commonly, it occurs in the lower back region. Other degenerative diseases that cause pack pain include spondylosis, spondylolisthesis, spinal stenosis, etc. Sciatica is another common type of back pain that occurs due to a herniated or ruptured disc.
Infectious and inflammatory causes can also cause severe back pain, which can increase if accompanied by postural or structural abnormality. Osteomyelitis, arthritis, lupus, shingles, or infections of other organs such as kidneys, urinary bladder, etc., can cause back pain. A benign or malignant tumor of an abdominal organ that compresses spinal nerves can be another causative factor. In some cases, a tumor of nerves itself can lead to back pain.

Risk Factors And Epidemiology

Aging is one of the major risk factors associated with back pain. Degeneration of spinal discs and weakening bones can increase the risk of back pain as you age. Another major risk factor for back pain is irregular posture. Standing for long hours, sitting in a hunched position for a long duration, or sleeping in an irregular position can cause long-term back pain, even in young adults. Strenuous exercises or lifting heavy weights can also increase the risk of causing mechanical injury to your spine. On the contrary, a complete lack of physical activity, increasing weight, or adopting a sedentary lifestyle can also increase your tendency to develop back pain at an early age. Psychological factors such as stress, anxiety, depression have also been noticed as contributing factors. Other risk factors may include genetic, pathologic, or cancerous diseases.
Back pain can occur at any age, but the majority of the individuals affected by back pain are over 40 years of age. It is more prevalent among males than females. It has also been observed that back pain occurs more commonly in smokers than non-smokers, the exact cause of which hasn’t been identified yet.

Signs and Symptoms

Signs and symptoms of back pain depend on its cause. Often, back pain is itself a symptom of another underlying condition. Acute back pain may occur due to traumatic, mechanical, or infectious causes. You may feel a severe ache in your back's affected region that does not improve with changing posture. Chronic back pain can occur due to postural abnormality, degeneration of discs, tumors, or other causes. The pain, in this case, is comparatively less severe, but it persists as a dull ache for a long duration of time. Other symptoms such as fever, malaise, weakness or numbness in legs, urinary incontinence, weight loss, etc., can be present, which are significant for an underlying systemic disease.

Diagnosis

Initial diagnosis of back pain is made after obtaining a detailed history from the patient, followed by a clinical examination of the affected region. Your doctor may ask questions about the onset, duration, severity, location, and recurrence of back pain. If there are any other symptoms present, they are noticed as well. Clinical examination involves checking for any structural abnormalities, swelling, or tenderness. Laboratory tests such as CBC, ESR, and CRP levels are done when your doctor suspects an underlying infection, tumor, or inflammatory disease. Raised levels of white blood cells, ESR, and C-reactive protein (CRP) are present in case of an infection or inflammatory disease. MRI is the preferred method of radiographic imaging, which is done only in a limited number of cases such as spinal stenosis, tumor, etc.

Differential Diagnosis

Since back pain is a symptom of multiple diseases, it is important to identify its cause to differentiate it from other underlying conditions. Back pain can happen due to genetic, mechanical, traumatic, vascular, degenerative, immunological, infectious, inflammatory, or oncologic causes. History, symptoms, lab tests, and radiographic imaging shall be utilized in identifying the original cause.

Treatment

Mild to moderate back pain due to aging, postural abnormalities, or degenerative diseases can be managed without any medical therapy. Stretching exercises, yoga, and physiotherapy are suggested to help with back pain management. Posture should be aligned while sitting or sleeping, and supporting cushions may be used to correct posture. Heat or massage therapy may also help reduce back pain. Medications are prescribed for severe or chronic back pain. If any other treatment option does not work, then your doctor may suggest surgery as a last resort to correct any structural abnormality or disc-related issues

Medication

Use of analgesics such as aspirin, diclofenac sodium, etc., is suggested in case of moderate to severe back pain. Muscle relaxants such as cyclobenzaprine, metaxalone, etc., may be prescribed in limited cases. Corticosteroids such as dexamethasone are only prescribed if other analgesics do not resolve localized pain.

Prognosis

Back pain can be a life-long debilitating condition if it is not managed well at an early stage. Lifestyle modifications and the use of medications can improve the condition and prevent it from worsening that may cause severe complications.

Prevention

Prevention of back pain can be done by maintaining an aligned posture while standing, sitting, and sleeping, taking breaks between long sitting hours, stretching your back muscles, maintaining physical activity, weight, proper diet, and hydration levels.

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