Back Pain is one of the commonest reasons for absence from work. And it is also the commonest reason to seek medical treatment. It can be uncomfortable, debilitating or disabling.

Back pain can result from injury, extraneous activity or some medical conditions. Back pain affects people of any age, for a variety of reasons. With increasing age, the chance of developing back pain increases, especially in the lower back. This can be due to various factors such as previous work and degenerative changes in Spine or  any disease.

Lower back pain is commonly linked to the bones in the lumbar spine or the discs between the vertebrae but can also be due to ligaments around the spine and discs, spinal cord and nerves, the lower back muscles, internal organs in the abdomen and pelvis, or the skin around the lumbar area.

Pain in the upper back is usually more sinister and may be due to the disorders of the large blood vessels aorta or vena cava, tumors in the chest, lungs and or the spine.

Causes back pain

Problems with the spine such as osteoporosis commonly seen in the elderly can lead to back pain.

The human or mammalian back is made of a complex structure of muscles, ligaments, tendons, intervertebral discs, and bones, which form a framework together to support the body and enable us to dynamize our movements.

The individual bones of the spine are cushioned alternatively with soft cartilage-like shock-absorbing pads called disks.

Problems with any of these constituents can cause back pain. Still in some cases, the cause of back pain remains unclear.

Damage  to spine or supporting structures can result from excessive strain, medical conditions, poor posture and other unknown causes.

Strain

Back pain commonly results from excessive strain, tension, or injury. Common causes of back pain are:

• overstrained muscles or ligaments
• a paraspinal muscle spasm
• muscle tension
• damaged or degenerated disks
• Injuries or fractures

Activities causing strains or spasms include:

• lifting things improperly
• lifting too heavy things
• abrupt and awkward movements of the back

Structural problems

A number of structural problems in or around the spine can result in back pain.

• Ruptured disks: Vertebrae in the spine is cushioned by disks on both top and bottom. If one of these disks ruptures, it bulges out and puts pressure on a nerve, resulting in back pain that can radiate to the limbs.
• Bulging disks: Similar to ruptured disks, a bulging disk can cause more of a back pain but is less likely to have radiating pain in the limbs.
• Sciatica: common term for sharp and shooting pain from the buttock and down the back of the leg, caused by pressure on the nerves in the spinal canal.
• Arthritis: Osteoarthritis or degeneration of any of the three joints between two vertebrae can cause pain in the hips, lower back, and other places.
• Lumbar canal stenosis: The space around the spinal cord narrows due to thickening of the ligaments. This is known as spinal stenosis.
• Abnormal curvature of the spine: Any change in the normal curves of the spine changes the mechanics and weight transmission, back pain can result. Scoliosis is one such condition, in which the spine curves and rotates to the side.
• Osteoporosis: With aging bones, including the vertebrae of the spine, become porous, less denser and brittle, causing compression fractures even with minor injury or even body weight.
• Kidney problems: Stones, infection or other disorders of kidney can cause back pain.

Movement and posture

Most of us use a desk for our work, especially while using a computer. Invariably we tend to get into a slouched or hunched posture for a long time. This is usually a cause for upper back and shoulder pain among the urban population or white collar workers.

Back pain also results from few day to day activities or poor posture.

Examples include:

• Overzealous twisting
• coughing or sneezing
• muscle tension or strain
• over-stretching
• bending awkwardly or suddenly
• pushing, pulling, lifting, or carrying out heavy manual activity
• standing or sitting for long periods in same posture
• straining the neck forward
• long driving without a break
• sleeping on an uncomfortable bed or position

Other causes

Some medical conditions can lead to back pain.

• Cauda equina syndrome: The cauda equina is the bundle of spinal nerve roots coming out of the lower end of the spinal cord. Symptoms can vary from a dull pain in the lower back and upper buttocks to numbness in the buttocks, genitalia, and thighs along with loss of bowel(defecation) and bladder(micturition) control.
• Cancer of the spine: A tumor in the spine arising from any structure can give rise to pressure symptoms and destruction of nearby tissues. All this can manifest as back pain.
• Infections of the spine: Tuberculosis of the spine is a common condition seen in the 3rd world population. Apart from back pain fever is another common symptom.
• Other infections: Inflammatory disease in the pelvis, infections of the bladder, or kidney may also lead to back pain.
• Sleep disorders: In studies, it has been noticed that individuals with sleep disorders are more likely to experience back pain.
• Shingles: Infection of the nervous system may lead to back pain.

Risk factors for back pain

Studies over the years have found the following associated factors for developing low back pain:

• occupational activities
• pregnancy
• a sedentary lifestyle
• poor physical fitness
• older age
• obesity and excess weight
• smoking
• strenuous physical exercise or work, especially if done incorrectly or without proper stretching or warmup
• genetic factors
• medical conditions, like arthritis and cancer

Lower back pain is also seen more commonly in women than in men, probably due to hormonal factors. Stress, anxiety, and mood disorders along with other psychological conditions have also been linked to back pain.

Symptoms of the back pain

Back pain is the commonest symptom in spinal problems which at times may shoot down all the way to the buttocks and legs.

Some back problems can cause pain in other parts of the body, depending on which nerves are affected.

The pain is usually temporary and often goes away with rest, but if it recurs or is associated with any of the following, you must visit a doctor:

• weight loss
• fever
• inflammation or swelling on the back
• persistent back pain, where lying down or resting does not help
• pain down along the legs
• pain that radiating below the knees
• Pain due to recent injury, blow or trauma to the back
• urinary incontinence or other disturbance
• fecal incontinence, or loss of control over defecation
• numbness around the genitals
• numbness around the anus
• numbness around the buttocks

When to see a doctor

You should seek medical care if you experience numbness or tingling, or if the back pain:

• that is not relieved with rest
• Caused due to an injury or fall
• with numbness in the legs
• With numbness in saddle area
• with weakness in legs
• with fever
• with significant weight loss

Diagnosis

Your doctor will be able to diagnose your back pain with few questions about symptoms and a physical examination.

Few imaging scan and other tests may be done to confirm if:

• back pain is a result from an injury
• there is some underlying cause for the pain
• the pain persists for a long period

An X-ray, MRI, or CT scan can help confirm the diagnosis by giving visual information about the state of the tissues in the back.

• X-rays help see the alignment of the bones and find signs of arthritis or bones, but they can’t reveal damage in the soft tissues like muscles, spinal cord, nerves, or intervertebral disks.
• MRI or CT scans give spatial visualisation of herniated disks or problems with other tissues such as tendons, nerves, ligaments, blood vessels, muscles, and bones as well.
• Bone scans pick up even very early changes in bone and can detect bone tumors or subtle compression fractures due to osteoporosis. A radioactive substance or also called a tracer is injected into a vein. The tracer gets concentrated in the high activity areas in bones, which is then visualised with the aid of a special camera.
• Electromyography or EMG measures the conduction of electrical impulses. This can help confirm nerve compression, due to a herniated disk or spinal stenosis or any other cause.

Your doctor may also advise a blood test if the infection is suspected.

Chronic or acute back pain?

Back pain is for management purpose categorized into two types:

• Acute back pain is a sudden abrupt start of the pain and may last for up to 6 weeks.
• Chronic or long-term pain develops gradually over a longer period, lasts for months, with or without waxing and waning phases and causes ongoing problems.

Some people have both occasional bouts of intense pain with intervening periods of fairly continuous mild back pain. This Makes it difficult for a doctor to ascertain or categorize the pain as acute or chronic back pain.

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