Backache

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Backache is a symptom, and it can be a symptom of hundreds of different diseases, illnesses and conditions.  Cancer can cause back pain; abscesses and tumours [both in the spine itself and in other organs], can cause back pain; obesity can cause back pain, as the extra weight compresses the spine and disks.  Poor posture when lifting things, or even in general, can cause backache.  Kidney disease can cause backache.  The eHealthme website provides an extremely long list of concomitant illnesses – see LINK for the list .

 It is common, with about nine out of ten adults experiencing it at some point in their life, and five out of ten working adults having it every year. Low back pain (LBP) occurs in all age groups from children to the elderly population.   Low back pain and sciatica disabled Aeneas of Greek mythology, Jacob of Biblical times, Sister Catherine and Thomas Jefferson. [PMID: 2692946]

Globally, years lived with disability caused by LBP increased by 54% between 1990 and 2015.[PMID: 30257145].  Low back and neck pain became the number one cause of disability-adjusted life-years in Spain in 2016, for example, just surpassing ischaemic heart disease [PMID: 30037695].

It is the single leading cause of disability worldwide.

It is a major contributor to missed work.  In the United States, low back pain is the fifth most common reason for physician visits and causes 40% of missed days off work.

It is one symptom where finding the CAUSE is essential, as it can make the difference between early diagnosis and a cure, or no diagnosis until too late and death.

Despite this, in as many as 85% of cases, doctors are unable to diagnose the cause and simply state ‘no physiological cause can be found’.

Symptoms

Backache is classified according to the location of the pain, its origin, its severity and its duration.

Location

Doctors first tend to classify back pain according to where it is felt:

• neck pain (cervical)
• middle back pain (thoracic)
• lower back pain (lumbar) or
• coccydynia (tailbone or sacral pain) 

Lower back pain tends to be the most common area for pain. 

Origin of pain

The key to all diagnosis, - finding the cause - is not the location of the pain but the ORIGIN of the pain.  It can originate from the muscles, nerves, bones, joints or other structures in the spine itself, - the back – or it can also originate from internal structures and in this case it is called referred pain.

The back itself

The spinal cord, nerve roots, vertebral column, and muscles around the spine can all be sources of back pain. 

• The intervertebral discs - Spondylosis is a painful condition of the spine resulting from the degeneration of the intervertebral discs.  It occurs when the discs fail at cushioning the vertebrae. The space between the vertebrae becomes narrower, resulting in compression and irritation of the nerves.  The anterior ligaments of the intervertebral disc are extremely sensitive, and even the slightest injury can cause significant pain.   ‘Spinal disc herniation’, also known as a slipped disc is a tear in the outer, fibrous ring of an intervertebral disc that allows the soft, central portion to bulge out beyond the damaged outer rings.
• The synovial joints of the spine have been identified as one of the primary sources of the pain in approximately one third of people with chronic low back pain, and in most people with neck pain following whiplash.
• Nerves can be affected pinched or damaged.  Radiculopathy is the term used when there is involvement.  The effects can be anything from agonising pain to almost the opposite  -  weakness, tingling and numbness, or difficulty controlling specific muscles.  Because the nervous system is involved, the effects may radiate out from the back into the arms and hands as well as the legs or feet.
• Spine itself - Backache can also be the by-product of having a spine that is deformed in some way, for example:
•  Kyphosis is curvature of the spine that causes the top of the back to appear more rounded than normal. Everyone has some degree of curvature in their spine. ... Sometimes kyphosis doesn't cause any symptoms other than the back appearing abnormally curved or hunched .
•  Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty.
• Kyphoscoliosis is a deformity of the spine characterized by abnormal curvature of the vertebral column in two planes (coronal and sagittal). It is a combination of kyphosis and scoliosis.

Referred pain

Back pain can also be due to referred pain from another source, such as the gallbladder, pancreas, aorta, and kidneys. Referred pain occurs when pain is felt at a location different from the source of the pain. An abdominal aortic aneurysm and ureteral colic can both result in pain felt in the back.

Duration

The next classification used is whether the pain is acute or chronic.   The duration of back pain is considered in two main categories.

• Acute pain lasts no more than 12 weeks, subacute pain refers to the second half of the acute period (6 to 12 weeks)
• Chronic pain is pain which persists beyond 12 weeks.Backache is the most common cause of chronic pain.  

