Back Pain

Back pain is one of the most common reasons people see a doctor and is a leading cause of disability around the world.  It can range from a muscle ache to a stabbing, shooting, or burning pain.  It can radiate out to the side or down your legs.  It can be mild or can be quite severe and debilitating.  Let's talk more about back pain, including things that you can do to help prevent it from happening to you.

What causes back pain?

There are several things that can cause back pain.  Here are the most common:

• Strain or sprain of a muscle or ligament - This can happen from repeated heavy lifting or from a sudden movement in an awkward position without any lifting. Strain/sprain injuries are more common, if you're in poor physical condition, but can happen to anyone.
• Arthritis - Wear and tear arthritic changes can affect the spine.  This can lead to bone spurs or other changes that can narrow the spinal canal or cause pressure on a nerve.
• Disc problems - The discs in the spine are sort of like gel pads between the bones of your spine (vertebrae).  The soft inside acts as a cushion or shock absorber, and the fibrous casing holds the discs and the vertebrae in proper alignment.  If the soft material inside the disc bulges or ruptures out of the fibrous casing, this can sometimes cause pressure on a nerve or the spinal cord. 

If the fibrous case is damaged, it can cause one vertebral bone to slip out of line a bit.

Osteoporosis - If your bones lose calcium, they become porous and weaker.  In the spine, this can lead to a type of fracture where the vertebral bone collapses on itself, which is very painful.

Does everyone with arthritis of the spine or disc problems have back pain?

No.  In fact, almost everyone develops some degenerative disc disease (DDD) and some arthritic changes in the spine as they get older.  These changes can be seen on imaging studies, such as X-rays or MRIs, even in people who have absolutely no symptoms related to their back.  It is considered a normal part of aging.  Researchers are still trying to understand why some people have back pain and some don't, even with the very same changes of their spine on imaging tests.  There are a number or things that may influence this pain.

Is there a link between smoking and back pain?

Cigarette smoking is an important risk factor for degenerative disc disease (DDD) of the spine.  Smokers are more likely to develop DDD, develop DDD earlier than those who do not smoke, and they are often more symptomatic as well.  Here are some of the reasons for this:

• Nicotine deprives disc cells of vital nutrients they need to stay healthy.
• Smoking increases the level of carbon monoxide in the blood. This also inhibits the ability of the disc to absorb needed nutrients from the blood.
• Smoking causes the discs to become prematurely dehydrated, which makes them less pliable and more susceptible to damage.
• Smoking leads to decreased blood flow to the spine, limiting its ability to heal injuries.
• Smoking increases the overall risk of chronic pain in any location in the body, especially in the spine.
• Smoking leads to increased risk of coughing over time. This abrupt motion, that is sometimes awkward motion, increases the pressure on the discs, and increases the risk of muscle strain.
• People who smoke are typically, on average, less physically active than people who don't smoke, which increases your risk of back pain.

What other factors increase your risk for developing back pain?

Back pain can happen to anyone, even children.  Here are some things that can increase your risk of developing back pain:

• Age - Back pain is more common as you get older, especially over age 40.
• Weak core muscles – Even people who are physically active sometimes don’t do enough to keep the muscles of their back and abdomen strong. The spine relies on the core muscles to help keep it healthy.
• Being overweight or obese - Extra weight puts more stress on your back.
• Inflammatory arthritis - Including rheumatoid, psoriatic, and others, can damage the spine.
• Improper lifting - Using your back instead of your legs, for instance.
• Cancer - Some cancers can spread to the spine.  Some cancer treatments can lead to bone loss in the spine (osteoporosis).
• Psychological conditions - People prone to depression and anxiety appear to have a greater risk of back pain.  Researchers are still trying to understand this connection.

Next week, we will talk more about back pain, including things that you can do to help prevent it from happening to you.

If you have any questions about back pain, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor