Many cases of back pain don't have a specific cause, but there are some types which do. Back pain can be the result of a sprain or strain caused during sport or heavy lifting, or general ‘wear and tear’ associated with age (often the result of degeneration of the spine) and this type of pain is referred to as ‘mechanical’ back pain.
One in 20 cases of acute low back pain are, however, the result of neuropathic, or nerve root pain such as sciatica where a nerve in the spinal cord is irritated or pressed on (a ‘trapped nerve’). Nine out of 10 cases of nerve root back pain are due to a prolapsed disc, often talked about as a ‘slipped disc’.
Other less common causes include osteoporosis which causes the spinal vertebrae to crush because of a lack of strength, and usually affects the lower or middle of the back.
Ankylosing spondylitis, a type of inflammatory back pain, commonly starts in people under 40. It causes swelling of the joints of the spine, and pain and stiffness in the lower back which doesn't ease with rest.
Rheumatoid arthritis (progressive inflammation of the joints), an autoimmune disease can also affect the spine, as can osteoarthritis, a degenerative disease which affects the joints in the back and neck, as well as elsewhere in the body.
Non-specific back pain typically causes a low-level throbbing or dull ache focused in one area of the lower back although it can spread to either one or both buttocks. The pain generally feels worse if you cough or sneeze.
Ankylosing spondylitis typically gets worse in the second half of the night and results in stiffness on waking, which can take 30 minutes to wear off.
In sciatica, sufferers feel pain shooting along the leg and possibly foot, but other signs are pain in the buttocks and pins and needles. Slipped discs cause numbness, tingling and weakness in parts of the body.
Most cases of non-specific back pain clear up quickly without medical attention, so scans and X-rays are generally not needed.
However, if your pain is accompanied by some of the symptoms outlined above or includes numbness or tingling, chest pain, loss of bladder or bowel control, a temperature of 38 degrees or above, or it started after a car accident or a bad fall you could need further investigation.
Diagnosis should include taking a detailed history of symptoms, a physical examination and a blood test to rule out inflammatory markers. An MRI scan to produce a detailed picture of the area may also be necessary and in some cases, you may need referral to a back specialist or a rheumatologist.
Who gets back pain?
You're more at risk of low back pain if you're over 60, are unfit, overweight, or your job involves heavy lifting or repetitive movement. Equally, though having a inactive job can be bad for your back too.
You could also have an inherited risk, as in ankylosing spondylitis, and smokers are three times more likely to suffer than non-smokers.
Most non-specific lower back pain sufferers treat themselves with a combination of anti-inflammatory painkillers, heat or cold compression patches and gentle exercise such as yoga. Treatment with a physiotherapist may also help.
Inflammatory back pain or rheumatoid arthritis may be treated with drugs including methotrexate, a disease-modifying drug (DMARD) that can help treat the underlying inflammation as well as ease pain.
For sciatic nerve pain, anti-inflammatory painkillers like ibuprofen are recommended. For severe pain, stronger anti-inflammatories such as diclofenac or naproxen can be prescribed but some people (with asthma, high blood pressure, kidney or heart problems) are unable to tolerate anti-inflammatories. Stronger painkillers include codeine or co-codamol (paracetamol and codeine) and tramadol, or a muscle-relaxing drug like diazepam may be needed. Painkillers can be combined with manual therapy by a physiotherapist, an osteopath or chiropractor, however, sometimes surgery is needed for conditions such as slipped discs.
Lifestyle changes such as losing weight, regular exercise, taking care when lifting and improving posture can all help prevent flare ups.