People with chronic back pain can occasionally get the additional symptom of the equivalent of ‘phantom limb’.  Even after apparently being cured and having otherwise normal scans, the person is left with a longer-lasting state of heightened sensitivity to pain. This persistent state maintains pain even after the initial injury has healed.

Severity of pain

The pain may be characterized as a dull ache, shooting or piercing pain, constant agonising pain, or a burning sensation.

Causes

Backache should not be treated as a stand-alone symptom.  It has to be taken with the other symptoms that accompany it before it can be diagnosed.  Someone with backache and weight loss, for example, may have cancer.  Someone with backache, urinary retention, overflow incontinence, loss of anal sphincter tone, or faecal incontinence may have an intestinal or a urinary and bladder disease.  The combination of effects [symptoms], may then lead back to one or more causes, but eventually the cause will always be external to the body irrespective of how much collateral damage it has done in its path.

Thus it is not correct for any doctor to say, ‘ah yes the cause is bladder infection’, to cure the bladder infection you need to know what pathogens or toxins for example you are infected with.

Stress, anxiety, loneliness, grief, anger and depression

Stress is an often overlooked but extremely common cause of backache.  Many studies suggest that ‘psychosocial’ factors such as on-the-job stress and dysfunctional family relationships correlate closely with back pain.  The person unconsciously tenses the back muscles when stressed and this puts pressure on the spine and compresses the disc and nerves.  The person feels the pain and because they are psychologically already stressed, they do not react by relaxing and thus relieving pressure, but by further tensing the muscles.  And so the cycle gets worse – more pain, more tensing, more pressure.  Stress also depresses the immune system, and as the cause of back pain can be pathogens, any depression of the immune system will result in the pathogens being able to increase and act:

Left:  Chair designed to help in muscle relaxation and correct posture whilst working

There is a known relation between chronic back-pain and psychological problems. …. We questioned 39 patients (19 female and 20 male)….. excessive emotional or existential problems were found in 79.5% of the whole cohort. PMID: 30257782

Anxiety and depression have the same effect

So does loneliness

And yet more instances of negative mental outlook

Pregnancy

About 50% of women experience low back pain during pregnancy. It may be severe enough to cause significant pain and disability in up to a third of pregnant women. Back pain typically begins at around 18 weeks gestation, and peaks between 24 and 36 weeks gestation. Approximately 16% of women who experienced back pain during pregnancy report continued back pain after pregnancy.

Biomechanical factors of pregnancy shown to be associated with back pain include increased curvature of the lower back, or lumbar lordosis, to support the added weight on the abdomen. Also, a hormone called relaxin is released during pregnancy that softens the structural tissues in the pelvis and lower back to prepare for vaginal delivery. This softening and increased flexibility of the ligaments and joints in the lower back can result in pain. Back pain in pregnancy is often accompanied by radicular symptoms, suggested to be caused by the fetus pressing on the sacral plexus and lumbar plexus in the pelvis.  Back pain in pregnancy may also be characterized by pain radiating into the thigh and buttocks, night-time pain severe enough to wake the patient, pain that is increased during the night-time, or pain that is increased during the day-time.

Other causes - But great care must be taken as it should never be assumed that back pain in pregnancy is caused by the natural changes that take place during the pregnancy.  Laos, for example, has the highest maternal mortality ratio in mainland Southeast Asia and a high incidence of infectious diseases.
Right: a wedge pillow in memory foam used for support during pregnancy

Physical damage

Physical damage may result from simple wear and tear, to a very specific accident.  A whole host of accidents can result in damage – everything from minor falls, to sports injuries, poorly executed lifting of heavy weights, or other accidents.  For example

The majority of back injuries in athletes generally involve the lumbar spine.  Sward studied 142 top athletes in Sweden and found that the incidence of low back pain ranged from 5% to 85%, depending on the sport.

Physical damage can also result from one’s occupation.  Farm workers, construction industry workers, even office workers sitting in poorly designed chairs or with poor posture can cause wear and tear type damage.  Farming is a physically arduous occupation and this places farm workers at potential risk of musculoskeletal disorders. Tractor drivers, in particular, seem to have more Low Back Pain.

Low back pain is a common occurrence in dancers. Studies have shown its prevalence to be around 12% of all dance type of injuries, however, while acute traumatic injuries to the low back are occasionally seen in dance, most back injuries are the result of "overuse," or repetitive microtrauma. The differential diagnosis of back pain in dancers usually falls into one of four categories--mechanical, discogenic, spondylolytic, and vertebral body fractures--all of which are etiologically linked to overuse.

