Spine · Conditions

Back Pain: Definition, Causes, Risk factors & Complications

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Definition of Back Pain

The general definition of back pain is pain felt in any part of the back. Back pain can be an annoyance, or it can be excruciating and debilitating. It often results from, among other things, muscle problems and the degeneration of discs between the vertebrae.

For some people, it develops because of muscle problems in the lumbar or lower spine. For others, the discs that lie between the vertebrae become worn out or degenerated. The pain can be acute, sub-acute or chronic, depending on its location in the body and the duration of its existence.

Back pain can occur because of problems in the internal organs which lie in the pelvis, the abdomen, or in the skin that covers the lower back. Back pain in the upper or thoracic area can be a result of problems with the main vessels of the heart, because of tumors in the chest and can also occur because of spinal inflammation.

People with spinal problems can also develop other symptoms related to their condition, such as pain in their hips and buttocks, and muscle spasms and cramps.

The degree and manageability of back pain differs from person to person. For instance, an individual can have a large herniated disc and yet feel no pain at all, while another individual can experience a seemingly minor muscle strain, only for it to cause him agonizing back pain.

Additionally, some conditions can cause periodical back pains, sometimes showing up days apart, other times reemerging months after their last occurrence. More often than not, the pain intensifies over time.

The definition of back pain as presented by the patient is critical when dealing with back pain. In such a description, the patient should mention just how widespread the pain is, as well as any other symptom he or she is experiencing. Based on the details of the description, a doctor can recommend the best way to manage the pain.

Common types of back pain include:

  • Axial pain – this is also known as mechanical pain. It can be described in a number of ways, like sharp or dull, constant or sporadic. Muscle strain is often the culprit of axial pain.
  • Referred pain – this type of pain tends to move around the spine and can vary in intensity, depending on its location. It is characterized as dull and achy. A good example of referred pain is the degenerative disc disease in the lower back. It can cause referred pain to the hips and posterior thighs.
  • Radicular pain – causes of radicular pain include inflammation, injury or compression to a spinal nerve root. People experiencing this type of pain describe it as a deep a searing pain. It usually follows the path of the affected nerve into the arm or leg and is at times accompanied by weakness or numbness.

Prevalence

Back pain statistics in the United States indicate that more than 75% of all Americans will experience at least one episode of back pain in their lifetime. These statistics are quite similar to those recorded in most other developed countries.

Three out of four adults will be affected by pain in their back at some time during their life. Additionally, back pain cases are more common in adult women than men. A research conducted by the CDC revealed that close to a third of the female population in the United States suffers from back pain, compared to a quarter of the male adult population.

However, men are more likely to report it if the back pain affects their ability to work. A survey carried out by The American Physical Therapy Association (APTA) found that 31% of men acknowledged that low back pain affects their work compared to 20% of women.

A research study conducted by the University of Michigan found that nearly half of all pregnant women will complain about back pain at some point during their pregnancy.

One out of three adults agrees that back pain affects their daily activities, including sleep. APTA conducted a survey which required over 2600 respondents to share their experiences and habits regarding back pain. 39% of the respondents reported that back pain prevents them from fully engaging in the activities of their daily lives. Among this, 38% noted that back pain affects their exercise and 37% have challenges when sleeping because of back pain. More than half of the respondents reported that their sleep quality was reduced as a direct result of chronic back pain.

More than half of all back-pain cases in the US are from desk workers. This is an interesting fact, essentially revealing that back pain is no longer a problem prevalent among those who spend the better part of their day standing. In fact, back pain statistics from one survey revealed that 54% of all Americans suffering from back pain spend their day sitting.

The majority of the people who complain about back pain suffer from lower back pain, often leading to moments where they are practically incapacitated. It is estimated that 10% of the world’s population suffers from lower back pain (LBP). A recent study by Annals of Rheumatic Diseases revealed that one in ten people globally are affected by lower back pain. This is based on over 100 studies conducted in over 80 countries.

Lower back pain affects almost everyone, regardless of their age; from children to the elderly. Low back pain is a very common reason why people schedule medical consultations. Estimates from the 2010 Global Burden Disease show that LBP is among the top 10 diseases and injuries that account for the highest number of disability-adjusted life year (DALY) worldwide.

