As you probably already know through personal experience, back pain can be very complex and difficult to accurately diagnosis and treat. There are myriad causes and contributing factors, and a wide range of possible back pain treatments that may or may not work for the same condition.
This blog will outline some of the basic tenets of back pain to help you on your journey to finding and participating in a treatment approach that works for you.
Back pain is a complicated, personal experience
The level, degree, and manageability of pain is very different for every person. Some people may have a large herniated disc and experience no pain at all, and for others a simple muscle strain can cause excruciating back pain that can limit one's ability to walk or even stand.
Also, with some conditions, the pain can flare up from time to time and then reside, but may get worse over time. Because only you know your level of pain, your treatment will most likely be more successful if you proactively participate in making decisions about your medical care.
Many structures in your back can cause pain
While the anatomical structure of the spine is truly a marvel in terms of its form and function, many different structures in the spine are capable of producing back pain. Moreover, the spine is a part of the body that is highly prone to injury because it is subject to many strong forces: torque and twisting, sudden jolts and daily stresses (e.g., from poor posture). Common anatomical causes of back pain include:
- The large nerve roots that go to the legs and arms may be irritated.
- The smaller nerves that innervate the spine may be irritated.
- The large paired back muscles (erector spinae) may be strained.
- The bones, ligaments, or joints themselves may be injured.
- The disc space itself can be a major cause of back pain.
For more information, please see Spinal Anatomy and Back Pain.
The source of the back pain can be complex
There is a lot of overlap of nerve supply to most of the anatomical structures in the spine (discs, muscles, ligaments, etc.) which often makes it impossible for the brain to distinguish between injury to one structure versus another. For example, a torn or herniated disc can feel identical to a bruised muscle or ligament injury.
For this reason, your physician will first take a thorough medical history and physical exam, discuss your symptoms and may conduct diagnostic tests (such as an X-ray or MRI scan, if indicated) in order to try to distinguish the underlying condition causing your pain.
Description of your pain is important
The type of back pain (the way you describe the pain) and the area of distribution of the pain and related symptoms is an important part in determining a back pain diagnosis, and the treatments can be very different depending on the type of pain. Three common classifications of back pain include:
- Axial pain. Also called mechanical pain, axial pain is the most common cause of back pain and may present in a number of different ways (sharp or dull, constant, comes and goes, etc.). A muscle strain is a common cause of axial pain.
- Referred pain. Often characterized as dull and achy, referred pain tends to move around and vary in intensity. It may radiate from the lower back into the groin, pelvis, buttock, and upper thigh. Injury to any of the interconnecting sensory nerves of the lower back can cause this type of pain. As an example, degenerative disc disease may cause referred pain to the hips and posterior thighs.
- Radicular pain. Often described as deep and radiating through the extremity (arm or leg), radicular pain can be accompanied by numbness and tingling or weakness. This type of pain is caused by compression, inflammation and/or injury to a spinal nerve root. Another term for radicular pain is sciatica and can be caused by such conditions as a herniated disc or spinal stenosis.
For more information, see the following articles:
- Understanding Low Back Pain (Lumbago)
- Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain.
If no anatomical reason is found, your pain is still real
Frequently, even after many tests and visits to different doctors, there may be no apparent anatomical cause for back pain. However, the pain is still real. While psychological factors, such as depression and sleeplessness, will often need to be included as part of a comprehensive treatment program, it is also important to treat the pain, and there are a variety of nonsurgical care options that can help alleviate the pain.
Additionally, you should always make sure to see a qualified spine specialist for persistent back pain symptoms to check for serious medical conditions that could be causing the pain (such as tumor or infection). For more information, see the following articles:
- Chronic Pain as a Disease: Why Does it Still Hurt?
- Modern Theories of Chronic Pain
- Specialists Who Treat Back Pain
Ultimately, participating in the decision-making process about your medical care should definitely help you have a better outcome, and understanding your pain is an important element of this process.