Dance makes extreme demands on the spine, especially in movements involving leg extension to the rear. Photos by Jaye R. Phillips, courtesy of the Boston Ballet.

Nutritional deprivation

Inadequate nutrition is a known factor in all musculoskeletal disease:

Cold environment and draughts

Nowhere near enough attention is paid to the fact that cold draughts and a cold working environment, perhaps coupled with unsuitable clothing that exposes the back area to that cold, can cause backache and severe pain.  The cold results in both tensing of the muscles, and also reduction in blood supply to them.  Then if any physical activity is undertaken the muscles in the back do not have a sufficient supply of blood, oxygen and nutrients; and strain, tears or damage can result.  For example

Note that the use of cold as a therapeutic measure for backache is counter-productive, as although it may temporarily numb the nerves, it serves to reduce the blood supply to the damaged tissue thereby preventing healing taking place.  If used as the main means of treatment it can result in infection of any wounds, as the immune system cannot work effectively when the blood supply is almost cut off, and oxygenation and nutrition is almost prevented.  Heat therapy [warmth applied to the painful area] has been shown to heal by increasing blood supply to the wound enabling oxygenation, nutrition and immune system function.
[Medical brace with integrated thermal heater shown above right for use in healing and when working in cold environments]

Bacterial infections

All pathogens are capable of getting into the spine, the spinal cord and so on, where they attack the nerves, spine and muscles.  Medical text books are starting to be rewritten around the findings that SOME [not all] back pain may be caused by bacteria

Recent studies have shown that anaerobic bacteria are present in a high percentage of painful, herniated discs …. It is thought that these anaerobic bacteria in the disc may stimulate inflammation through toll-like receptors to further exacerbate disc degeneration. [PMID:  26562470]

As the list of bacteria implicated is extremely long, we have provided some examples along with their PubMed reference numbers so that you can get the details:

• Streptococcus agalactiae, - has caused lumbar spine epidural abscess, facet joint septic arthritis affecting the iliopsoas muscles, and led to urine retention…..[a delay in both diagnosis and aggressive treatment can lead to not only severe neurological deficit but also to septicaemia, multiorgan failure, and death]. PMID: 29534714
• Staphylococcus aureus (MSSA) infection of the lumbar spine leading to septic arthritis of the knee, ankle and sternoclavicular joint. PMID: 29507017
• Streptococcus viridans infection leading to fever, vertebral osteomyelitis with associated paravertebral and epidural abscesses. … ‘the patient reported having had a maxillary tooth extraction followed by a dental implant 2 months prior to the onset of her symptoms’.  PMID:  27268493

It is notable that there is more than one paper on PubMed implicating dental procedures and the bacteria resulting from dental problems with back problems often tumours and abscesses. 

• Streptococcus intermedius in a man with spinal infection, for example, was traced to necrotic dentition [PMID: 29162118]
• Helicobacter cinaedi leading to vertebral osteomyelitis in the Th11-L2 vertebral bodies and discs. PMID:  29321407
• The Granulicatella and Abiotrophia species were also classified until recently as streptococci and natural inhabitants of the oral and urogenital flora. They are uncommonly associated with human pathology, although they can cause septicemia, endocarditis, or bacteremia and backache  PMID:  28939536
• Propionibacterium acnes  - although big question marks hang over whether the bacteria this time is actually benign and helpful as opposed to a pathogen. PMID:  29151051
• Burkholderia Pseudomallei  - Neurosurgeons need to consider melioidosis as a possible rare cause of back pain and possible neurological deterioration. PMID: 30038101
• Treponema pallidum - Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum subspecies pallidum. It can cause backache.  It is called tertiary syphilis of the spinal column and results in destructive bone lesions.

Surgery

One interesting research paper has posed the question –‘ in those cases where bacteria has been found during surgery is the bacteria getting in via the surgical procedure itself, or was it there anyway’? 

