Potential causes of back pain

Causes of low back pain

You use your back day in, day out so there is constant strain being applied in nearly everything you do. Activities like bending down, lifting objects and even just sitting down awkwardly can make it vulnerable. Quite often a common cause is wear and tear, or degenerative changes, which usually start to occur in your 30s. We will all experience these changes as we get older, but not everyone will experience symptoms. However, there are lots of other possible causes of pain, such as falling over or injuries such as a disc prolapse (also called a slipped disc).

Read more about low back pain.

What is referred pain?

Referred pain is pain that is felt in an area away from the actual source. This type of pain is caused by nerves from two separate areas of the body, in this case a problematic tissue or joint in the spine and the tissue where the pain is being felt, converging on the same part of the brain. Essentially, this leads to a confusion in the nervous system which recognises the pain in the wrong part of the body.

Referred back pain in the thoracic area, emanating from the joints of the spine, is often felt radiating around the rib cage to the sides. The costovertebral joints which connect the ribs with the spine often refer pain in to the shoulder blade area. Muscular middle spine pain may refer pain in to the scapular area or towards the large trapezius muscle next to the neck.

The lower spinal joints refer to a slightly different area of the pelvis or leg dependent on the level of the lumbar spine that is affected. The upper lumbar levels often refer pain to the front and side of the pelvis or into the groin region. The lower lumbar levels which are far more commonly affected, refer pain in to the gluteal region or the back of the thigh. In rare cases referred pain from the lower spinal joints can even refer pain to the lower leg.

The term referred pain is commonly mistaken as being pain radiating in to an arm or a leg from an inflamed or compressed nerve in the spine. This is actually nerve root pain, or radicular pain as it is sometimes known, which is felt appropriately in the problematic tissue i.e. the nerve itself in the limb which is inflamed.

Can back pain be caused by stress?

There is no evidence to suggest stress may be a cause of developing back pain. However, there is a growing amount of evidence to suggest that stress may contribute to developing long term spinal pain once the back pain is present. For this reason, stress, anxiety and depression are seen frequently in individuals who suffer with long term, widespread spinal pain and as a result some treatments for individuals on back pain may also address these issues.

Screening tools, often in the form of questionnaires, are often used to identify certain lifestyle and psychological factors when an individual initially seeks treatment for back pain. These enable clinicians and the back pain services to address these issues early on in the treatment pathway which has demonstrated to reduce the incidence of long term spinal pain.

The reasons why the development of longer term spinal pain is associated with high stress levels and depression is likely due to a number of reasons. The reduction in general activity levels and fatigue which is a result of long term stress certainly plays a part. Similarly, individuals who are anxious may become more fearful of movement with their spine which has been demonstrated to be unhelpful in reducing back pain.  

Aside from these two reasons long term stress may also cause significant changes to the way in which our neurological system processes information and pain. Under periods of stress our bodies release adrenaline and cortisol to deal with situations. However if our brain, spinal cord and nerves are exposed to these chemicals over a prolonged period of time the nervous system may become more sensitive to pain.

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