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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.

Non-specific low back pain has become a major public health problem worldwide. The lifetime prevalence of low back pain is reported to be as high as 84%, and the prevalence of chronic low back pain is about 23%, with 11-12% of the population being disabled by low back pain.  PMID:  21982256

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’.

The prevalence of Chronic low back pain (CLBP)  in adults has increased more than 100% in the last decade …. affecting both men and women in all ethnic groups…..Answering the question "what is the pain generator" among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a mis-diagnosis can generate therapeutical mistakes. Traditionally, the notion that the etiology of 80% to 90% of LBP cases is unknown has been a mistake …. In most cases, low back pain can be attributed to a specific pain generator, with its own characteristics and with different therapeutical opportunities. PMID:  27408698

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

A few years ago, I had a chronic back problem.  I had been diagnosed with kyphoscoliosis 10 years ago which I had made worse by lifting weights during my twenties.  The chronic problem happened after several months of severe depression.  My back twisted and turned and I felt like I was not only leaning to one side but it felt like my whole back had twisted right round, -it was severe.

So does loneliness

Perceived social isolation is prevalent among patients with low back pain (LBP) …..Some level of social isolation was reported by 39.2% of the participants (n = 80) with 5.9% (n = 12) being very socially isolated. …. PMID: 25185789

And yet more instances of negative mental outlook

Self-reported symptoms of somatization, anxiety, phobic anxiety, obsessive-compulsive, depression and hostility are all more common among patients with low back pain compared to the general population.  PMID:  25964126

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

……………..250 pregnant women were recruited to this study between February 2006 and November 2010.. ……Headache, myalgia, back pain and arthralgia were described by >60% of patients …. Of those with confirmed diagnoses, 132 (53%) had a single disease and among those who had a single disease

  • dengue fever was the most common diagnosis, followed by
  • pyelonephritis,
  • scrub typhus,
  • murine typhus
  • typhoid
  • tuberculosis
  • appendicitis
  • Staphylococcus aureus septicaemia
  • Leptospirosis
  • Japanese encephalitis virus infection
  • and Plasmodium falciparum malaria

PMID:  27050192

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 sacroiliac joint (SIJ) is a diarthrodial joint that has been implicated as a pain generator in approximately 10% to 25% of patients with mechanical low back or leg symptoms. Unique anatomic and physiologic characteristics of SIJ make it susceptible to mechanical stress and also create challenges in the diagnosis of SIJ pain. A variety of inciting causes for SIJ pain may exist, ranging from repetitive low-impact activities such as jogging to increased stress after multilevel spine fusion surgery to high-energy trauma such as in motor vehicle accidents. PMID: 30278010

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.

the prevalence of back pain is significantly higher in farmers exposed to whole body vibration than in those not exposed to vibration. The frequency of back pain is related with whole body vibration, as well as with prolonged sitting position, wrong body posture and physical work load (especially lifting and carrying loads). The prevalence of these symptoms increases with the increased vibration dose and duration of exposure. … Long-term exposure affecting the whole body is harmful to the skeletal system (degeneration of the spine). ….. PMID: 21698878

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.

It is commonly thought by health professionals who specialize in dance medicine that sacroiliac (SI) dysfunction is one of the more common causes of low back pain in dancers. The aetiology of SI dysfunction in dancers is related to both the biomechanics of the SI joint and the physiological demands placed on the SI joint from the dynamics of dance. Injury to the SI joint can be due to a combination of a single traumatic incident, from overuse factors involving repetitive microtrauma or from emotional stress. PMID:  11440519

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:

A decrease in nutrient availability at the bone-disc interface has been indicated as a relevant risk factor and as a possible initiator of cell death processes. …. Results showed that a reduction in metabolite concentrations at the bone-disc boundaries induced cell death …. Slight local mechanical enhancements of glucose in the disc centre were capable of decelerating cell death but occurred only with healthy mechanical properties. … mechanical deformations were responsible for a worsening in terms of cell death in the inner annulus, a disadvantaged zone far from the boundary supply with both an increased cell demand and a strain-dependent decrease of diffusivity. Such adverse mechanical effects were more accentuated when degenerative properties were present. PMID: 24612720

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

Monitoring of indoor climate is an essential part of occupational health and safety. ….. The aim of this study was to evaluate perceived indoor climate among workers with chronic pain compared with pain-free colleagues …. Eighty-two male slaughterhouse workers, 49 with upper-limb chronic pain and 33 pain-free controls, replied to a questionnaire ……. The number of indoor climate complaints was twice as high among workers with chronic pain compared with pain-free controls.   PMID: 26425368

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

Considerable interest has been generated recently regarding an alternative hypothesis for the pathogenesis of low back pain and radiculopathy in the presence of intervertebral disc prolapse. Traditionally, back pain and radicular (sciatic) symptoms have been attributed to mechanical compression of neural tissue by herniated disc material and to inflammation caused by exposure of the nerve roots to disc tissue. Recent research however has suggested that low-grade infection within the intervertebral disc by anaerobic bacteria may be responsible. The development of Modic changes in the corresponding adjacent vertebral endplates has also been suggested as an indicator of infection.  PMID:  25648861

