Back Pain: Symptoms, Causes, Diagnosis, and Treatment

One of the most common reasons for a trip to the doctor’s office, your back pain is not a condition in and of itself. Rather, it is a symptom of an underlying cause.

Often occurring in your lower back, about 13% of US adults aged 20–69 will suffer from back pain. In some, the pain may subside just as quickly as it occurred. Others live with back pain chronically.

In this article, we’ll review the most common causes of back pain and detail the steps you can take to find relief.

First, let’s talk about the signs and symptoms.

The Signs and Symptoms of Back Pain

As there is a wide array of possible causes for your back pain, the signs and symptoms can be just as variable and range from mild to severe.

There are a few categories you should be mindful of as they can help to characterize your pain best. Relaying this information to a medical professional may be all that is standing between you and a solution for your pain.

Ask the following questions to help you determine if medical care is necessary:

Location:

• Is the pain in the upper, mid, or lower back?
• Is there an area that is tender to touch?
• Does the pain stay in one location, or does it move?
• Is there associated pain in the buttocks or groin?

Quality:

• Is the pain dull or achy?
• Is the pain sharp and stabbing?
• Is there numbness or tingling over your back or into your legs?
• Is there pain with a specific movement like twisting?
• Is there pain at rest?
• Do certain positions offer relief?

Quantity:

• On a scale of 0-10, with 0 being no pain at all and 10 representing the worst pain imaginable, where does your pain fall?
• Does this number improve or worsen with rest or certain activities?
• Has it been the same number since it started, or has it gradually worsened?
• Has it been steadily getting worse?

Some Red Flags to Consider:

• The inability to control your bladder or bowel movements in conjunction with your back pain may be a medical emergency. Seek immediate attention.

• If you experienced recent trauma to your back and notice bruising, abrasions, or tenderness over your spinal column, be sure to get evaluated by a medical professional.

• Fever, headaches, chills, and neck stiffness along with your back pain may be the result of a serious underlying condition. Seek medical care.

• A focal area of tenderness over a bony prominence in the setting of general symptoms like fever, fatigue, night sweats, and weight loss can indicate a severe underlying condition. Again, seek the care of your physician.

What Causes Back Pain?

Characterizing your pain is an important part of determining the source.

As there are a wide variety of causes for your pain, identifying the right one is necessary to optimize your plan of care.

In this section, we’ll review some of the more common causes of back pain.

Muscle Strain

Most commonly, back pain is caused by muscle strains. The exacerbating factor is typically pain during a lifting movement.

Using poor form while lifting a heavy object places you at risk for this injury - remember to emphasize the muscles in your legs, not your back.

Disc Herniation

Discs are situated between your vertebrae and act as shock absorbers. These injuries can occur gradually with degeneration over time, or they may occur acutely during a traumatic episode.

Those with disc herniations experience numbness, tingling, and weakness that extends into one or both legs. These symptoms are often worse with sitting or bending at the waist.

Spinal Stenosis

Spinal stenosis is a chronic degenerative process that results in the narrowing of the canal that transmits your spinal cord.

Pain, numbness, and weakness occurs in the legs and is usually worsened with walking or prolonged standing. Unlike disc herniations, it improves with sitting or bending at the waist.

Fracture

Fractures of the spine occur most commonly due to motor vehicle crashes or falls. Again, these injuries can occur gradually over time or in the setting of acute trauma.

As the vertebral column supports 80% of your body weight, pain is worse with load-bearing activities like standing or walking.

Other Causes

Less common causes of back pain include tumors and infection.

Tumors that occur on the spine most often originate as other cancers, like breast or lung cancer. General symptoms like fever, night sweats, fatigue, and weight loss are common.

Infection can occur on the vertebrae, disc, spinal cord, or surrounding muscles. Infection occurs most often in those with a compromised immune system. Associated symptoms in addition to

Available Treatment Options and When to Seek Help

There are a variety of options that may offer relief for your symptoms, though success is dependent on the underlying cause.

The good news is, the majority of the less serious sources of back pain reviewed in this article resolve spontaneously within 3-months. However, up to ⅓ of patients will have chronic symptoms.

If your pain is acute, stable, less than 5/10, and you are free of the previously mentioned red flags, non-invasive care is warranted.

This can include physical therapy, heat or ice application, massage, and nonsteroidal anti-inflammatory drugs (NSAIDs). Be sure to take the NSAID of your choice (Tylenol, ibuprofen, etc.) as directed - they are better at preventing pain than they are at relieving pain.

If your back pain is chronic, and you are free of any associated red flags, exercise, tai-chi, yoga, and physical therapy have been proven to be beneficial.

Seeking the opinion of a medical professional may be warranted if non-invasive measures fail to improve your symptoms or if your pain continues to worsen.

More invasive options are available with medical supervision like steroid injections, opioid medications, and even surgery.

If you are experiencing red flag symptoms or believe you may have a fracture, infection, spinal cord injury, or tumor, seek immediate medical attention.

The Bottom Line

Back pain is extremely common, though there are a variety of potential causes.

There are several steps you can take to find relief. Be mindful of the location, quality, and quantity of your back pain.

If your symptoms are mild and you’re free of red flags, some conservative measures can offer benefits. Over the counter pain medication in conjunction with physical therapy, heat, and ice can improve your pain considerably.

When these measures fail, or when you notice red flags, seek the care of a medical professional. More invasive measures may be warranted, but properly identifying the cause is necessary.