Back Pain

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What is Back Pain?

Back pain, particularly lower back pain, is a very common reason for patients visiting their local doctor. Although the underlying pathology is usually not serious, it is an important cause of pain in the community and has considerable impact on the economy due to time taken off work. Back pain is often secondary to back trauma and usually resolves after a short period of time. Occasionally it may indicate a more serious underlying condition.

Who gets Back Pain?

Back pain is an extremely common condition. Up to 80% of individuals will experience back pain at some time during their lives. The vast majority of patients with back pain will recover within 6 or so weeks, while a small number will go on to develop long-term pain, other symptoms or problems with function. Back pain is one of the leading reasons for a patient to visit a doctor but the underlying cause of the pain is not always obvious.

Men:

Research has shown that approximately 7/10 men will experience back pain at some time in their lives. For the majority of men, there will be no apparent cause or injury and only 2/10 men can identify a particular injury, event or accident to be the cause of the pain. Physicians themselves may have difficulty eliciting the cause of the back pain also.

Women:

Back pain is slightly more common in women than men. A survey of the point prevalence of back pain in workers showed that approximately half of women sufferred recurrent back pain. However, women were less likely to take time off work or to speak to their employer about the pain. Women can suffer back pain from menstruation, pregnancy, arthritis and osteoporosis (thinning of the bones). Studies have shown that around 80% of women suffer back pain during pregnancy. If women experience back pain during mentruation at a young age, they may become used to back pain and not immediately seek medical advice.

Children:

Back pain in children is considered more serious than that in adults. Pain in young children (particularly those under 4 years of age) is more likely to result from a serious underlying disorder. All back pain in children should be considered as serious. If your child has back pain for several days or pain that worsens, medical advice should be sought. This allows early identification of the problem to avoid progression and long-term complications.

Predisposing Factors

Features that suggest an increased likelihood of back pain due to a serious cause include:

Increased age
History of violent trauma or injuries
History of cancer
History of drug use
Weight loss
Fever of unknown cause
Nervous system problems (leg weakness, loss of control of bladder)
Constant unrelieved pain
Use of corticosteroid and blood thinning medications.

Children:

As forementioned, back pain in children should be considered serious. In young children the cause is often sinister such as infection or tumours. Older children may suffer from inflammation, trauma or psychosomatic causes in addition to those above.

Adolescents can quite commonly suffer from Scheuermann's syndrome. In this condition damage to the bones causes the spine to become increasingly rounded (like a hunch back) which can lead to significant deformity and long-term complications.

Stress fractures, slipped vertebrae, tumours and infections are other serious causes to consider but the most common cause is musculoskeletal pain.

Progression

It is often extremely difficult to identify the cause of back pain in the general practice setting. Only a small number of patients will have an underlying disease, and fewer still have a life-threatening condition. Serious conditions include infection, cancer, rheumatologic diseases (rheumatoid arthritis, ankylosing spondylitis) and when there is involvement of the nervous system.

The most common causes of lower back pain are mechanical. Examples include spinal joint dysfunction and disc prolapse (commonly referred to as a 'slipped disc'), muscular strains and arthritis in the spine (which increases as people age).

Serious conditions include cancer (usually from another source such as the prostate or lung), serious infections and compression of the spinal cord.

Other causes include inflammatory arthritis (e.g. ankylosis spondylitis, Reiter's disease and psoriatic arthritis), and fractures due to osteoporosis. Back pain may also be 'referred' from another location.

In degenerative conditions, spinal disease and sacroilliac disease the onset is typically gradual. In contrast, back pain secondary to injury is often sudden in onset and may occur in a previously well individual. Crushing, lifting and twisting forces can lead to bone, ligament and muscular damage respectively.

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