Why Back Pain Should Not Be Ignored?

Back pain is one of the leading causes of disability in the world and is one of the most common reasons for hospital visits. But many people tend to ignore it thinking that it is just a muscle strain. Although most back problems are related to strains of daily life, there are certain serious disorders that can cause back pain too. Neglecting back pain may lead to a delay in diagnosis of any serious condition and result in more complications.

Causes of back pain:

1. Mechanical causes: Recurrent over strain and injury to the discs and other tissues around the spine (muscles, ligaments etc)
2. Degenerative diseases: Age related wear and tear changes of the spine leading to disc prolapse or spinal canal stenosis.
3. Inflammatory disorders: sacroiliitis, ankylosing spondylitis
4. Infections: infections and abscesses in the spine, most commonly Tuberculosis.
5. Cancer: Primary tumors in the spine and cancers from other organs that have spread to the spine

Referred back pain:

Some conditions that are completely unrelated to the back might still cause back pain; this is called referred pain. Many conditions that cause back pain which are confused for a spine related issue include:

• Kidney stones
• pancreatitis
• Colon cancer and prostate cancer
• Gallstones, Gastric or Duodenal ulcers
• Gynecological conditions: Tubal pregnancy, Uterine fibroids, Endometriosis, pelvic infections
• Aortic aneurysms/dissection

What are the complications of untreated back pain?

Back pain is a threat to your productivity. If you have back pain, your ability to do chores related to home or workplace is compromised. Neglecting back pain can have other consequences too:

• Increasing severity of the underlying cause: Based on the pain characteristics itself, one cannot pinpoint the exact cause of back pain. For eg: Sudden severe back pain can be a minor muscle injury, kidney stones or even related to cancer. Thus, if you keep ignoring back pain, the cause of it (which could be minor or major) can get aggravated- at times with serious consequences.
• Chronicity of back pain: Acute back pain is usually due to muscle strain or soft tissue injury around the spine. If you have had some acute back pain, you need to allow it to heal adequately or else, the pain may become chronic (pain that persists for more that 12 weeks). This may impact mental health and reduce quality of life. Rest, pain medications, structured exercise programs and posture correction can prevent your pain from becoming chronic.
• Injury to the spine: When you have back pain, the mechanics of spine gets altered. This may put unnecessary strain on healthy spinal structures and cause spinal injury. In addition, condition like nerve impingement can cause irreversible disabilities if not managed adequately. Vertebral fractures, if not managed can become complicated and may lead to spinal stenosis and damage to spinal nerves. Infections or tumours in spine can lead to spinal cord or b=nerve root compression and result in paralysis if not diagnosed in time and treated appropriately.
• Sleep issues: Back pain may interfere with sleep. Having poor sleep has tremendous impact on physical and mental health.
• Depression: Chronic pain is linked with depression and anxiety. Inability to work, increased medical costs may all aggravate depression.
• Compromised spinal movements: If the back pain is untreated, the spinal mobility is compromised, and the body slowly becomes stiff. Having an inactive lifestyle owing to such factors may lead to other problems like obesity and muscle weakness.

When to seek medical attention?

You should be seeing a doctor if you experience any of the following signs and symptoms:

• Intense Pain: If you experience sharp, stabbing type of pain, you might have a torn muscle or ligament or pathology of an internal organ like kidney stones.
• Radiating pain: If you have radiating pain in your legs, it probably indicates that you have some nerve compression which may need medical intervention.
• Limb weakness: If your back pain is accompanied with limb weakness; it may indicate that you have serious spinal issues like spinal cord stenosis, spinal cancers.
• Tingling numbness in the groin and buttocks region: If your back pain is accompanied with pins and needles sensation in the groin/buttocks area, it may indicate a serious spine pathology like cauda equina syndrome which is a medical emergency.
• Bowel and bladder incontinence: If your back pain is accompanied with incontinence, it may indicate major spinal pathology like spinal stenosis or spinal infection.
• Fever: If you have fever with back pain, it may indicate some underlying infection.
• Night pain or rest pain, sleep disturbance: If there is rest pain or if you feel sudden excruciating back pain at night that wakes up you up from sleep, it could indicate more serious problem like spinal infection or tumour in spine.
• Unexplained weight loss: If you have unexpected weightless along with backache, it may be due to infection or tumors.
• Significant trauma: A back pain that starts after a significant forceful injury may indicate a spinal fracture. In the elderly with weak bones, even a slip and fall at home can cause a fracture.
• Unresponsive to usual medication and rest: Persistent back pain that doesn’t respond to rest and routine pain medications should be brought to medical attention, especially in those above 50 years of age.

Moreover, if your back pain has started after a fall or accident, it may be due to vertebral fracture or herniated discs. So it is always advisable to consult a doctor if your back pain has started after an accident or trauma.

Management of back pain:

Usually if your pain doesn’t last for more than 72 hours; your pain seems to be easing out without any medications, maybe with just some rest, few stretches and little icing- you probably have nothing to worry about. However, if your pain persists for more than 3 days and does not go away despite trying home remedies, it is best to consult a doctor.

If the patient has acute (less than 6 weeks) non-specific back pain:

1. Analgesics, muscle relaxants and/or topical painkillers
2. Home remedies like ice or hot fomentation

Once the pain subsides, physical therapy can be recommended to improve back strength and flexibility. 85% of back pain has non- serious causes which can be managed by the above measures. However, if the patient exhibits any warning signs, the doctor would suggest tests to assess the cause of back pain.

If the pain is persistent and has lasted more than 6 weeks (chronic):

Investigations are needed to identify the underlying cause of back pain. After your complete physical assessment, your doctor may ask you to take any of these tests:

1. Blood tests: To check for infection, arthritis or other systemic pathology that could be contributing to back pain.
2. Imaging tests: Such as X-ray, MRI or CT, to screen for injuries of the vertebrae, discs and soft tissue around the spine

Based on the reports, your treatment course would be decided. You may be given

1. Stronger painkiller medications like opioids or painkiller injections if the pain is non- specific.
2. If a spinal problem is evident, you may be recommended medications, surgery and physical therapy to manage the back problem
3. If the systemic cause is identified, you may be prescribed medications and/ or surgery to treat the cause.

Dr Phani Kiran S

M.B.B.S, M.S (ORTHO), D.N.B (ORTHO), F.N.B. (SPINE SURGERY)

Senior Consultant - Spine Surgeon
Institute of Advanced Spine Science