Back Pain

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Introduction

What is back pain?

Back pain is any type of pain or discomfort throughout the posterior (back) portion of your trunk, from the pelvis up through the neck. Back pain is a very common problem in the United States, second only to headache, according to the National Institute of Neurological Disorders and Stroke.

Your back pain may last briefly or it may be chronic, which is defined as lasting more than three months. Back pain may be described as a dull, annoying ache or a sharp, acute pain. Acute back pain often resolves with basic self-care measures within a few weeks, but it can persist and lead to more serious problems over time.

The back consists of the spine (spinal column), spinal cord, nerves, discs, muscles, ligaments, and tendons. Any of the structures in the back can become irritated or inflamed in response to a variety of mild to serious conditions. Reasons for back pain include sports injuries, poor posture, arthritis, muscle strain, and trauma suffered from a car accident. The origin and cause of chronic back pain is harder to diagnose and treat.

Back pain may be localized to a specific area, such as lower back pain, or it may cover a more generalized section of the back. In addition, localized pain anywhere in the back can radiate, or spread, to other areas of your body. The converse is also true; pain somewhere else in your body can radiate to your back.

Back pain accompanied by other symptoms, such as loss of bladder or bowel control and numbness in your extremities (arms or legs), is a serious condition and should be evaluated as soon as possible or in an emergency medical setting. In addition, if your pain is extreme, persistent, or causes you concern, contact a medical professional.

Symptoms

What other symptoms might occur with back pain?

Back pain may occur with other symptoms depending on the underlying disease, disorder or condition. For instance, if your back pain is due to arthritis, you may experience pain in other parts of your body. Back pain due to a pinched nerve can even lead to loss of bladder control. Back pain is often a major symptom of fibromyalgia, which is also characterized by fatigue and sleep problems. The range of symptoms that may accompany back pain include:

  • Anxiety
  • Blood in the urine (hematuria)
  • Depression
  • Fatigue
  • Fever
  • Headache
  • Morning back stiffness
  • Pain through the buttocks and down one leg to below the knee
  • Paresthesias (stinging, burning, tingling, crawling sensations)
  • Redness, warmth, or swelling of the back
  • Shoulder, neck, or hip pain
  • Sleep disturbance

Serious symptoms that might indicate a life-threatening condition

In some cases, back pain may occur with other symptoms that might indicate a serious or life-threatening condition, such as a heart attack or cauda equina syndrome (when the nerves in the spinal cord are compressed or paralyzed, cutting off sensation and movement).

Back pain that occurs with any of the following symptoms should be immediately evaluated in an emergency setting:

Causes

What causes back pain?

Understanding the parts that make up your back and how it works can help you understand why you have back pain. Your back is made up of  bony structures called vertebrae that surround and protect the spinal cord. Within the spinal cord run nerve roots from the brain that send and receive messages to and from the rest of the body. Between the vertebrae are spongy sacs of cartilage, called discs, that act as a cushion and provide range of motion to the back. Muscles, ligaments and tendons provide additional support.

Any of these structures in the back can become irritated or inflamed in response to a variety of mild to serious conditions. A common cause of mild to severe back pain is a sudden or awkward movement during activities, such as gardening and sports, particularly in people who normally lead a relatively sedentary lifestyle. A problem in another part of the body, such as the heart or the reproductive organs, can also radiate to the back. This is called referred back pain.

Structural causes of back pain

Back pain can be due to injury, inflammation, or infection of the bones and tissues including:

  • Herniated disc
  • Muscle spasm
  • Osteoarthritis
  • Osteomyelitis (infection or inflammation of the spinal bones)
  • Osteoporosis (metabolic bone disease)
  • Paget’s disease of the bone
  • Sciatic nerve damage and sciatica due to spinal stenosis or degenerative disc disease
  • Spinal degeneration (degenerative disc disease, also called spondylosis)
  • Spinal stenosis (a narrowing of the spinal canal that presses on the spinal cord or nerves)
  • Spine fracture
  • Spondylitis (infection or inflammation of the spinal joints)
  • Sprains and strains due to overuse or injury

Other possible causes of back pain

Back pain can also be due to systemic problems or problems affecting other body systems including:

Life-threatening causes of back pain

In some cases, back pain may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Possible life-threatening conditions that involve back pain include:

What are the risk factors for back pain?

Although anyone can experience back pain, there are certain risk factors that make you more likely to encounter back pain at some point in your life. Back pain most often begins between 30 and 50 years of age. The activities associated with this age group, along with the increasing age of the spine and associated tissues, are the most influential factors in back pain. Risk factors include:

  • Congenital (present at birth) or acquired back deformities, such as scoliosis)
  • Family history of back pain or disease, such as degenerative disc disease)
  • Increasing age
  • Obesity
  • Poor posture
  • Sedentary lifestyle
  • Smoking
  • Stress and anxiety
  • Weak abdominal (core) muscles

What are the potential complications of back pain?

The complications associated with back pain depend on the underlying disease, disorder or condition. For example, back pain resulting from a degenerative condition such as spondylosis can lead to inactivity and its associated complications. Fortunately, most cases of back pain can be alleviated or minimized by physical therapy, basic self-care measures, and the treatment plan outlined by your doctor.

However, in some cases the degree and duration of your back pain may become overwhelming and affect your everyday living. Research into the diagnosis and treatment of back pain is ongoing, so contact your doctor for the latest information.

Over time, back pain can lead to complications, including:

  • Absenteeism from work or school
  • Chronic pain or discomfort
  • Permanent nerve damage (due to a pinched nerve), including paralysis
  • Permanent physical disability
  • Physiological and psychological response to chronic pain
  • Poor quality of life
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 11
  1. Low back pain fact sheet. Medline Plus, a service of the National Library of Medicine National Institutes of Health  http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
  2. Kahan S, Miller R, Smith EG (Eds.). In A Page Signs & Symptoms, 2d ed. Philadelphia: Lippincott, Williams & Williams, 2009.
  3. Domino FJ (Ed.) Five Minute Clinical Consult. Philadelphia: Lippincott Williams & Wilkins, 2013.
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