Also Known as Lumbago, Sciatica, Backache, Back trouble, and Slipped disk

Overview

Back pain is one of the most common pain complaints that almost everyone has had at some point in their lives. This pain is felt in the back of the body, stretching from the shoulders to the hips. 

Back pain can be either acute or chronic. When pain strikes suddenly and lasts for a few days, it is referred to as “acute.” Symptoms are typically sudden and transient. Chronic back pain lasts for more than three months and returns regularly, making daily activities difficult.

Increasing age is a significant risk factor for back pain. Factors like injuries, inactive lifestyle, poor posture, illness, strains, injuries, and fractures can contribute to back pain.

It can be prevented by lifestyle modifications, like being physically active, losing excess body weight, maintaining good posture, managing stress, and getting adequate good quality sleep. 

Most cases of back pain can be managed by over the counter medications and topical ointments. However, in case of chronic back pain, it is important to seek medical treatment to avoid long-term complications.

Key Facts

Usually seen in

  • Adults above 35 years of age

Gender affected

  • Both men and women but more common in women

Body part(s) involved

  • Back
  • Buttocks
  • Legs

Prevalence

Mimicking Conditions

  • Kidney stones
  • Endometriosis
  • Fibromyalgia
  • Lumbosacral muscle strains/sprains
  • Lumbar spondylosis
  • Disk herniation
  • Spondylolysis
  • Spondylolisthesis
  • Vertebral compression fracture
  • Spinal stenosis
  • Tumor
  • Infection
  • Fracture

Necessary health tests/imaging

Treatment

  • Medications: Ibuprofen, Codeine & Hydrocodone
  • Topical pain creams: Topical Diclofenac & Trolamine Salicylate
  • Surgery
  • Cortisone injections
  • TENS (transcutaneous electric nerve stimulation) therapy

Symptoms Of Back Pain


The main symptom is an ache or pain anywhere in the back. Pain may be described as a shooting, burning, or stabbing sensation. In addition, the pain may sometimes radiate down to the buttocks and legs or worsen with bending, twisting, lifting, standing, or walking. It may also occur along with other symptoms such as:

  • Back inflammation
  • Fever
  • Warm area on the back
  • Swelling on the back
  • Loss of control
  • Numbness and tingling sensation
  • Chills
  • Weakness
  • Increased sensitivity towards pain
  • Difficulty in walking without support
  • Bowel or bladder changes
  • Nerve pain
  • Muscle spasm
  • Unexplained weight loss
  • Pain awakening the patient from sleep

Causes Of Back Pain


The human back comprises many parts, including muscles, ligaments, tendons, discs, and bones, all of which work together to support the body and allow it to move. Disks are cartilage-like pads that support the spine fragments. Issues with any of these components can cause back pain.

1. Strain

Excessive strain or trauma can cause damage to the back. For example, improperly lifting something or lifting something too heavy. Other causes that can strain the back include:

  • Poor posture
  • Excessive exercise
  • Prolonged sitting and lying down
  • Sleeping in an uncomfortable position
  • Obesity
  • Pregnancy
  • Muscle or ligament strain
  • Spasm of a muscle
  • Muscle tenseness
  • Damages disks 
  • Falls or fractures

2. Structural problems 

A variety of structural issues can also cause back pains. They include:

  • Ruptured discs: Each vertebra is cushioned by discs. If the disc ruptures, there will be increased pressure on a nerve, resulting in back pains.
  • Bulging discs: A bulging disc can put more pressure on a nerve, causing back pains.
  • Sciatica: It is a sharp and shooting pain usually caused by a bone spur or herniated disc pressing on the nerve and radiating through the buttock, down the back of the leg along the sciatica nerve.
  • Arthritis: It can cause pain in the lower back, joints of the hips, and other areas.
  • Scoliosis: It is a condition in which the spine curves to the side resulting in back pain. 
  • Osteoporosis: Brittle and porous bones, including those of vertebrae of the spine, can cause compression fractures resulting in back pains.

3. Inflammation

Inflammation can cause back pains localized to the axial spine (lower back) and sacroiliac joints (situated where the lower spine and pelvis connect). It is usually chronic in nature. Conditions that can cause this include:  

  • Ankylosing spondylitis: It is an inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse. 
  • Sacroiliitis: It is an inflammation of one or both of the sacroiliac joints. Sacroiliitis can cause pain in the lower back or buttocks and can extend down one or both legs.
  • Tuberculous spondylitis: Also known as Pott disease, it is a rare disease associated with the gradual onset of progressive back pain.

