Low Back Pain

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Low back pain is a condition that will affect 80% of the population at some point in their life. Fortunately, for the majority of these cases, the problem will resolve itself without any medical intervention. And, of the low back pain cases that do require medical intervention, the majority of those episodes can be managed without surgery.

Good news, right? Well it is if the problem were well understood. Unfortunately, however, low back pain is not that well understood and has been an enigma to the medical community for centuries.

Part of the problem stems from the lack of fundamental understanding of why pain is experienced in the first place. The last quarter century has seen a marked increase in what we know about back pain. In fact, it’s safe to say that the accumulation of low back pain knowledge over the past 25 years surpasses the understanding of what we knew about back pain for the previous 200 years combined. Yet, despite these advances, low back pain remains a source of controversy and discussion.

The purpose of this article is to provide you with a framework of what we know about low back pain and to provide a foundation from which better questions can be asked. Keep in mind that, while these views are the consensus views of much of the scientific community, they, in no way, represent a definitive position on the matter. Instead, they formulate a logical explanation of the origin of low back pain based on the observation of tens of thousands of patients.

With that in mind, the first step to understanding low back pain is understanding that back pain describes a symptom and not a disease. The reality of this statement perplexes doctors everyday because the second leading reason for a person seeking medical attention is low back pain. And, with low back pain not being a treatable disease, coupled with the poor understanding of the origin of low back pain, and the fact that many of the problems associated with low back pain stem from outside the spine, management of the condition becomes difficult at best.

To assist patients, physicians, and other health care providers with a better understanding of low back pain, I have divided back pain into 5 categories: psychogenic, viscerogenic, neurogenic, vascular, and spondylogenic. A review of each of these entities follows.

Psychogenic Back Pain

Although rare in the truest sense of the word, many times a definitive, organic reason for a person’s back pain cannot be established. As a result, significant emotional overtones based on confusion and cloudiness of the facts can manifest themselves. In these cases, it is important for the treating clinician to wade through these issues, keeping the patient focused on real versus abstract issues. Fortunately, true psychogenic back pain is rare.

Viscerogenic Back Pain

Viscerogenic back pain is back pain that is derived from the organs such as the kidneys or gall bladder. The key to differentiating viscerogenic back pain from pain originating in the spine is that viscerogenic pain is not elicited by activity nor is it relieved by rest. In other words, the pain remains constant.

Vascular Back Pain

Aneurysms and peripheral vascular disease can produce symptoms that mimic the symptoms associated with sciatica or spinal stenosis. However, unlike sciatica or spinal stenosis where the back pain symptoms respond adversely to movement and positively to no movement, movements such as bending, lifting, or stooping, do not affect back pain of a vascular nature.

Neurogentic Back Pain

Neurogenic back pain is classically defined as irritation, tension, or compression of the spinal nerve roots that results in pain or “numbness” in one or both legs. Although diagnostic evidence (MRI, CT scans) may suggest the problem being within the spine, often times the actual source of irritation is well outside the spine. A classic example of neurogenic back pain whose source is outside the spine is piriformis syndrome. What’s important to glean from this discussion is the fact that MRI and CT scans don’t always give us the “answer” to the back pain question. Clinical exam must corroborate the imaging studies for a definitive diagnosis to even be considered.

Spondylogenic Back Pain

Spondylogenic back pain is the most common source of low back pain. The condition refers to pain derived from the spine and its associated structures – ligaments, muscles, joints, etc. The general characteristics of spondylogenic back pain are pain with certain activity and relief of pain with certain rest positions. To some extent, most back pain has a spondylogenic origin.

The 5 generally accepted types of low back pain have been presented. Although by no means complete in their description, the reader should come away with at least a means of asking better questions related to his or her condition.

I certainly welcome your input, comments, and questions. Please use the form below should you have a question or comment.