Back Pain

Back pain is the pain on the upper or lower back part of the body that is caused by a series of mechanical and inflammatory factors. The pain in the upper back (neck and shoulders) and the lower back (hips and legs) is one of the most common causes of absenteeism in the United States, and it is estimated that approximately $90 billion is spent every year to treat back pain cases.

Lower back pain is seen more frequently than upper back pain mainly due to the differences between the thoracic spine (upper back) and the lumbar spine (lower back). The lumbar spine is designed to provide the body with mobility; hence the parts that make up the lumbar spine are much more flexible than the thoracic spine that is designed to be stable and strong in order to protect the vital organs and are less prone to stress or injuries.

The symptoms range from an acute attack that generally heals by itself (and with the help of some mild exercise regime) to a chronic pain condition that can severely hamper daily functions and activities. In addition to these timeframe-based definitions (acute and chronic), back pain can be classified under three groups: localized, radicular and referred.

Localized back pain is the condition in which the pain symptoms occur in the same area where the source of the problem lies; radicular pain is pain that spreads to extremities (to arms and hands in upper back pain, and to legs and feet in lower back pain); and referred back pain is the pain in the back that is caused by a problem in an internal organ (like a kidney).

Back Pain: Causes

The majority (almost 98%) of the back pain cases are caused by either mechanical or structural problems that are generally self-limited and not threatening to the individual’s general health. However, in approximately 2% of the cases, the source of the problem can be a much more serious condition like a tumor.

Mechanical factors that cause back pain are muscle strain, tension and irritation, overuse of muscles, physical trauma, poor posture and any injury or stress in ligaments or muscles; the structural factors are herniated disc, sciatica (or pinched nerve), arthritis or spine curvatures (scoliosis). These factors do not normally cause any other problems than back pain and can generally be treated with conservative treatments. However, in severe cases, more aggressive or invasive treatments may be indicated.

Back Pain: Life Threatening Conditions

In approximately 2% of the cases, the real cause can be a serious (and dangerous) condition. If the pain is accompanied by symptoms like fever, sudden weight loss, incontinence (bowel or bladder) and progressive weakness in the legs, it can be a sign for a more serious and potentially life-threatening problem, and should be immediately diagnosed and treated by a doctor. In addition, individuals with cancer history should immediately contact their doctors if the back pain continues for a prolonged time as it can be a sign of metastasis.

It should also be noted that osteoporosis or multiple myeloma patients, or individuals who have taken corticosteroids for extended periods of time are prone to back pain caused by spinal fractures.

Back Pain: Treatment

The treatment methods for back pain depend on the underlying cause. Most of the time, as the real cause is not understood and hence thought to be mechanical, doctors prefer conservative treatments that aim to relieve the pain and strengthen the abdominal and back muscles to prevent future occurrences. More invasive treatments are indicated if the condition persists or worsens after these conservative treatments. Most of the time, exercise and NSAIDs are enough to remove the pain; surgery is generally the last resort in some cases like herniated discs.

You can find detailed information about the causes, treatment and pain relief for back pain (both upper back and lower back) in the articles published in this section of the website.