Back Pain.

Figure 3 - Healthy disc versus ruptured disc

Figure 4 - The parts of a joint, including cartilage

Causes and effects

What causes back pain?

Back pain can be a symptom of arthritis or many other conditions; this material is intended for anyone who has back pain, regardless of the cause.

Anything that puts pressure on your back muscles or nerves can cause pain. Any illness or damage to your spine also can cause pain. The cause of most acute back pain is unknown, but probably is due to minor strains, sprains and overuse. Emotional stress may add to the pain, especially since it slows the rate of recovery. Other possible causes of back pain are listed below.

Ruptured intervertebral disc

This may be the most painful, yet easiest condition to identify. A ruptured or herniated disc is one that bulges into the spinal canal, pressing on the nerve roots (see figure 3). This causes the nerve roots to become irritated. A disc can rupture after bending over and lifting, or it may occur for no apparent reason. A ruptured disc may cause back pain and muscle spasms, but a more common symptom is sciatic pain. This is severe pain spreading down one leg and often into the foot. Sometimes it is the only symptom of a ruptured disc. A ruptured disc usually can be detected by a physical examination alone. Sometimes a procedure such as a myelogram, computerized axial tomography (CAT) scan, or magnetic resonance imaging (MRI) is needed to confirm the diagnosis and determine if surgery is necessary.

Spinal stenosis

In spinal stenosis, the spinal canal becomes narrowed. This squeezes the back nerves and puts pressure on them. It is this pressure that causes the back pain. Numbness, pain and weakness in the legs also can occur. The most common symptom of spinal stenosis is pain that worsens when walking and subsides when sitting down.

Osteoarthritis is just one form of arthritis that can cause back pain. It breaks down the cartilage (soft, elastic material) that cushions the spinal joints and other joints in the body (see figure 4). Lower back pain can become more intense when osteoarthritis affects the hips or the knees. Osteoarthritis also can directly affect the spine, causing muscles, tendons, or ligaments to become strained, which can lead to back and/or neck pain.

Ankylosing Spondylitis

Ankylosing spondylitis is a form of arthritis causes the joints in the spine to become stiff and swollen. In time, stiff joints can fuse (grow together). The most common symptoms are pain and stiffness in the buttocks and lower back (particularly in the morning) that continue for more than three months.

Injury or accident

Have you ever moved a piece of furniture that didn't seem too heavy, only to feel pain in your back the next day? Have you ever stretched for something that was just a little out of your reach and felt a twinge in your back? Many back injuries are caused by an unexpected twist or sudden motion. This usually results in muscle strain.

With either an injury or accident, severe muscle spasms usually last 48 to 72 hours. They generally are followed by days or weeks of less-severe pain. It usually takes two to four weeks to heal completely from a mild back injury. It could take from six to 12 weeks if there are strained ligaments or if the strain is more severe. Severe back injury from a fall or accident may require hospitalization and a longer recovery period.

Osteoporosis

Osteoporosis is a type of bone disorder that causes bones to become thin and weak due to calcium loss. Fragile bones, especially those bones in the spinal column, can break more easily, and there is an increased tendency for this to happen in older women. Osteoporosis also contributes to compression fractures, or spinal fractures in which the vertebrae become flattened. Falls, lifting heavy objects or moving the wrong way can result in a compression fracture.

Rheumatoid Arthritis

Rheumatoid arthritis causes any joint to become stiff, painful and swollen. It can affect the neck but almost never the joints in the lower back.

Polymyalgia Rheumatica (PMR)

Polymyalgia rheumatica is a rheumatic disorder that causes muscle pain, aching and stiffness in the neck and shoulders, lower back, thighs and hips. It can last a few months or many years. Most people experience severe stiffness in the morning.

Fibromyalgia

People with fibromyalgia feel pain and stiffness in muscles and tendons, especially in the neck and upper back. The pain can last for weeks, months or years. The symptoms may disappear by themselves. This condition often is related to sleep problems, poor conditioning or an old injury.

Paget's Disease

Paget's disease is a type of disorder in which the calcium in the bone spreads unevenly. The bones most commonly affected are in the lower back, pelvis, tailbone, skull and long bones of the legs.

Back pain may be a symptom, but most often there are no obvious symptoms. Paget's disease usually is discovered on an X-ray or bone scan done for reasons other than pain.

Other conditions

Sometimes pain felt in the back actually originates elsewhere in the body. Such problems may include:

• prostate trouble in men
• problems with reproductive organs in women
• kidney diseases, such as an infection or kidney stone
• diseases of the intestines or pancreas, such as cancer or a blockage
• cancer that has spread to the spine
• multiple myeloma, a form of cancer of the bone and bone marrow
• curvature of the spine
• rarely, a tumor on the spinal cord

What does back pain do?

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