4. Tumors

Patients experience intense back pains in malignancies (cancer) that have metastasized (spread) to the spine like:

  • 5. Degeneration
  • It is usually seen in construction or heavy load workers as their age advances. Degeneration of the lumbar spine and surrounding tissues can lead to the development of the following which eventually leads to back pain:
  • Spondylosis deformans: It is characterized by the presence of bony spurs or osteophytes along the edges of the bones of the spine.
  • Lumbar intervertebral disc degeneration: It is marked by the breakdown of one or more of the discs that separate the bones of the spine.
  • Lumbar non-spondylolysis spondylolisthesis: It occurs when one vertebra slips out of place onto the vertebra below it.
  • Ankylosing spinal hyperostosis: It is a fusion of the vertebral column resulting from the formation of bone tissues in the ligaments without significant disc disease or joint involvement.
  • Lumbar spinal stenosis: It is a narrowing of the spinal canal in the lower part of your back.

6. Infections

  •  Some infections can also lead to back pains. These include:
  • Infection of the spine and discs
  • Epidural abscesses (the fluid-filled cavity between the bones of the spine)
  • Muscular/soft tissue abscesses

  • 7. Pregnancy
  • Studies have shown that the majority of women experience back pains, which affects their daily  activities, quality of life, and ability to work. It is due to weight gain during pregnancy, an increase in the size of the stomach, and the consequent shifting of the body gravity center that increases the strain, especially on the lower back.

8. Other causes

In addition to diseases that arise in the structures of the back, pains can be referred to the back due to disorders involving the organs like: 

  • Liver
  • Gallbladder
  • Pancreas
  • Uterus
  • Ovaries
  • Urine bladder

Risk Factors For Back Pain


A variety of factors can put you at risk for back pains. Following are the risk factors that can increase your chances to suffer from back pain:

1. Age

Individuals ≥35 years are found to have significantly more risk as compared to those less than 35 years.

2. Gender

Women are more prone to developing back pains when compared to men. 

3. Genetics

Research also shows that the genetic component plays a significant role in chronic and disabling lower back pain. 

4. Lifestyle factors

The following lifestyle factors are also associated with back pain: 

  • Lack of exercise leading to overweight/obesity
  • Smoking 
  • Poor sleep quality
  • Awkward posture
  • Excessive alcohol consumption
  • Physical activities like lifting heavy objects
  • Excessive strenuous exercises

5. Comorbidities

Chronic conditions, such as asthma, headache, diabetes, and mental health problems, can increase the likelihood of developing pain, especially in the lower back area.

6. Related symptoms

Previous episodes of pain, high initial pain intensity and repeatedly occurring radiating pain can increase the risk of chronic back pain.

7. Psychological factors

Psychological factors that act as a risk factors for back pain include:

  • Depression
  • Anxiety
  • Catastrophizing (considering any situating is worse than it actually is)
  • Low self-esteem
  • Fear avoidance

8. Occupation

The prevalence of musculoskeletal disorders is found to be higher in the following:

  • Coal miners 
  • Truck drivers
  • Gold smiths 
  • Manual laborers
  • Farmers
  • Nurses
  • Office workers


These factors affecting the intensity and duration of back pain depend on:

  • Workload
  • Number of hours of work
  • Tenure of work 
  • Weightlifting
  • Bending 
  • Twisting
  • Sitting for long hours

9. Socioeconomic status

Low socioeconomic status with low income and education are related to chronic back pain because of lower health literacy, and lack of health care facilities. 

Long working hours can be a cause of back pain! People who spend most of their day at work, especially a desk job using laptops and smartphones, tend to sit for longer periods of time which can lead to chronic back pain. 

Diagnosis Of Back Pain


Back pain is usually diagnosed after asking the individual about his/her symptoms and by: 


1. Physical examination

The doctor examines the back to check if one can walk, sit, stand and lift your legs. The intensity of the pain is rated on a scale of one to ten. The doctor may further advise one or more of the following tests to diagnose the condition.

