What is causing my back pain? How serious is my pain? Does the timing of my pain matter?
These are just some of the questions that I hear when patients visit me in my office and are searching for answers to understand their back pain. I am going to help break down your back pain, so you can gain a better understanding for what is going on with your own health.
Timing of Back Pain
Back Pain can be acute, subacute or chronic. And the timing for when you first present to a doctor’s office for work-up and treatment can matter on the outcome of your treatment. Therefore, it is critical that you seek help as soon as possible and you visit someone with experience in the treatment of back pain specifically.
Acute back pain is anything less than four weeks. This type of pain is usually due to some sort of trauma, a change that has occurred from a chronic illness, or post-surgery pain. This type of pain has the best outcome in terms of treatment as the person generally presents early and treatment can be tapered as the person heals. Some acute pain can also resolve on its own without treatment. This pain can also recur several times over, resolve completely and then recur. At this point, the pain may start becoming subacute or chronic.
Subacute back pain occurs within four to twelve weeks. It can come on suddenly or can gradually build up from an illness, injury or surgery. This type of pain still can be treated well and may not require on-going medical care to keep symptoms in check. Some subacute pain however may result in a chronic condition.
Chronic back pain occurs after twelve weeks. This usually occurs gradually starting with a non-treated acute injury or illness that gradually becomes an on-going problem with symptoms that can alter ones’ lifestyle and function. This type of back pain is often difficult to treat. It usually requires multiple types of treatments and prolonged medical care.
Causes of Back Pain
The causes of back pain can be broken down into four main categories: Pain caused by 1. Structural issues of the spine, 2. Muscle and Fascia, 3. Nerves or neuropathic pain, 4. Referred pain.
1. For better understanding, the structural issues of the spine can be further broken down into a) problems with the curvature of the spine, b) the alignment of the spine affected by spondylosis or spondylolisthesis, c) the discs between the vertebra, d) the vertebral bones themselves or e) the opening of the bones where nerves and the spinal cord run through, f) facet or joint pain.
a) The curvature of the spine or scoliosis, lumbar lordosis, kyphosis are all types of curvatures of the spine that if significantly pronounced can cause increased pain.
b) The alignment of the spine can be affected by spondylosis, which is a degenerative diseasethat affects the spine, causing the cartilage in the joints to wear down, osteophytes or outgrowth of bone to form leading to possible misalignment. Spondylolisthesis is when a vertebra slips out of place. If significant enough, both conditions can cause pain.
c) Disc bulging and herniations can be painful for several reason. When the disc between the vertebra slips out of place, this may cause malalignment. It may impinge on a nerve or pinch it. It may migrate into the canal causing pressure on nerve roots and the spinal cord itself. The degree of herniation does matter in terms of the type of treatment that makes sense to relieve your pain.
d) The vertebrae themselves can be worn down because of degenerative disease. They can be fractured because of trauma or osteoporosis. Or a tumor can also change the structure of the bone itself. All these things can again change the alignment of the spine, cause pain within the bone itself or cause impingement on the nerves or spinal cord.
e) The spinal canal where the spinal cord runs through or the lateral foramen where the nerves run through can be affected by arthritis. This can cause pinching of the nerves or impingement of the cord itself leading to pain. This is called spinal canal stenosis or lateral foraminal stenosis respectively.
f) Facetogenic pain or pain in the joints between the vertebrae is generally due to degenerative disease or osteoarthritis. This type of pain causes “axial” back pain or pain in a beltline fashion across your back.
2. The muscles and fascia that surround the spine play an important role in stabilizing the spine. This is why physical therapy is so important in the treatment of back pain as it helps to condition and build the muscles around the spine. The more stable your spine is, the less pain you feel. If the muscles become tight or develop spasms because of injury, illness, or post-surgery, for example, this can cause pain. Muscles can also become strained causing pain from overuse, poor posture or poor body mechanics.
3. The nerves that travel through the foramen in the spine can become pinched, injured, or severed due to trauma or surgery. The term neuropathic pain describes pain caused because of nerves being affected. Radiculopathy is a term used to describe pain travelling from the nerve roots in your spine, along your nerves, to your extremities. Nerves can become pinched because of several reasons, but the most common being a herniated disc or arthritis (degenerative disease) in the spine.
4. Pain that is referred, is pain that is caused or started elsewhere in the body, usually an affected organ, but is felt in the back. So, an example would be inflammation of the gallbladder or cholecystitis. Although the cause of a person’s pain is from the gallbladder, it is often felt at the tip of the scapula.
How serious is my back pain? Do I need surgery?
Once the possible cause of your pain is identified by clinical physical exam and history taking, an x-ray, MRI of your spine and possibly EMG/NCS can be ordered to further investigate your pain. Whether or not you need surgery will depend on the severity of your symptoms, where in your spine your pain is located and how severe the findings are. Most back pain can be relieved with some combination of simple non-narcotic medications, physical therapy/muscle conditioning and strengthening, injections, various modalities and advice on proper body mechanics. This is why it is critical to seek help from individuals who have experience in treating back pain and who can guide you appropriately.
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