Why back hurts: causes and treatment

Back pain is a popular disease of modern civilization: almost everyone suffers from back pain at least once in their life. Fortunately, in about 90% of cases, the causes do not threaten health. Therefore, patients themselves can do a lot to combat back pain - from heat compresses to exercises to develop the muscles of the back. Learn more about the causes and treatment of back pain in this article.

short info

• Back pain: are among the most common types of pain and affect mainly women. Most often, back pain is nonspecific.
• Classification:duration (acute, subacute and chronic back pain), position (upper, middle, or lower back) and form (specific and non-specific back pain).
• Causes:there is no reason per se for nonspecific back pain. In contrast, specific back pain has a detectable symptom.
• Surveys:depending on the patient's physical condition: blood and urine tests, neurological examination, gynecological examination, electroneurography, and so on.
• Treatment:Heat treatment, medicinal plants, correct flexion and extension, sports to strengthen the back, workout for the back in the workplace, relaxation techniques, acupuncture, possibly medication

Back pain: description and classification

Low back pain, lumbago, back stiffness, or just back pain are the names of one symptom. Sometimes she squeezes the cross, sometimes she pulls her neck. Sometimes back pain radiates to the side, arms or legs. Symptoms can be permanent or only temporary. Sometimes they are so strong that the victims can barely move.

No matter how varied the nature and extent of complaints: back pain can haunt people of almost any age. They are among the most common problems of modern man. Women in all age groups are more likely to report back pain than men. This phenomenon also manifests itself in other types of pain.

Doctors divide back pain according to different criteria:

Classification by localization of back pain

• Upper back:pain in the upper spine (neck area) can be acute or chronic. It is often felt in the shoulders, arms, and / or the back of the head. Neck pain is caused, for example, by poor posture in the workplace, a herniated disc, or a mental disorder.
• In the middle of the back:Back pain in the thoracic spine is rarely caused by injury. Most often they are caused by irritation of large muscle groups in this area or dysfunction of the joints of the costal vertebrae.
• In the lower back:back pain is most commonly seen in the lower back. Because the lumbar spine is more prone to injury and damage than the neck and thoracic spine. Lower back pain is called "back pain". Possible causes are, for example, herniated discs or muscle strain.

Classification by duration of back pain

Depending on the duration of the symptoms, doctors distinguish between acute, subacute and chronic back pain:

• Acute back pain:This is back pain that occurs for the first time or after at least six months without pain and lasts a maximum of six weeks. The prognosis is generally good: acute back pain disappears in most victims within a few weeks.
• Subacute back pain:if back pain lasts from six weeks to a maximum of three months, they are considered subacute.
• Chronic back painor chronic recurrent back pain: persists for more than three months. The intensity of the pain can change during this time - sometimes the back pain is weaker, sometimes more severe. Chronic back pain is more common with age.

Classification for causes of back pain

Depending on whether it is possible to determine the clear cause of the disease, doctors distinguish between specific and non-specific back pain. Read more in the next section.

Main reasons

Back pain can be roughly divided into two main causes: nonspecific and specific back pain.

Nonspecific back pain

For nonspecific back pain, the doctor cannot find a clear cause for the symptoms. The vast majority of all back pain cases fall into this category.

Specific back pain

An overview of the important causes of specific back pain:

