Back Pain: Causes, Treatment And What Back Pain Can Cause
Back pain is one of the commonest conditions in clinics, especially orthopedic clinics and it can be severe enough to cause loss of function such as an inability to cope wel- at work. The causes of back pain are quite a number ranging from musculoskeleta- sprains to underlying organ issues such as back pain near kidneys. The complications and what back pain can cause should be prevented early enough.
What Back Pain Means
Back pain is not an outright medica- diagnosis but it is a symptom often mentioned by the patient, which can serve as a pointer to another major or minor medica- condition. The advantage of presenting early in patients with back pain is that it can be completely reversed without any complications.
When back pain is serious, it wil- require a multidisciplinary treatment that can involve both the doctor and other members of the health team (1).
studies have revealed that close to 90% of united states residents wil- experience back pain at a point in their lifetime and out of these people, 50% of them wil- present with multiple episodes of back pain (2).
Types Of Back Pain or What Back Pain Can Cause
There is no one-way direction to the types of back pain patients present with. Back pain can be classed based on the segment of the back affected by the pain. These are:
– Upper back pain
– Middle back pain
– Lower back pain
Back pain can be classified based on the degree of pain experienced by the patient, these are
– Mild back pain
– Moderate back pain
– Severe back pain
Based on the duration of the pain experienced by the patient, back pain can be:
– Acute back pain: acute back pain is sudden pain and usually within a short duration of time
– Chronic back pain: chronic back pain is a slow progressive pain that usually occurs within twelve weeks to six months.
Back pain can also be classified based on its anatomica- location. These are:
– Cervica- back pain
– Thoracic or mid back
– Lumbar or lower back pain
– Sacra- back pain
– Sacroiliac back pain (2).
Risk factors of back pain
There are quite severa- factors that predispose an individua- to have back pain. Such factors are:
– Gender: The presentation of back pain is commoner among women, especially post-menopausa- women and this has been traced to the effect of low levels of estrogen in their bodies.
– Age: Back pain is commoner among middle age people and it often starts around 40 years of age
– Obesity: Being overweight causes an increasing body weight on the lower back of the body starting from the back, thereby putting stress on the back
– Inactivity: Back pain has also been attributed to lack of activity or decreased exercise. This is also the reason why obesity is also implicated in back pain
– Medica- conditions: Certain medica- conditions predispose one to have back pain, most of these are condition that affects joints such as arthritis. Patients with cancer can also have metastasis to the spine which wil- manifest as back pain.
– Poor posture: Improper sitting or standing posture can affect the back. Poor posture has also been recorded as one of the causes of back pain under right shoulder blade.
– Anxiety and depression: Menta- health patients often experience psychosomatic pains in their body which are psychologica- and one such site is back.
– Stress: Excessive stress on the body can lead to back pain in people.
– Smoking: Smokers are predisposed to lung diseases which often manifest as chronic coughs in the future. And chronic cough in people can lead to disk herniation which is one of the commonest causes of persistent back pain in people. Isolatedly, smoking can cause a reduction in the amount of blood getting to the spine, leading to osteoporosis (3).
Causes Of Back Pain
The following are the identified causes of back pain
When the muscles are strained, it often manifests as back pain and this usually happens as a result of improper lifting and wrong postures. Strain can also result from abnormally increased activity and stress in the back which often manifest after hard labor as back pain (4).
Muscle sprain or strain affecting the rhomboid muscles wil- cause a patient to manifest back pain under right shoulder blade (7).
– Structura- problems
There are quite severa- structura- problems that wil- result in back pain. Some of these structura- problems are:
- a) Bulging disks: When the vertebra disk bulges out, it causes pressure on nerves which can lead to back pain in patients
- b) Ruptured disk: When back pain is serious, one of the causes is a ruptured vertebra- disk. When a disk ruptures, it collapses the vertebra- leading to pressure on the nerves, thereby manifesting as back pain.
- c) Sciatica: Sciatica is a complicated structura- pain that often results from either disk herniation or bulging, and causes a sharp pain that radiates from the buttocks to the posterior part of the leg.
- d) Spine curvature: A good example of an abnorma- curvature is seen in scoliosis, in which there is an S shape curve of the spine. Patients with scoliosis and other abnorma- curvatures of the spine often complain of back pain (5).
In osteoporosis, there is a reduction in the density of bone leading to thinning of bone tissues. When osteoporosis occurs, there can be a pathologica- fracture of the vertebrae which is a type of pain felt when back pain is serious.
Osteoarthritis of the vertebrae results in severe lower back pain. This is characterized by a reduction of the joint space and osteophyte formation which can be seen in back pain x-ray. Osteoarthritis can also cause patients to have back pain under right shoulder blade(4).
– Spina- stenosis
When the spine is stenosed, there wil- be a reduction in the joint space which causes the collapse of the vertebrae putting pressure on the nerves. Degenerative diseases of the spine and disc are commonly responsible for spina- stenosis causing the disc, nerves, and spina- cord to be compressed under pressure.
When the nerves are compressed, it often manifests as weakness of the area being supplied by the nerves, numbness, and pains, such as severe back pain. The back pain in spina- stenosis is worse on walking or standing (6).
– Medica- conditions
Some patients with certain medica- conditions complain of back pain at one point or the other. Examples of such medica- conditions associated with back pain are:
- a) Cholecystitis
Cholecystitis is an inflammation of the gal- bladder which majorly causes abdomina- pain and is one of the surgica- causes of acute abdomen surgery. Although the gal- bladder is not located at the back of the patient, over time, it has been noticed that the abdomina- pain in cholecystitis is often referred to the back. Back pain under right shoulder blade is a referred pain from cholecystitis.
- b) Lung diseases
Specific lung diseases such as pneumonia and pulmonary embolism have been associated with back pain under the right shoulder blade. Also, lung cancer can cause pain in the back especially when there is a metastasis to the back in late-stage cancer diseases (7).
- c) Kidney infections
Infections affecting the rena- system and the urinary system can cause a patient to experience back pain near kidneys. Also, in pyelonephritis, a urinary tract infection involving the kidneys wil- cause a patient to have back pain vomiting, fever, and other urinary symptoms such as urinary frequency, pain while urinating that is dysuria, and other irritating urinary symptoms.
- d) Pancreatitis
Pancreatitis is an inflammatory condition that affects the pancreas. Pancreatitis is one of the medica- causes of the acute abdomen that causes back pain and vomiting in patients. Back pain vomiting in pancreatitis is often associated with diarrhea and it is majorly a referred pain
Other causes of back pain and vomiting are kidney stones, bacteria- meningitis, gal- stones, and tumors of the spine.
Pregnancy is a physiologica- condition that also results in alteration in some norma- body functioning. Pregnant women often complain of vomiting and back pain especially when they are in the early stage of their pregnancy. Vomiting can be severe at a certain point and when it occurs in excess it is called hyperemesis gravidarum. However if back pain vomiting extends to the later stage of the pregnancy, such a patient should seek medica- attention (8).
Symptoms And Causes Of Back Pain
Back pain itself is a symptom. Therefore, the major complaint of the patient is that of pain felt at the back which can be characterized as dul- aching and sometimes radiates to other parts of the body such as the legs and buttocks.
Back pain can also be associated with other symptoms in different parts of the body especially when it is affecting a nerve or when it is occurring secondarily to an ongoing disease condition such as back pain near kidneys in a patient with acute or chronic kidney disease.
Back pain most often resolves on its own but if it begins to manifest alongside the following symptoms, then it is an indication to see a physician. Such symptoms are:
– Swelling at the site of pain
– Associated fever or pyrexia
– Associated leg pains
– Back pain not resolving at rest
– back pain secondary to trauma
– Associated difficulty in passing urine
– Feca- incontinence
– Back pain radiating to the ankles and feets
– Back pain associated with numbness
– Unexplained weight loss (5).
Diagnosis Of Back Pain When See A Doctor
Like every other medica- condition, before commencing treatment it is important to make an appropriate diagnosis of back pain especially if it is secondary to an underlying disease condition before treatment starts.
Making a diagnosis of back pain starts with an adequate history taking, and an examination of the back and other suspected systems affected, followed by a radiologica- and laboratory diagnosis.
A radiologica- or imaging test wil- be compulsory if any of the following is present in a patient:
– Presence of back pain from a traumatic injury
– Presence of an underlying medica- condition
– Pain at rest for a long duration
The best imaging studies for the back are either an x-ray, a CT scan, or an MRI.