We found that bacteria were common in the spinal disc material of people undergoing spinal surgery. …... However, further work is needed to determine whether these organisms are a result of contamination or represent low grade infection of the spine which contributes to chronic low back pain.  PMID:  25609421

Left photo:  A soft foam wedge can be used to relieve pressure on the back and promote a better posture

The following case history shows that the poor woman had undergone four operations for her back pain, none of which was successful, and all of which appear to have been caused  by TB

Viruses

A very large number of viruses can cause backache, here are some examples

And

The symptoms of virus infection are often similar – fever, headache, arthralgia, myalgia, non-purulent conjunctivitis, and lower back pain, rash, and pruritus, meaning tests are always needed.  Some more examples of viruses that have caused back pain, but this time just a list with the PubMed reference numbers so that you can get more details.  It is frequently the case that these viruses exhibit latency and as such the infection of the joints will be chronic ………

• West Nile virus (WNV) - PMID:23910388
• Toscana virus (TOSV)  - PMID:23910388
• Middle East respiratory syndrome coronavirus ( MERS-CoV ) - PMID: 26255008
• Chikungunya Virus - PMID 20404278
• Coxsackievirus -  PMID: 27491355
• Dengue virus  - PMID:  27050192
• Zika virus (ZIKV) - PMID: 27070912
• Parvovirus B19  - PMID: 7971841
• Ebola virus disease (EVD) - EVD survivors infected during the 2014-15 outbreak in Guinea had both inflammatory pain (45%) and low back pain (77%). - PMID: 28371810
• Herpes simplex virus - PMID: 19625294
• Puumala hantavirus PMID:  23121909

Fungal infections

We did not find as many papers implicating fungal disease as the culprit of backache as we did bacteria and viruses, but this may be because fungal infections have not been the subject of tests:

Parasites

Parasites are a known cause of many spinal infections

and

Toxins – Heavy metals

Lead, mercury, aluminium, and cadmium are all heavy metals that are known to cause back pain once they enter the spine.  Itai-itai disease, for example,  is caused by cadmium poisoning and one of the first symptoms in patients is leg/back pain which develop to become severe manifestations such as ambulatory disturbance and bone fractures.[PMID: 16006079]

The way these heavy metals are able to enter the spine is generally via the blood

Occasionally, however, lead enters by different routes

Toxins – Pesticides, Insecticides, Herbicides etc

A number of man-made chemicals have also been associated with backache and back pain.  The chemicals get into the blood stream and then eventually reach and cause damage in the spine, in some people they also appear to cause damage to the brain causing ‘minor psychiatric problems’

And

Toxins – chemical weapons

Pharmaceuticals

The eHealthme website provides a very long list of drugs that could case backache – see LINK.

Pharmaceuticals that decrease immune function, such as chemotherapy, and chronic corticosteroid [immunosupressants] use, increase the risk of developing a whole host of pathological infections.  As we have seen, bacteria, parasites, viruses, fungi and toxins may all cause back ache, thus these pharmaceuticals increase the risk of getting an infection from the pathogen or being attacked by the toxin.

Pharmaceutical intake can also directly cause spinal problems with the symptom of backache.  For example, Spinal epidural hematoma is a collection of blood in the potential space between the dura and the bone, along the spinal canal. Significant bleeding can lead to spinal cord damage, causing neurological injury and deficit and is classified as a neurosurgical emergency:

But there are other ways.  One route used to enter the body is the intestine.  It has been known for some time that antibiotics disrupt the intestinal flora causing gut dysbiosis, but as research proceeds, more and more pharmaceuticals are being implicated:

This means that pharmaceuticals that destroy intestinal flora, also destroy gut protection and the gut may become permeable to pathogens and toxins which then enter the blood stream.  Once in the blood stream, they can go anywhere and cause damage – and this includes the back and all the organs that if diseased may cause back pain.

As such in pharmaceuticals we have a major possible root cause of backache and back pain.

Constipation

Constipation isn’t the root cause of back pain, but now we have shown the correlation between pharmaceuticals and gut dysbiosis this may help to put the following findings in context

In effect, pharmaceuticals can cause gut dysbiosis and gut dysbiosis can cause constipation, and constipation can cause back pain.

Diagnosis and Treatment

The doctor should test for infection by doing a blood test or better a metagenomics test on the blood.  If the backache is chronic or suspected to be caused by physical damage the current practise is to use plain radiographs (x-ray), CT scan, or magnetic resonance imaging (MRI) to help identify the damage.

Doctors generally use palliative treatment – alleviating symptoms. 

Also

But unless one knows the cause this may actually be counter-productive, in some cases it can be dangerous, as such the one thing that must be done is to FIND THE CAUSE.