• Muscle tension:very often muscle tension is the cause of back pain. Poor posture, one-sided load or lack of physical activity make the muscles uneven - some muscles are overloaded, others are underutilized. As a result, muscles shorten or harden, which can cause tension and pain. A pinched nerve can also result from muscle tension and cause back pain.
• Herniated disc. . . The discs are located in the form of cushion-shaped shock absorbers between the individual vertebral bodies. They consist of a soft gelatinous core surrounded by a fibrocartigue ring. If the jelly core slips and breaks through the fiber sheath, a herniated disc occurs. This causes severe back pain when the gelatinous mass exiting the sliding disc presses on nearby nerves.
• Abrasion of the spine(arthrosis of the joints of the spine, phase syndrome): with age, the vertebral joints wear out in the body.
• Rachiocampsis. . . In so-called scoliosis, the spine is bent laterally. This leads to premature wear and tear, which can cause muscle tension and back pain. In addition, with the so-called Scheuermann's disease, bends of the spine are characteristic. Consequences are hunchback, back pain and limited mobility.
• Spondylolisthesis(Spondylisthesis): In this condition, the vertebrae are unstable so that they can be easily moved. This occurs especially in the lumbar region. Many patients have little or no complaints. But exercise and certain movements can cause back pain. When the displaced vertebra presses on the nerve root, neurological disorders, such as emotional disturbances or paralysis, are also possible.
• Osteoporosis(bone loss). With osteoporosis, bones become increasingly fragile. Then you can break them even with the smallest loads (e. g. falling, stumbling). This often leads to vertebral fractures that are associated with back pain. Even the harbinger of osteoporosis - osteopenia - may already be associated with back pain.
• Pregnancy: many pregnant women have back pain. There are several reasons for this. For example, hormonal changes in pregnant women lead to relaxation of the tendons and ligaments in the pelvic floor area. As a result, they become unstable, which can cause pain in the pelvis and lower back. In addition, the woman's center of gravity shifts due to the growing fetus. It can also cause back pain. In addition, strokes and premature birth can be associated with back pain.
• Pyelonephritis:Pelvic kidney inflammation is usually caused by bacteria and especially in women. Especially if it is a chronic condition, it can cause long-term back pain.
• Stones in the kidneys:Unlike pelvic kidney inflammation, kidney stones are more common in men. Sometimes they are so small (semolina) that they are simply excreted in the urine through the ureter. Large kidney stones, on the other hand, can become lodged in the ureter. The result is renal colic, which can cause, among other things, burning, cramping back pain, depending on the location of the kidney stone.
• Pneumonia(pneumonia): In addition to coughing with fever and back pain, pneumonia is sometimes attributed. The inflammation is mainly caused by bacteria.
• Inflammation of the pancreas(pancreatitis): Both acute and chronic pancreatitis cause pain in the upper abdomen. It often radiates to the back and is perceived as back pain.
• Spinal swelling and rib swelling:Back pain can also be caused by a tumor in the spine or chest. Sometimes these tumors are benign, sometimes malignant. In the second case, these are almost always secondary tumors of cancerous tumors in other parts of the body, such as breast cancer or lung cancer.

Back pain risk factors

There are several factors that increase the risk of back pain. This is primarily:

• Work-related factors:Carrying and lifting heavy loads, vibrations (for example, when working with a jackhammer) and working in uncomfortable positions put stress on the spine, joints and muscles. This can lead to back pain in the long term. Therefore, some back diseases are recognized as occupational diseases.
• Work-related psychosocial conditions:People who are unhappy with their workplace or have to work monotonously from morning to evening (for example, on an assembly line) are more prone to back pain. In addition, social conflicts in the workplace and high labor intensity without adequate rewards (in the form of money, recognition, promotion opportunities) can contribute to back pain.
• Social status.Back pain is more common in people with low social status in terms of education, profession and income than in people with high social status.

The course of existing back pain can be influenced by adverse conditions such as psychological factors. These include, for example, unrealistic fears of back pain, depression, as well as passive or overactive behavior - that is, expressed restraint or too much activity.

Back pain therapy

With specific back pain, the doctor, if possible, will eliminate the cause of the disease. For example, for a herniated disc, conservative (non-surgical) therapy is usually sufficient, such as thermal treatments, physiotherapy, relaxation techniques, and pain relievers or muscle relaxants. Surgery is rarely necessary. If your back pain is caused by pyelonephritis, your doctor will usually prescribe antibiotics. Most bacteria are the cause of inflammation.

It is best to always consult with your doctor about a technique before trying it.

• Exercise and sports:Physical therapy and back exercises are especially recommended for subacute and chronic non-specific back pain, but not for acute back pain.
• Relaxation procedures:Targeted relaxation helps against stress and tension (both play an important role in back pain). If the pain is already chronic, VUR may also be helpful. By the way, there are other relaxation techniques such as autogenic training and meditation. Many patients with back pain have also had positive experiences in this area.
• Holistic methods and practices:yoga, qigong and tai chi chuan also have a relaxing effect. These complex exercise methods are suitable for preventing lumbago and herniated discs.
• Thermal therapy:Applying heat (eg, heating pads, thermoses, mud baths, fango bags) relaxes the muscles and can relieve nonspecific back pain.
• Medicinal plants:combination preparations of ash and aspen can relieve back pain. For painful muscle tension, a capsaicin cream or patch can help.
• Aromatherapy:If you are experiencing lumbago (back pain), you can rub pine, sandalwood, or ginger oil on the affected area. This can help relieve symptoms.
• Back-friendly nutrition:bones, joints, muscles and discs need a lot of nutrients to function. Make sure you have enough essential fatty acids, calcium, fluoride, vitamins C, D, and E, as well as B vitamins, magnesium, boron, selenium, and zinc. It not only helps the back well, but also contributes to good health in general.
• Drink a lot:The nutrient supply of the intervertebral discs works only with large amounts of fluid.

