As you may already know through personal experience, back pain can be uniquely complex and difficult to diagnose and treat. There are many types of back pain, and a wide range of treatments that may or may not work for the same condition.
Here we outline several insights that you may find helpful in your journey to finding and participating in a treatment approach that works for you.
Back pain is a complicated, personal experience
The intensity and manageability of pain are very different for every person. For example, one person with a herniated disc may experience excruciating pain while another person with the same condition has no symptoms at all. Similarly, a muscle strain can range from mild to debilitating.
With some conditions, back pain can flare up and then subside, only to flare up again after a few weeks or months and gradually intensify over time. Because only you know your level of pain, your treatment will most likely be more successful if you are an active participant in making decisions about your medical care.
Many structures in your back can cause pain
Your back is subjected to various strong forces throughout the day, such as from twisting, sudden jolts, or poor posture when sitting hunched over. Any of your spine’s many interconnected and overlapping structures are capable of becoming injured and producing back pain. Common anatomical causes of back pain include:
- Large muscles that support the spine
- Spinal nerves that exit the spinal canal and may go to the legs or elsewhere
- Facet joints that connect the vertebrae along the back of the spine
- Intervertebral discs that provide shock-absorption for the bones
For more information, see Spinal Anatomy and Back Pain.
Bones, ligaments, tendons, and other anatomic structures are also capable of causing back pain.
The underlying cause of pain may be hard to identify
It is usually difficult for the brain to distinguish between injury to one spinal structure versus another nearby. For example, a torn or herniated disc may feel similar to an arthritic facet joint due to their close proximity. In some cases, the same nerve root can be compressed or irritated by different structures, such as a disc or bone spur.
Your physician will take a thorough medical history, discuss your symptoms, and conduct a physical exam in order to accurately diagnose the cause of back pain. Sometimes diagnostic tests—such as X-rays, MRI scans, or diagnostic injections—are needed when trying to locate or confirm the underlying cause of pain.
Description of your pain is important
How you describe your pain, its area of distribution, and any related symptoms are important to determine a back pain diagnosis. Three common classifications of back pain include:
- Axial pain. Also called mechanical pain, axial pain is confined to one spot or region. It may be described a number of ways, such as sharp or dull, comes and goes, constant, or throbbing. A muscle strain is a common cause of axial back pain as are facet joints and annular tears in discs.
- Referred pain. Often characterized as dull and achy, referred pain tends to move around and vary in intensity. As an example in the lower back, degenerative disc disease may cause referred pain to the hips and posterior thighs.
- Radicular pain. Commonly described as electric shock-like or searing, radicular pain follows the path of the spinal nerve as it exits the spinal canal. This type of pain is caused by compression and/or inflammation to a spinal nerve root. In the lower back (lumbar spine), radicular pain may travel into the leg. Other terms for radicular pain are sciatica or radiculopathy (when accompanied by weakness and/or numbness). It can be caused by conditions such as a herniated disc, spinal stenosis, or spondylolisthesis.
Once your doctor reaches an accurate diagnosis for your back pain, an effective treatment plan can begin.
Pain is still real even if no anatomical reason is found
Even after many tests and doctor visits, in a small percentage of patients the anatomical cause for your back pain may remain elusive. If this is the case, the pain still needs to be treated and there are a variety of nonsurgical care options that can help alleviate or manage the pain.
Psychological factors, such as depression and sleeplessness, can make the pain worse and also need to be included as part of a comprehensive treatment program.
For persistent back pain and/or any neurological symptoms, it is always important to see a qualified spine specialist for a diagnosis. Ultimately, participating in the decision-making process about your medical care may help you have a better outcome. Understanding your pain is an important element of this process.