Back Pain

Back pain is a common health problem in the United States. It can occur at any age in both men and women. Back pain usually starts after an injury or structural problem. Problems with the discs that cushion the spine and various types of arthritis are other causes of back pain. Figuring out the cause of back pain and treating it properly are vital for restoring function. 

Causes

Arthritis
Back pain can be caused by various forms of arthritis, such as: 

• Degenerative disc disease.
• Spinal stenosis.
• Osteoarthritis.
• Axial spondyloarthritis.
• Psoriatic arthritis.
• Enteropathic arthritis.
• Polymyalgia rheumatica.

Injury
Most back pain is due to an injury to the muscles, tendons or ligaments that support the spine. These are usually short-term problems, but in some cases, these injuries can lead to arthritis. 

• Strains or Sprains. When playing sports, gardening or even sneezing, muscles in the back can pull (called a strain) or ligaments can be stretched or torn (called a sprain). The pain of a sprain or strain can be severe and can be localized to one spot or it can hurt all over.
• Spasms. Overworked muscles can go into spasm, causing painful cramps and trouble moving. Spasms are the body's way of protecting itself. When muscles are in spasm, they become painful and rigid, so no further damage can be done.
• Ruptured or Herniated Discs. When the discs that cushion the bones of your spine are weakened, the hard outer covering can split open. This allows the squishy center to bulge out, causing pressure and irritation to nearby nerves.
• Vertebral Fractures. Bones of the spine can break due to trauma. But more often fractures are the result of osteoporosis, which weakens the vertebrae and causes them to crumble. These are called compression fractures.

Other Causes
Back pain is very common, and has many other potential causes, including:

• Pinched nerves. Nerves that get pinched when leaving the spine to the rest of the body (such as sciatica).
• Overuse or inactivity. Strenuous activity can cause muscle soreness. Lying in bed or sitting still can cause muscle and joint stiffness.
• Obesity. Being overweight puts added stress on the back and stomach muscles. 
• Poor posture. Not standing or sitting straight shifts the body out of balance and causes or worsen back pain. 
• Stress. Psychological stress can result in tight back and neck muscles. 
• Kidney stones or infections. Located near your low back, kidney problems can be felt as back pain. 
• Pregnancy. Weight gain can stress the back and stretch the muscles that support the spine.
• Endometriosis. This condition (when tissue that lines the uterus grows outside the uterus) causes pain in the abdomen and back.
• Tumors. In rare cases, tumors – either cancerous or non-cancerous – can affect the back, causing pain.
• Scoliosis. A curvature of the spine can result in muscle imbalance and pain. 

Symptoms

Pain in your back can be position-specific or constant. It may feel achy or burning or sore. Being able to tell the doctor the location and nature of the pain will help in the diagnosis. 

If you have a severe fall or injury, call the doctor. If your back pain is accompanied by any of the following, make an appointment to see a doctor immediately:

• Pain that doesn’t improve when you lie on your back.
• Weakness, pain or numbness in one or both legs.
• Fever or unintentional weight loss.
• Pain during or difficulty urinating.

Diagnosis

A primary doctor can evaluate and treat most cases of back pain. Some more complicated causes of back pain will require referral to a specialist.

A health history, a physical exam and possibly diagnostic tests will be used to make a proper diagnosis and rule out some possible causes of pain.

Some tests the doctor could order include:

• Blood tests. Certain blood markers and genetic tests can help diagnose inflammatory forms of arthritis. 
• Nerve evaluation. The doctor runs a device called a pinwheel along the skin to check for any areas that are either abnormally sensitive or insensitive.
• Muscle tests. The doctor checks the strength of the different muscle groups to detect possible nerve problems.
• Sciatic nerve stretch test. The doctor determines whether stretching the sciatic nerve causes pain, suggesting possible nerve-root problem.
• X-rays. For most cases of simple back pain, X-rays are not necessary. They are most helpful if arthritis, infection, or a tumor is suspected.
• CT, MRI and Bone Scans. Computerized tomography (CT), magnetic resonance imaging (MRI) and bone scans are usually not necessary but can be helpful in determining the cause of chronic back pain. 
• Myelogram. In a myelogram, a special dye is injected into the spinal canal and X-rays are taken. 
• Electromyography. This nerve test determines whether the electrical activity of the nerves has been disrupted because of problems in the back.

Treatment