Back pain medications

Medications reduce back pain so much that physical activity is possible again. Over time, the dose of medication should and can be reduced: as they exercise, patients generally need less medication to move (almost) painlessly. The doctor gives each patient specific instructions as to when the medicine can be used, in what dosage, and for how long. Patients should follow these instructions to avoid side effects or addiction.

Even with specific back pain, drug therapy can be helpful and necessary. Basically it is only for a short time.

In principle, different groups of active ingredients are available for the treatment of back pain. Depending on the type and severity of the symptoms, it depends on which drug is most appropriate in each case:

• conventional pain relievers (analgesics);
• very strong analgesics from the opiate group;
• muscle relaxants: not recommended for non-specific back pain;
• some antidepressants, for example, for chronic nonspecific back pain, when the patient is simultaneously suffering from depression or sleep disturbance

When do you need to see a doctor?

Back pain is not always a sign of a more or less serious medical condition that requires a visit to the doctor. There are often relatively harmless causes behind it, such as muscle tension from lack of exercise or poor posture. However, in the following cases, you should see a doctor for safety reasons:

• atypical back pain
• persistent back pain
• increasing back pain

Important research

These studies help to clarify the causes of complaints:

• cardiac catheterization;
• joint puncture;
• electromyography;
• radiography;
• disease history;
• CT scan;
• scintigraphy;
• ultrasound;
• cystoscopy;
• arthroscopy.

Back pain: examinations

To clarify back pain, your doctor will first talk to you in detail to compile your medical history. Possible questions:

• Where does back pain occur?
• Does your back pain spread to other parts of your body (such as your sides or one leg)?
• How long does the current attack of pain last?
• Have there been any previous cases of back pain? How did the pain proceed?
• Are there factors that cause, worsen, or relieve back pain (eg, fever, coldness, movement)?
• How was back pain treated (medication, massage)? Were the measures successful? Are there any side effects?
• What is the (daily) time course of back pain?
• How bad is your back pain? Do they interfere with daily activities?
• Do you have any concomitant mental or physical illness?

Examination by a doctor

After a medical history, the doctor may conduct various studies to investigate the causes of back pain.

• Blood tests :measurement of various blood parameters can be, for example, evidence of spinal cord abrasion, inflammation (such as pleurisy, prostatitis, pyelitis) or heart attack as a trigger for back pain.
• Analysis of urine:testing a urine sample can clear or strengthen suspicions of kidney disease or acute prostatitis.
• Electromyography (EMG):Measuring the electrical activity of a muscle also serves to identify a herniated disc as a possible cause of back pain.
• Ultrasound procedure:if your back pain is caused by pyelonephritis or kidney stones, an ultrasound can help determine the cause.
• X-ray:a simple x-ray can provide information on various possible causes of back pain, such as pneumonia, pneumothorax, spinal obstruction, spinal inflammation (ankylosing spondylitis), or osteoporosis.
• Computed tomography (CT):performed when there is a suspicion that back pain is caused by a herniated disc, spinal cord abrasions, aortic aneurysm, pancreatitis, or a lung tumor.
• Magnetic resonance imaging (MRI):this test can be used to identify suspicions of a herniated disc or spinal inflammation (ankylosing spondylitis).
• Scintigraphy:This nuclear medicine test determines the state of activity of various tissues, such as bone tissue (bone scintigraphy: suspected ankylosing spondylitis) or lung tissue (lung scintigraphy: suspected pulmonary embolism).

When what research is needed

Physical examination and laboratory tests (blood, urine) are common in diagnosing back pain. In contrast, X-rays - that is, X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) - are only recommended if specific back pain is suspected. In the first clarification, acute and uniformly chronic back pain is deliberately omitted: too many examinations may cause the patient to fear that there may be a serious cause behind back pain that has simply not yet been identified. This can make acute back pain chronic (chronic).