References and further reading

Because  the number of references we used in preparing this entry is very large, we have placed them in the science section, so that they do not make the section excessively long - all the references can be found by following this LINK

Related observations

Healing observations

• A systematic review of efficacy of McKenzie therapy for spinal pain 027633
• Alexander technique and Supervised Physiotherapy Exercises in back paiN (ASPEN): a four-group randomised feasibility trial 026379
• Alexander Technique Training Coupled With an Integrative Model of Behavioral Prediction in Teachers With Low Back Pain 027452
• An Open Trial of Morning Bright Light Treatment Among US Military Veterans with Chronic Low Back Pain: A Pilot Study 027536
• Can a patient educational book change behavior and reduce pain in chronic low back pain patients 027632
• Devils claw and back pain 005666
• Effect of music therapy among hospitalized patients with chronic low back pain: a controlled, randomized trial 026356
• Effectiveness of back school versus McKenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial 027631
• Effects of exercises with a pelvic realignment device on low-back and pelvic girdle pain after childbirth: A randomized control study 027562
• Effects of flotation-REST on muscle tension pain 027630
• Effects of flotation-restricted environmental stimulation technique on stress-related muscle pain: what makes the difference in therapy--attention-placebo or the relaxation response? 027612
• Effects of Stabilization Exercise Using a Ball on Mutifidus Cross-Sectional Area in Patients with Chronic Low Back Pain 027710
• Erskine, Professor Alexander - The Power of the Sub-conscious Mind – Healing using ‘magnetic energy’ 027267
• Healing low back pain by increasing sleep times and avoiding video games 026357
• Improvement in automatic postural coordination following alexander technique lessons in a person with low back pain 026377
• Loving-kindness meditation for chronic low back pain: results from a pilot trial 026358
• Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint 027634
• Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy with Older Adults: A Qualitative Review of Randomized Controlled Outcome Research 027537
• Mudang spiritual experiences – The kut for Chisun's Grandmother – 01 Introduction 027200
• Mudang spiritual experiences – The kut for Chisun's Grandmother – 02 The preparations and attendees 027201
• Mudang spiritual experiences – The kut for Chisun's Grandmother – 03 Chisun's Grandmother in Possession 027202
• Mudang spiritual experiences – The kut for Chisun's Grandmother – 04 Ritual Murder 027203
• Mudang spiritual experiences – The kut for Chisun's Grandmother – 05 Aftermath 027204
• Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis 026351
• Paul Newman on the benefits of the Alexander technique 027460
• Physiotherapy diagnosis in clinical practice: a survey of orthopaedic certified specialists in the USA 027635
• Randomised controlled trial of Alexander Technique lessons, exercise, and massage (ATEAM) for patients with chronic low back pain 026376
• Roald Dahl on the benefits of the Alexander technique 027461
• Rural workers' experience of low back pain: exploring why they continue to work 027561
• Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial 026384
• Tai Chi for Chronic Pain Conditions: A Systematic Review and Meta-analysis of Randomized Controlled Trials 027642
• The Alexander Technique for Back Pain 026375
• The effect of sensory deprivation in the reduction of pain in patients with chronic low-back pain 027629
• The Effect of Swiss Ball Stabilization Exercise on Pain and Bone Mineral Density of Patients with Chronic Low Back Pain 027711
• The impact of Alexander Technique lessons on chronic mechanical low back pain 026378
• The qigong of 18 Luohan Hands and yoga for prevention of low back pain: A conceptual synthesis 026385
• Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial 026344
• What is the perceived impact of Alexander technique lessons on health status, costs and pain management in the real life setting of an English hospital 027448
• Yoga Journal - Recommended asanas for Back pain 026343

Hallucination

• Apparent lisinopril overdose requiring hemodialysis 027534
• Effect of addition of epidural ketamine to steroid in lumbar radiculitis: one-year follow-up 027535
• Physical, Psychological, Social, and Existential Symptoms in Older Homeless-Experienced Adults: An Observational Study of the Hope Home Cohort 027533
• Prostatic and Central Nervous System Histoplasmosis in an Immunocompetent Host: Case Report and Review of the Prostatic Histoplasmosis 027569
• The neurological complications of chikungunya virus: A systematic review 027559

In time

Synaesthesia, Pure or enhanced perception, Inter composer communication, Vision, Dream, Perception recall, Exploring group perception

• Mudang spiritual experiences – The kut for Chisun's Grandmother – 03 Chisun's Grandmother in Possession 027202
• Mudang spiritual experiences – The kut for Chisun's Grandmother – 04 Ritual Murder 027203

Other observations

• ffects of lifetime occupational pesticide exposure on postural control among farmworkers and non-farmworkers 027720
• The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. 027713
• The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. 027712