2. Imaging tests

  • X-rays: They are done to evaluate any fractured bones, or arthritis. 
  • CT scan:  It is used to detect any issues with the bones, muscles, tissue, nerves, ligaments, and blood vessels of the back.
  • MRI: It is used to identify any structural abnormalities.
  • Electromyography: This test can confirm nerve compression caused by herniated disks or narrowing of the spinal canal.

3. Blood tests

The following tests are done if an infection is suspected to be causing back pain:

Prevention Of Back Pain


It is important to keep the back muscles strong to avoid any back pain. The following lifestyle changes can help you do the same:

Exercise regularly: Physical activity, such as back strengthening exercises, can help reduce inflammation and muscle tension. Yoga also helps to improve strength, balance, flexibility, and proper posture.

Maintain a healthy weight: A healthy weight can help to prevent or control back pain.

Quit smoking: Smokers are more prone to back pain because smoking reduces nutrient-rich blood flow to the spinal discs. Hence quitting smoking is always a great option.

Avoid heavy lifting: If you can’t avoid it, keep your back straight while lifting. Allow your legs to do the work. Only bend at the knees. Maintain a close grip on the weight.

Correct the postures: This can be done by following these simple tips:

  • While sleeping: Sleep on one side with the knees pulled up slightly towards the chest.
  • While standing: Stand with the heels against a wall, the calves, buttocks, shoulders, and back of the head should all touch the wall. If the posture changes when you take a step forward, it is time to correct it.
  • While sitting on a chair: Keep the back straight or support the low back. One can also place the legs on a stool so that the knees are slightly higher than the hips.
  • While using a laptop: Place the laptop on the desk while using it. Do not lean forward. Bending forward puts pressure on the vertebrae in the neck which can cause headaches and pain in the back and neck.
  • While typing on phone: Do not type on the phone for more than a few minutes at a time. While typing on the phone, one bends the head and curves the spine, putting strain on the neck and back.


Take a break: Every 10 minutes, take a 20-second break. Stand for at least 2 minutes and stretch. This makes the tight and stiff joints relax and increases blood flow.

Wear comfortable footwear: High heels can cause back pains by shifting the center of gravity. Hence it is advised to avoid them and wear comfortable footwear.

Eat a well-balanced diet: Make sure to get enough calcium in the diet, as it is essential for bone health. A healthy diet also aids in weight management.

Focus on the core: Strong core muscles can reduce the likelihood of back injury.

Note: Change your shoe. Muscle strains in the back, legs, and neck are caused by ill-fitting and wearing shoes.

Specialist to Visit


If you experience the signs and symptoms of back pains, make sure not to ignore them and consult your doctor. You can take over-the-counter (OTC) painkillers for relief from the pain. If the pain doesn’t subside even after three days, you should consider immediate medical attention.

Specialists who can assist with back pains management include:

  • Orthopedists
  • Rheumatologists 
  • Neurologists


Orthopedic doctors and surgeons can treat neck, spine, disc-related pain, or other common back pains complaints. Rheumatologists help you if you are diagnosed with arthritis. Neurologists can help in managing severe sciatica and other back pain problems caused by nerve involvement.

Treatment Of Back Pain

Back pains usually improves after a month of home treatment. Back pain is a complex ailment that affects everyone differently. Many people’s discomfort lasts for months, but only a few people suffer chronic, severe pain. In such case, various types of treatment can provide relief such as:

Heat and cold treatments

These treatments are recommended to relieve aching pain by applying a hot compress or an ice pack to the sore spot. To stimulate blood flow and healing, use a cold pack for the first 24 to 48 hours after an injury, then switch to heat therapy. Packs should not be worn for longer than 20 minutes at a time.

Medications 

Pain relievers sold over the counter (OTC) and various non-steroidal anti-inflammatory drugs may help provide relief.


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Topical pain medications/creams

Come in the form of gels, gel patches, sprays, or foams that can be applied directly to the affected area of your back. They include:

  • Topical diclofenac: This is a topical NSAID used to treat arthritis symptoms such as pain, swelling, inflammation, and stiffness.
  • Trolamine salicylate: This topical pain reliever cream is frequently prescribed for arthritis pain. It has a chemical structure that is similar to aspirin and has a mild anti-inflammatory effect.