Consider the following facts about low back pain:

  • In industrialized countries, the lifetime prevalence of common low back pain stands at between 60% and 70%.
  • The prevalence rate among children and adolescents is lower compared to among adults. However, statistics are showing an increasing prevalence in this group.
  • Low back pain prevalence increases between the ages of 35 and 45.
  • Low back pain will increase substantially as the world population ages, largely because of the deterioration of the intervertebral discs in the older population.

Risk factors

Although anyone can develop back pain, there are certain factors that place some at an increased risk of developing pain in their back. Specific back pain risk factors include:

  • Pregnancy – The common cause of back pain during pregnancy is the malfunctioning of the sacroiliac joint. Even though it can be extremely painful, this condition can be successfully treated, and will subside once the pregnancy is over.
  • An inactive or sedentary lifestyle – this kind of lifestyle hinders us from the proper conditioning that our bodies require in order to meet the demands of the day. Failing to do some basic exercises makes the back to become stiff. The stiffness is usually worse in the morning. Muscles can become tight, weak and painful for the remainder of the day. The discomfort caused by the tight muscles in turn deters the person from wanting to exercise.
  • Age – this is one of those back pain risk factors hat affect the elderly. Older people are more likely to develop back pain than children or younger adults. As a person grows old, the disks between the vertebrae shrink and wear away. The bones start to rub against each other, resulting in stiffness which in turn causes pain. Moreover, the space around the spinal cord narrows as we age. This condition is known as spinal stenosis. It exerts pressure on the spinal cord and the nerves, causing pain.
  • Anxiety and depression – There is nothing abnormal about reacting emotionally to the development of pain in your back. Indeed, many people suffering from back pain are anxious to know its cause, how long it will last, and how it is likely to interrupt their day to day activities. The normal healing time for back pain is two to four months. Therefore, many people start to worry if their back pain lasts longer than this, sometimes resulting to psychological distress and depression. Consequently, the distress and depression lead to more pain.
  • Weight – being overweight or obese increases your risk of developing back pain. Our spines are designed to carry the body’s weight and distribute the loads we encounter during rest and activity. When our bodies carry excess weight, the spine has no choice but to adapt to the burden. This, in turn, can lead to structural compromise and damage to the spine ultimately causing significant back pain.
  • Smoking – smoking cigarettes is not good for any part of the body, including your back. In fact, smoking increases your risk of developing back pain. Smoking can prevent vital nutrients from flowing into the disks in your spine, thus preventing them from being properly lubricated. This can cause you to develop pain in the back.
  • Strenuous physical exercise – physical exercise can strain your back, especially if the exercise is performed incorrectly. If the strenuous physical exercises continue for an extended period, back pain may develop.
  • Strenuous physical work – strenuous physical work puts extra stress on your back and can put you at risk of developing back pain, especially if you are performing the tasks incorrectly.
  • Gender – Available research shows that women suffer from back pain more frequently than men.
  • An emotionally or mentally stressful job or career – people with these kinds of jobs tend to develop signs of back pain.

Reasons

There are many sources and potential causes of back pain. At times, pain that originates from different tissues in the spine can create very similar symptoms. It is difficult to determine the actual back pain causes without using diagnostic procedures that sometimes are invasive.

One possible cause of back pain is an injury in the skeletal muscles of the back. Pain in the muscle tissues can be caused by muscle strains or “pulled muscles”, muscle spasms, or by imbalances in the muscles. In many cases, imaging studies do not support the idea of muscle damage leading to back pain and precisely how muscle imbalances lead to muscle spasms is not well understood by medical science.

In approximately one-third of people with chronic lower back pain, and also for those with whiplash, the fluid-filled synovial joints have been identified as a potential source of back pain. These joints provide cushioning and lubrication for the vertebrae.

There are many other common potential reasons back pain may develop. These include:

  • Degenerative disc disease – the discs between our spines shrink or tear as we age. This causes the bones to rub together thus causing pain.
  • Spinal disc herniation – spinal discs keep the spine flexible and also act to absorb shock for the spine, but a disc can bulge or break open when damaged. This is what is referred to as disc herniation and can lead to back pain.
  • Osteoarthritis – it is also known as the degenerative joint disease and happens when a cartilage and bone break down. It mostly affects middle-aged people and older.
  • Lumbar spinal stenosis – this causes your spinal cord to narrow. As a result, significant pressure is added to the spine and nerves. This causes the legs and shoulders to feel numb. Lumbar spinal stenosis usually happens to people above the age of 60.
  • Trauma, such as fractures caused by car accidents, falls, strains and muscle sprains are also leading causes of back pain.
  • Cancer – tumors in the spinal cord can either expand or weaken the bone. Sequentially, this can lead to spinal fractures, nerve compression or spinal instability. However, back pain causes that are related to cancer are very rare.
  • Infections – bacterial infection can lead to back pain, especially low back pain. Available research shows that close to 40% of the cases of lower back pain are caused by bacteria. Furthermore, statistics indicate that most people with lower back pain caused by herniated disc and swelling in the spine depend on antibiotics for treatment.
  • Inflammatory disease and wear and tear of the sacroiliac joint – the sacroiliac joint lies where the spine and the pelvis come together. It doesn’t move much, but it is responsible for moving the weight of the upper body to the lower body. Any inflammatory, swelling or wear and tear in that joint can cause considerable back pain.
  • Ankylosing spondylitis – this is also known as spinal arthritis and causes the bones of the spine to fuse together, making the spine rigid. This fusion of spine bones can cause mild or sometimes severe back pain.

The anterior ligaments of the spine are very sensitive and even a very minor injury can cause a great deal of back pain.

Lumbar radiculopathy, also known as sciatica, is pain in the lower back that radiates to the hip and down the leg due to spinal nerve compression. This is often easy for physicians to distinguish from other types of "non-specific" back pain and can usually be diagnosed without more invasive testing or procedures. Lumbar radiculopathy, or sciatica, causes severe, and sometimes debilitating pain.

Classification

Back pain classification plays a major role in the treatment of back pain cases. Back pain types depend on the area of the body in which it is located: neck pain, mid-back pain, low-back pain or coccyx (tailbone) pain. It can also be classified by the length of time it lasts, or its duration:

Acute back pain: This is pain that is new and can last up to 12 weeks. It can be caused by inflammation, irritation, tissue damage or injury, a procedure or surgery or by illness or disease. This pain usually ends when the condition causing it is treated or is resolved.

Chronic back pain: This lasts more than 12 weeks. It persists or occurs with a chronic disease such as arthritis or degenerative disc disease. It can be continuous, or it may come and go. Chronic back pain affects some people to the point that they are unable to work, get adequate rest or enjoy their life.

Back pain can also be classified according to its cause.

Non-specific back pain: This indicates that the cause of the back pain is not precisely known, but it is thought to be caused from problems in the soft tissues. The soft tissues include the muscles, ligaments and the fascia (a sheet of connective tissue that covers, separates or holds together organs, soft tissues or muscles).

Back pain with radiculopathy or spinal stenosis

A radiculopathy or spinal stenosis is caused by inflammation, compression or injury to the cervical spine or lumbar spine. This causes pain to the spinal cord in the neck or the spinal nerve roots in the lower back. Arm pain is a common symptom of cervical stenosis, while leg pain and leg tingling, numbness and weakness are the signs of lumbar stenosis. Cervical stenosis with myelopathy is known to cause challenges in coordination.

Of all other back pain types, this is the most prevalent as it affects people between the ages of 45 and 64 and it affects more females than males, with females accounting for 53.69% of all the people with spinal stenosis.

Causes back pain with radiculopathy or spinal stenosis include:

  • Herniated disc with nerve compression – this is the most common cause of spinal stenosis.
  • Foramina stenosis – this is caused by arthritis or bone spurs and causes the narrowing of the hole through which the spinal nerve exits. It is more prevalent in the elderly.
  • Nerve root injuries.
  • Diabetes.
  • Scar tissue from a previous spinal surgery.

Back pain with another specific cause

Nearly all (98%) of patients with back pain are diagnosed with acute non-specific back pain that has no serious underlying cause. Back pain that is caused by another underlying disease accounts for the remaining 2% of patients suffering from back pain.

The underlying conditions may include cancer that has metastasized, an epidural abscess or spinal osteomyelitis. These conditions account for approximately 1% of the remaining 2%. The other underlying condition that is frequently responsible for back pain due to another specific cause is disc herniation. Herniated discs most often occur in the lowest two vertebrae of the lumbar spine.

Definition of back pain
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