Rather than being a medical condition, back pain is a symptom that can be caused by various underlying diseases. The quality, intensity, and pattern of the back pain will vary from one person to another. Based on the underlying problem, certain complications may also arise. For this reason, a doctor will ask details about the type of pain, so he can understand the root cause and provide the treatment accordingly.
This article is all about back pain, how symptoms vary depending on the type of back pain, and possible complications.
Back pain is complicated
We move a lot during the day. Standing up, sitting on the chair, walking, twisting, sudden movements, poor posture all place pressure on the back. Many anatomic structures can be involved-the muscles that support the spine, the spinal cord and nerves, the vertebrae, intervertebral discs, and many ligaments and tendons.
Sometimes there are one acute episode of back pain, other times flare-ups alternating with pain-free periods. Some may experience long-term, chronic back pain.
The intensity and quality of the pain may vary. For example, a herniated disc causes severe pain. Muscle sprains and strains can cause mild aches and pains and in some cases more intense pain.
Mechanical pain versus inflammatory pain
Mechanical pain has pure physical causes involving bone, ligaments, discs, nerves, and joints of the spine. Sprains and strains, spinal stenosis, herniated discs, vertebral fractures, and sprains and strains of the muscles are common causes of mechanical pain.
The pain is usually experienced when flexing the trunk and with exercise, when bending laterally, or when the doctor palpates the affected vertebrae. Mechanical pain usually has an acute onset, improves with rest, and progressively improves as the healing takes place. It is felt in the lower back or other places along the spine, depending on the location of the injury. Mechanical pain is more common in older adults over the age of 40. Short-term rest, heat and ice pads, nonsteroid anti-inflammatory drugs, and physical therapy -especially the McKenzie method- help manage most cases of this type of pain. The prognosis is excellent, as most people fully recover.
Inflammatory back pain is caused by an immune response that leads to inflammation, for example in individuals with autoimmune diseases (ie psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis). It is less common than mechanical pain. Generally speaking, this type of back pain starts slowly and can last months or even years. Pain is felt when waking up or getting up, after repetitive bending, usually in the lower back and buttocks. The pain may be felt on and off during the day and is associated with stiffness. The pain improves with exercise and movement. Inflammatory back pain is seen more often in younger adults (35- 40 years of age or younger). Non-steroid anti-inflammatory drugs like ibuprofen are more effective for inflammatory back pain than mechanical pain. Physical therapy and exercise can help as well.
For mechanical back pain, identifying the underlying cause helps predict possible complications. Many cases of back pain due to muscle strains and sprains in the lower back resolve without causing any complications.
A herniated disc can lead to back and leg pain, weakness, and numbness thus affecting day-to-day activities. Losing bowel and bladder control can also complicate a herniated disc. Complications of spinal stenosis include nerve compression, loss of strength in the legs, worsening of pain, balance problems, risk of falls, incontinence, numbness, and in rare cases even paralysis.
Cauda equina syndrome is a rare condition that requires urgent surgery to relieve pressure on nerves and prevent permanent damage like paralysis, incontinence, or loss of sexual function. It can be caused by a severely ruptured disc in the lower back, spinal stenosis, a tumor, inflammation, bleeding, or severe spinal injury (i.e. from a car crash or fall).
The immune response associated with inflammatory back pain also affects the bones. Thus possible complications include bone remodeling, osteoporosis, and risk for vertebral fractures. Other organs such as the heart and kidney can also be affected. Long-term use of nonsteroid antiinflammatory drugs for pain relief has been linked with increased risk of peptic ulcer, aggravation of lung disease, heart and kidney complications.
Pain- whether it is back pain or from another source interferes with day-to-day life, increases the risk of stress, depression, sleeping problems, and weight gain.
If you experience mild back pain, you can try home remedies and over-the-counter anti-inflammatory drugs. However, you need to see a doctor if the pain persists for more than a couple of weeks if it is getting worse or more symptoms to develop. In addition to physical examination, X-rays, MRIs, and other tests can help identify the underlying cause. It may take a lot of time to diagnose the underlying cause of inflammatory back pain, as autoimmune diseases require extensive testing and investigations.