Common Causes of Back Pain and How to Prevent It

Team Udayavani, Oct 17, 2024, 5:26 PM IST

Back pain is one of the most common causes for which patients visit doctors. In some individuals it tends to be persistent, leading to significant disability and work loss. People of any age can present with back pain arising from mechanical or nonspecific causes. Mechanical back pain is seen in 90% of cases, so individuals can easily miss other causes while focusing on this one. Causes of back pain differ for each age group, which can guide the Doctor in determining the appropriate treatment. Most cases of back pain can be managed conservatively. Identifying the red flags and determining the appropriate treatment are the most important aspects of back pain management. Association with neural dysfunction and other alarming signs warrants a thorough investigation and a multidisciplinary approach.

Commonly used medicines are pain relievers, muscle relaxants and medicines to target peripheral and central neural pathways. Many forms of physical therapy are also used along with medication for pain relief and early recovery. Various types of injection therapy are shown to improve back pain. Surgery is reserved when the symptom is accompanied by severe nerve dysfunction or is due to serious causes like infection and tumours. Back pain that does not resolve 6 weeks after acute injury warrants further evaluation like radiography (X-rays), computed tomography (CT), or magnetic resonance imaging (MRI).

How common is back pain?

Back pain is widespread among adults. Studies show that up to 23% of adults worldwide suffer from chronic low back pain, with one-year recurrence rates reaching 24% to 80%. Approximately 84% of adults suffer from back pain once or more in their lifetime. Back pain is less common among children than in adults.

What are the causes of Back pain:

Below are some common causes of back pain-

Mechanical and postural: back pain may arise from either having a bad posture for a long time or doing some repeated movements in a biomechanically abnormal manner. This is one of the most common causes of back pain.

Degeneration: various structures in the back like, joints, discs and muscles can go age related changes and can cause lower back pain

Traumatic: any injury to the back produces both acute and chronic back pain depending upon the severity. This needs thorough evaluation by an expert Doctor to find out the severity of injury.

Inflammatory: there are some systemic inflammatory conditions which can affect the back. They are commonly seen in younger individuals with some typical clinical presentation. Examples are Ankylosing spondylitis and rheumatoid arthritis.

Metabolic: Variations in calcium and bone metabolism can lead to chronic long standing back problems for example Osteoporosis, Osteomalacia (deficiency of Vitamin D in adults) and rickets in children.

Infection: many microorganisms can cause severe problems to the spine. They need a high degree of suspicion, detailed evaluation and early treatment. Examples are tuberculosis and other bacterial spinal infections.

Congenital: some abnormalities in the structure of spinal bone by birth can lead to back pain in some individuals.

Neoplastic: pain coming from tumours or cancers arising from spine can produce severe back pain. Cancers can arise within the spine itself or more commonly by a secondary deposit of another cancer from elsewhere.

Referred pain: problems of some other nearby organs can also present with back pain, for example a kidney stone or mild heart attack can present like neck and left arm pain.

Non-organic: here there’s no identifiable cause of back pain and actually the pain is arising from the mind of the individual. This needs a detailed evaluation by a neurologist or a psychiatrist.

So a thorough clinical evaluation and appropriate diagnostic tests are usually enough to determine the exact cause of this symptom. Depending upon the condition, referral to specialists such as spine or orthopaedic surgeons, neurologists, rheumatologists, or any other specialists may be necessary for further evaluation and treatment planning.

How do Doctors evaluate a patient with back pain?
Determining the cause of back pain starts with a thorough history and a detailed physical examination. The onset of the pain is first established. Acute back pain, where pain started less than 6 weeks back and is usually precipitated by trauma or sudden changes in the course of a chronic pain persists longer than 12 weeks. Information about what provokes or alleviates the pain will be elicited. This gives additional clues to the diagnosis, and also guides the doctor in determining the appropriate pain control measures for the patient. The quality of pain helps to distinguish between internal and external pain. Any associated symptoms can serve as further clues about the source of back pain. Other pertinent information will be obtained from the patient’s medical, family, occupational, and social history. For example, a history of previous medications should raise suspicion of the disease a patient is suffering. A focused physical examination should include following steps: look (inspection), feel (palpation), move and measure. Some provocative manoeuvres will give a definitive idea about the cause and origin of pain. Testing the nervous system will help in assessment of the integrity of both the musculoskeletal and neurologic systems. History and physical examination are enough to determine the cause of back pain in most cases. Wherever doctors sense Red flag-signs in history or physical examination, further imaging and other diagnostic tests will be done. As a rule in adults, back pain persisting longer than 6 weeks despite appropriate conservative management is an indication for imaging. In the children, the recommendation is to perform imaging tests for continuous pain lasting more than 4 weeks.

How do Doctors manage Back Pain in Adults?
For acute and severe back pain, serious conditions must be ruled out. If there are no indications for further testing, the patients will be given reassurance about the condition and symptomatic relief. The first-line treatments are non pharmacological such as, early return to normal routines, avoiding activities that precipitate the pain along with patient education. Second-line options that may be offered to the patient are nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, medicines acting on the neural pathways along with physical therapy, and superficial heat application. Education about the possible causes of back pain must be tailored to each condition. It plays a crucial role in preventing worsening of back pain or recurrence. The patient may be advised to follow up after 2 weeks. Resumption of normal routines must be recommended if asymptomatic during follow-up.

The management approach to chronic back pain is also similar. Start by ruling out serious conditions. If the cause is nonspecific, advice to remain active and avoid precipitating factors will be given. Exercise therapy and cognitive behavioural therapy are also considered first-line treatments. Second-line treatments include yoga, stress reduction, NSAIDs, neural medicines and interdisciplinary rehabilitation.

Prognosis of back pain
In adults, the prognosis of back pain depends on the aetiology (cause of back pain) most nonspecific cases resolve without serious sequelae. The success of conservative therapy and patient education in treating adult back pain shows that pain is subjective and often stress-related. For some patients with unidentifiable causes of back pain, prior back pain episodes, greater symptom intensity, depression, fear-avoidance behaviour, and the presence of leg or widespread symptoms are associated with chronic, disabling back pain. Patient education about preventing back pain recurrence or aggravation must be tailored to personal factors. For example, individuals with jobs that do not require hard physical labour must be reminded to stay active to maintain a healthy body weight. BMI greater than 25 correlates with poor outcomes. The same reminder must be given to people with labour-intensive occupations. However, these individuals should also avoid factors precipitating back pain, such as heavy-load lifting and excessive or repeated back-twisting. These patients should lighten their loads or use lifting equipment when moving weighty objects. All patients must be reminded to avoid smoking, which increases the risk of back pain in people of any age.

A thorough evaluation of individuals with back pain helps determine the exact cause and origin of pain. With this approach one can not only develop a tailored treatment plan but also avoid missing a major illness which can lead to severe disability and complications.

Authored By Dr Ishwara Keerthi C, Consultant Spine Surgeon, KMC Hospital, Dr. B.R. Ambedkar Circle