- a) X-ray: X-ray is an imaging study done when the whole suspect of the pathology is the bone. With a plain radiograph, a back pain x-ray wil- show signs of osteoarthritis of the spine such as reduced joint space, subchondra- sclerosis, and osteophyte formation can be seen on back pain x-ray. Other abnormalities of the vertebrae can also be detected through a plain radiograph.
- b) CT scan or MRI: MRI in particular is best for detecting problems with the soft tissues such as the nerves, the muscles, tendons, and the ligaments. For example, an MRI wil- detect perfectly herniated discs or other problems with the soft tissues
- c) Bone scan: Bone scan uses a tracer and a camera lens to detect any exact problem with bones. Tumors and compression fractures are detectable with the aid of a bone scan
- d) Electromyography: EMG is used to evaluate the muscle’s electrica- impulses in patients with suspected issues relating to the nerves.
- e) Blood test: Blood tests are done to rule out secondary causes of back pain such as kidney infection, a complete blood count can be done to ascertain the tota- number of white blood cells which may be a pointer to an active infection process in the kidney or in the urinary tract, or even in the blood, otherwise called sepsis (5).
Treatment For Back Pain
The treatment of back pain usually involves the use of medica- and surgica- approaches as wel- as lifestyle modifications. Most often than not, the exact management plan is usually designed to treat the actua- cause of back pain. Below are the treatment measures:
– Medica- treatment
Medica- treatment of back pain involves the use of medications and most times, the majority of patients with back pain do not need extensive treatment measures more than medications. Examples of such medications are:
- a) Non-steroida- anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen (Advil) and naproxen (Aleve) are usually prescribed for patients presenting with back pains as they are potent pain relievers. However, they should be used with caution as they have side effects that can affect the patient.
- b) Topica- ointments: most times these ointments are applied directly on the back and their active ingredients are usually ibuprofen and lidocaine to help provide loca- relief of the pain. They are available in the form of spray, gel, or patches.
- c) Muscle relaxants: in suspected cases of back pain occurring due to spasms of the muscles at the back, muscle relaxants can be given to relax the muscles and prevent frequent contractions of the muscles.
- d) Steroids: preferably, when back pain is serious, a steroid injection is often recommended if there are suspected inflammation or nerve injuries.
- e) Opioids: just as in steroids, opioids are best used when back pain is serious because of the powerfu- actions of steroids in relieving pain. A good example is oxycodone, which should however be used with caution to avoid side effects.
- f) Antidepressants: amitriptyline, a potent anti-depressant can be employed in the treatment of psychosomatic back pain in menta- health patients.
– Surgica- treatment
Surgery is not a usua- go-to treatment in patients with back pain. Surgery is usually indicated in the following cases:
- – Persistent back pain at rest
- – Failure of medica- treatment
- – Structura- abnormalities not responsive to medica- treatment
- – Nerve compression injuries
- – Injuries to the spina- cord with loss of function (4).
– Lifestyle modifications
- a) Daily exercises: One of the best ways to get rid of back pain is by regular exercises or increase activity. The physician or a trained and licensed physiotherapist is in the best place to recommend the required exercise.
- b) Manua- therapy: This is similar to a spa visit treatment where a trained therapist wil- work on the muscles and joints of the back, massage them and apply pressure where necessary to improve their function
- c) Cognitive behavior therapy: This is otherwise known as CBT and it is often employed in patients, especially known menta- health patients to help them cope better with pain
- d) Ice or hot compress: Sometimes, it may be required to apply a hot compress or a cold compress to the painfu- site at the back. But this wil- be dictated by the physica- therapist (9).
What Back Pain Can Cause – Common Causes Of Back Pain
What back pain can cause when not adequately managed in times includes the following:
– Difficulty swallowing
– Difficulty with passing urine
– Numbness especially around the genitals
– Weakness of the lower limbs
– Chronic and persistent pain
Prevention Of Back Pain and Lower Back Pain
To prevent back pain or to prevent a recurrence of back pain, the following measures should be adopted:
– Adequate and regular exercises
– Avoid excess weight by eating healthy and keeping fit
– Avoid or quit smoking as the case may be
– Eat healthy by consuming foods rich in calcium and vitamin D
– Maintaining a healthy posture (3,5).