Back Pain: Symptoms, Types, Causes and Treatment
Back pain is a frequent reason for consultation in primary care. Sometimes, as in trauma, the origin is usually obvious.
In other cases, a medical evaluation is preferable to have an early diagnosis and timely treatment.
Below, you’ll find a short article about the most interesting aspects of this condition. Keep reading to find out more!
The clinical features of back pain vary greatly depending on the origin. Regarding the location, the lumbar region is usually the most affected, causing a clinical condition called lower back pain.
In turn, the pain can obey various patterns, being continuous or intermittent, for example. Some patients may report an excruciating sensation, but it generally tends to be oppressive.
There are situations where the sensation can get worse. For example, changing positions and lifting a lot of weight can trigger pain in patients with herniated discs, a surgical condition of the spine.
When there’s a suspicion of some type of infection, especially of the kidneys, the following associated symptoms may occur:
- Fever (body temperature above 38.3° C)
- Profuse sweating
- Bleeding through urine
- Pain, burning, or itching when urinating
In the case of obstructions in the urinary tract, as is often the case in kidney stones, severe pain may also occur along with profuse sweating (diaphoresis).
Back pain can affect the cervical region, giving rise to neck pain. Anatomical alterations in the vertebrae in this part of the spine can lead to abnormal sensations in the upper limbs, especially tingling.
Types of back pain
As we discussed in the previous section, back pain can be classified according to its anatomical location into the following:
- Cervicalgia, if it originates in the neck region.
- Back pain, if it’s in the upper back of the back.
- Lower back pain, if it’s in the lumbar region, just behind the abdomen.
The sensation of pain originates thanks to the presence of numerous nerves in these areas.
Because these tend to be distributed in distant areas, it’s possible that some pathologies cause irritation of the nerves and transmit the pain to the back, even though the original problem isn’t actually there.
This is the case in urinary system problems and other gastrointestinal disorders, in which pain can sometimes appear in the lumbar region.
Lower back pain can also be classified depending on the pathological mechanism involved in mechanical and inflammatory issues.
The former usually occur due to anatomical problems (such as hernias or compression by tumors), while inflammatory causes cause progressive damage to the interior of the tissue. Rheumatoid arthritis is an example, although it doesn’t usually affect the spine, but rather the small joints of the hand.
What are the causes?
Next, we’re going to explain some conditions and pathologies that can trigger back pain.
Kidney and urinary problems
One of the main differential diagnoses that doctors consider when evaluating a patient with back pain are problems in the urinary system.
Nephritic colic is a very intense type of pain that can extend from the lumbar region to the inguinal region on the same side. This occurs as a result of partial or total obstruction of the urinary tract, usually when there is a stone.
There are many risk factors that influence the development of this condition, especially diets with lots of citrus fruits, carbonated drinks, salt, and little water.
Infectious pathology can also give rise to back pain, which, unlike renal colic, doesn’t usually leave the lumbar region.
This is the case of pyelonephritis, a term referring to inflammation of the kidney tissue, which can be the result of an infection by bacteria such as Escherichia coli. This, in fact, is responsible for many infectious diseases of the urinary tract.
The spinal column is made up of several bony structures called vertebrae, which surround the spinal cord. This last organ gives rise to the peripheral nerves, which are distributed throughout the body to produce movements and capture stimuli.
The vertebrae, in turn, are separated by a soft tissue called the intervertebral disc. In some cases, it can move out of its original place and encompass the area where the nerves come from. This can generate significant compression and stimulation of the vertebrae, which results in severe pain.
The latter, in fact, is the definition of a herniated disc. Like abdominal hernias, it usually occurs with intense physical exertion. Patients with connective tissue problems (such as Ehlers-Danlos syndrome) are more likely to suffer from the disease.
It tends to occur in young people (especially those under 40 years of age) and, in a small proportion of cases, it can cause disabling pain. Surgical resolution is necessary, with the goal of preventing more significant injuries and eliminating the cause of the disease.
This is an inflammatory disease that gives rise to progressive lesions in the vertebrae, especially the lumbar. It usually occurs between 20 and 40 years of age, and has the particularity of occurring in conjunction with other inflammatory diseases, especially in the ocular tissue, giving rise to clinical conditions such as uveitis and iritis.
Patients with ankylosing spondylitis often occur with lower back pain that tends to come and go spontaneously. However, in the absence of specific treatment, spinal deformities may develop, with significant functional (painful) and cosmetic consequences.
We know that it has a strong genetic component, as it has been associated with mutations in various genes. These can be inherited, so having a family history of this type of arthritis considerably increases the risk of suffering from it.
Diagnosing the cause of back pain
In general, the doctor who evaluates a patient with back pain usually reaches the diagnosis through clinical methods and complementary tests. Some of these are as follows:
- Complete blood count. It detects an increase in white blood cells, which suggests an infection.
- Plain radiography. It allows to detect fractures (in case of trauma) and, in rare cases, urinary stones, as long as they’re made of calcium.
- Computed tomography. This is a method that, through the emission of radiation, allows doctors to observe space-occupying lesions that compress nerves.
- Nuclear magnetic resonance. This has the advantage of allowing the nerve structures to be seen in better detail, making it useful for evaluating herniated discs or cervical spine injuries.
This aspect depends a lot on the cause that is triggering the pain. Treatment is usually based on relieving symptoms and eliminating the triggering cause.
- Nonsteroidal anti-inflammatory drugs, such as ibuprofen or diclofenac, are great for reducing pain. They can even be part of the specific treatment in cases of osteoarthritis.
- Surgical resolution is necessary, for example, in herniated discs, trauma, and very large kidney stones. In the latter case, percutaneous nephrolithotomy is one of the procedures most recommended by urologists.
Whatever the situation, a clinical evaluation by competent professionals is necessary.
It’s advisable to go to the doctor to have a timely diagnosis
When the pain is constant, is very annoying, or has associated symptoms, then it’s time to go and see a doctor. The initial consultation can be made with a family doctor, internist, traumatologist, neurosurgeon, or urologist. In some cases, the patient may be referred to another specialist.
- Chavarría J. Lumbalgia: causas, diagnóstico y tratamiento. Revista médica de Costa Rica y Centroamérica 2014;LXXI(611):447-454.
- Duffoo M, et al. Criterios de tratamiento de la hernia discal aislada y de hernias discales múltiples. Ortho-tips 2005;1(2):77-93.
- Fernández M. Lumbalgia y ciática, revisión. Farmacia profesional 2001.
- González Maza Carlos, Moscoso López Luis, Ramírez Elizalde Gastón et al. Tratamiento multimodal para lumbalgia crónica inespecífica. Acta Ortopédica Mexicana 2010; 24(2):
- Karnath Bernard. Clinical Signs of Low Back Pain. Hospital Physician May. 2003; 39-44.
- Peña Sagredo J.L. et al. Fisiopatología de la lumbalgia. Rev Esp Reumatol 2002;29 (10):483-488.