Cortisone injections

If previous treatments don’t work and the pain radiates down the leg, the doctor may inject cortisone, a powerful anti-inflammatory steroid, along with a numbing agent into the region around the spinal cord (epidural space). Although a cortisone injection can help reduce inflammation around the nerve roots, the pain alleviation is usually temporary.

Transcutaneous electric nerve stimulation (TENS)

A TENS machine is a small, battery-operated device that has leads connectd to sticky pads called electrodes. It  sends electrical impulses to specific nerves, blocking pain signals.

Surgery

Surgery may be beneficial in case of unrelenting pain with radiating leg pain or developing muscle weakening as a result of nerve compression. These procedures are usually reserved for pain that hasn’t responded to prior treatments and is caused by structural issues such as the constriction of the spine (spinal stenosis) or a ruptured disc.

Home-Care For Back Pain 


There are numerous home remedies and traditional back pain relief treatments that can help keep your back in good shape. Always consult your doctor before taking any new medication. 

1. Heat/ice therapy

In the acute phase of back pains, ice packs may relieve discomfort and help reduce inflammation. Please keep in mind not to apply ice directly to the skin. Wrap it in a thin towel or gauze. Warm compresses may also be used to relieve pain after the inflammation has subsided. Hence, it is advised to use alternate heat and cold therapy.

2. Exercise

Exercise can reduce the intensity of pain in chronic back pain. Along with this it has multiple benefits like:

  • Increases back flexibility
  • Increases back strength
  • Improves cardio-vascular endurance
  • Keeps mind calm and can help in managing pain

3. Use oils and creams 

For pain relief, menthol-containing pain relief creams give a cooling effect that temporarily relieves back pains.

4. Get enough rest

Simply not getting enough rest and sleep may result in back pains. If you sleep on one side, you should put an extra pillow between your knees for additional support.

5. Reduce stress

Muscle tension and pain can be brought on by stress. Stress-relief techniques such as meditation, deep breathing, and yoga can be tried.

6. Get proper support while working and sleeping

Poor posture can often lead to a stiff and tense back, leading to back pain. Try these tips instead:

  • Sit up straight while using your laptop
  • Use cushioned chairs 
  • Have a comfortable desk and chair if you need them while working
  • Sleep on your back, with a pillow or rolled towel under your knees.
  • Maintain healthy body weight
  • Excess weight especially affects the pelvis, back, and knees. Losing weight reduces the strain on the lower back muscles.

Here are some quick do’s and don’ts you need to follow to keep your back healthy and happy:


Do’s 

  • Straighten your back while sitting or standing
  • Lift correctly
  • Exercise regularly
  • Quit smoking
  • Keep moving
  • Maintain a healthy diet
  • Stay hydrated


Don’t

  • Do not sleep on your stomach
  • Do not sit for too long
  • Do not skip your exercise
  • Do not overload your back
  • Do not wear high heels
  • Don’t be a slouch

Complications Of Back Pain


Chronic back pain can cause a variety of health issues which can be divided into the following:

Physical complications

  • Reduction in activity: Severe back pains is the top reason for people missing work. Chronic back pain makes it difficult to sit, stand, or bend for long periods of time. 
  • Weight gain: Chronic pain prevents an individual from exercising regularly, which is an essential component of living a healthy lifestyle. Weight gain is inevitable when one’s movement is restricted due to back pain.
  • Loss of bone density: Loss of bone density is caused by an increase in weight and a decrease in muscle mass. Over time, this can affect the overall posture.
  • Muscle tissue loss: This occurs when movement is restricted due to increased pain, which reduces activity, increases weight, and reduces muscle mass.
  • Insomnia/inability to sleep: Severe pain disrupts a person’s sleep pattern, leading to insomnia. Not getting enough sleep can also lead to a bad mood, making it difficult to deal with day-to-day events.
  • Deformity: Back pain can create the form of a hump, also known as swayback, in which the back curves inward instead of outward. 
  • Bladder and bowel problems: Chronic back pains can affect the sacral nerves (nerves in the lower back) that influence the proper excretion of urine and stool.

Psychological complications

Back pain can cause psychological complications that can be assessed by:

  • Decreased productivity
  • Increased absenteeism at work
  • Increased irritability and agitation
  • Difficulty in concentrating