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Back Pain & its Causes

The majority of the population will suffer with back pain at one time in their lives! The range of conditions that cause back pain at different ages is different. Most causes of back pain are simple problems, not sinister, not chronic. Below are the commonest causes of back pain at different ages.


Muscle or ligament strain: common at all ages. Caused by trauma. Usually eases with rest. Often causes muscle spasm (stiff and rigid soft tissues around the injury), which can be very painful;


Intervertebral disc disease (IVDD). IVDD occurs mostly in the low back. Can be acute and severe in the young and middle aged (tear of the outer ‘annulus’ of the disc). Secondary muscle spasm very often occurs. Disc tears can lead to disc prolapse (“slipped disc”) which may then cause pressure on part of the sciatic nerve causing sharp/shooting/burning/severe leg pains to down below the knee or to the foot. In the elderly, IVDD is more likely to cause dull persistent aching pain in the back, sciatica is less likely, and co-existing facet joint osteoarthritis is common (see below);


Vertebral fracture. Rare under 50y old. More common the older the person, and more common in women than in men. Sudden, severe often mid back pain, with pain referred around the rib cage at the same level. There’s an urgent need for X-Ray/MRI and a need to consider vertebroplasty (see link below). The pain from a vertebral fracture can be severe requiring morphine to control the it very often. See link to information on Vertebroplasty below (NOS)


Axial Spondyloarthritis / Ankylosing Spondylitis. Can occur at any age (there is a juvenile form) but typically it occurs for the first time in a young adult. Pain is associated with stiffness in the back, it often disturbs sleep and is there in the morning on waking. The symptoms typically ease with movements (often go completely). Anti-inflammatory painkillers work best! Specialist Rheumatology review is highly recommended because the condition can become chronic, can be severe, can limit lifestyle considerably and there is very effective treatment. See links below also.


Facet joint arthritis. Rare in children, adolescents and young adults. Usually affects the lower back. The usual causes are osteoarthritis (condition of the elderly or middle aged) or psoriatic arthritis (see under Inflammatory Arthritis types). When long-standing, facet joint arthritis can lead to nerve root exit foramen or central lumbar canal narrowing. Essentially with this, the spinal nerves are crowded and compressed by the extra bone that forms around the arthritic joints, and this can cause leg symptoms – stiffening/heaviness worse on walking (though not always pain). The symptoms are often insidious not sudden in onset. When facet joint arthritis is severe, targeted injections can be done (usually in a ‘Pain Clinic’ environment by a specialist Pain Management Anaesthetist or Spinal Orthopedic Surgeon).


Links

About Back Pain generally https://www.versusarthritis.org/about-arthritis/conditions/back-pain


About Vertebroplasty – done to control pain from an acute vertebral fracture. https://nos.org.uk/about-osteoporosis/treating-osteoporosis/percutaneous-vertebroplasty

 
About axial Spondyloarthritis and Ankylosing Spondylitis https://nass.co.uk

See information on Spondyloarthritis on this website: http://www.drgavinclunie.co.uk/inflammatory-arthritis