One of the most common ailments that affect almost everyone sometime during their lifetime is back pain. Most cases of back pain are minor and self-limited. Other times severe or persistent back pain may be a symptom of a serious disorder that requires prompt evaluation and treatment. Musculoskeletal back pain (such as strains and sprains) is by far the most frequently seen by healthcare practitioners. This type of pain may be minor and annoying or quite severe and debilitating. Conservative therapy such as rest, ice, heat, and anti-inflammatory medications such as ibuprofen, pain medications such as acetaminophen, massage, stretching, and possibly physical therapy for persistent symptoms is indicated. Recovery usually takes days to weeks.
Other causes of back pain may stem from disease processes in other organ systems including the lungs, heart or aorta, kidneys, pancreas, or gut. For example, pneumonia or pleurisy may cause back pain that is worsened by breathing. Severe tearing pain between the shoulders or lower down the back may be caused from a dissection (tear) or aneurysm (bulging) of the aorta (the large vessel exiting the heart and supplying the body with blood). A heart attack or myocardial infarction that affects the posterior portion of the heart may cause quite severe back pain. Kidney infections or kidney stones may be the origin of excruciating back pain that often radiates down to the groin. Associated symptoms may include fever or vomiting. Inflammation of the pancreas (pancreatitis), ulcers, and gall bladder disease are examples of GI ailments that can present as back pain. A pinched nerve (often from a bulging or ruptured disc in the back) may cause quite severe pain radiating down the leg and occasionally is associated with weakness and/or numbness in the affected leg. Any numbness in the groin area or problems with bowel or bladder function should be evaluated promptly.
How is a patient supposed to determine if his or her back pain is being caused by a simple back strain or sprain or by some of the more serious conditions outlined above? As a general rule, the more benign, self-limited back disorders are milder in intensity, intermittent, associated with activity and relieved by rest. Improvement is often noticed by using over-the-counter medications such as ibuprofen or acetaminophen. The more serious causes of back pain often present as more severe pain that is not relieved by rest and often is serious at night. Frequently other associated symptoms are present such as fever, chills, sweating, vomiting, cough, shortness of breath, etc. As always a visit to your local primary care provider is in order if the origin of the pain is unclear or the pain is severe or persistent.
Article written by Gary Towle, MD