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

The aim of this study was to draw attention to rare spinal infections in recurrent failed spinal surgeries. .. A 59-year-old female was admitted to the hospital for back pain, ….. She had had an operation for L3-4 far lateral disc herniation … Then another operation for L4-5 disc herniation .. and immediately three months later she has an operation with L3-4-5 fixation again. We performed an operation by L4-5 discectomy …. Two days after her surgery, our Infection Disease Department reported acid resistant bacillus (ARB+) in samples and began anti-tuberculosis medication. CONCLUSIONS Spinal infections should always be taken into consideration in recurrent failed back surgeries.  PMID:  29507280

Viruses

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

Herpes zoster (commonly referred to as "shingles") and postherpetic neuralgia result from reactivation of the varicella-zoster virus acquired during the primary varicella infection, or chickenpox. Whereas varicella is generally a disease of childhood, herpes zoster and post-herpetic neuralgia become more common with increasing age. ………..Reactivation of latent varicella-zoster virus from dorsal root ganglia is responsible for the classic dermatomal rash and pain that occur with herpes zoster. ….. With postherpetic neuralgia, a complication of herpes zoster, pain may persist well after resolution of the rash and can be highly debilitating. PMID:  10794584

And

A 50-year-old woman experienced fever, cough, malaise, and low back pain, which had persisted for 6 days before she presented to our hospital, and oedema of the face and limbs, which had persisted for 5 days before her presentation. She was diagnosed with type B influenza infection. PMID: 29973143

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:

Histoplasmosis is an infection caused by a fungus called Histoplasma. Diagnosis of histoplasmosis is based on the culture of biological samples and detection of fungus in tissues. … We report a 65-year-old, immunocompetent, male patient with back pain. We describe the main clinical and radiological characteristics in our patient who had vertebral histoplasmosis that mimicked cancer. A computed tomography scan showed lytic lesions of the right side of T4, T5, and T6 vertebral bodies. Magnetic resonance imaging displayed abnormal marrow signals in T4, T5, and T6 vertebral bodies …. thoracic spinal surgery using the anterior approach was performed. An intraoperative frozen section examination and routine postoperative pathology showed thoracic histoplasmosis infection. PMID: 28606017

Parasites

Parasites are a known cause of many spinal infections

Neurocysticercosis is a common parasitic disease of the CNS that is caused by a pork tapeworm (Taenia solium). …. This report highlights spinal cysticercosis as a cause of low back pain, which is of special interest due to its rare etiology, reportedly accounting for only 1.2% to 5.8% of all cases of neurocysticercosis. PMID: 27868401

and

Spinal schistosomiasis is a severe presentation of Schistosoma mansoni infection, which is endemic in South America, the Middle East, and sub-Saharan Africa. With increasing international travel, a disease can spread from an endemic area to another part of the world easily.  We present a case of a US resident who developed acute paraparesis due to spinal schistosomiasis after traveling to sub-Saharan Africa.  PMID: 20737799

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

In 1984, a 56-year-old house painter developed intractable pain in his back and other joints. After several unrevealing medical work-ups, he was found to have a high blood lead level (122 microg/dL); he has a history of scraping and sanding lead paint without adequate protective measures. The patient was hospitalized and chelated with EDTA four times over the next 5 years; each time he felt better at the end of his treatment, but he returned to largely the same working conditions. He developed hypertension in April 1989, underwent a final chelation, and retired. ….. In 1997 he began calcium supplementation and a high-calcium diet; his blood pressure declined markedly, allowing him to taper off of two of his four antihypertensive medications..  PMID:  11171531

Occasionally, however, lead enters by different routes

The aim of this paper is to describe a clinical case of lead poisoning …...A 42-year-old male was hit by gunshot bullets during a holdup, and one of them was retained in the spinal cord. Six years later, he developed intense low back pain PMID:  19466296

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’

This was a cross-sectional study conducted in southern Brazil. A random sample of tobacco farmers was interviewed.. ….Chronic low back pain prevalence was 8·4%. …. exposure to tasks that require heavy physical exertion (PR 2·00), working in awkward postures (PR 1·36), green tobacco sickness (GTS) (PR 1·63), pesticide poisoning (PR 2·37), and minor psychiatric disorders (PR 2·55) were associated with CLBP.   PMID: 25633930

And

This paper reports four patients with chronic copper poisoning …. The cases … consisted of four members of a farmer family presenting to the emergency department (ED) with malaise, weakness, abdominal pain, headache, dizziness, tightness in the chest, leg and back pain, accompanied by significant anaemia …. The anaemia was attributed to chronic copper exposure acquired from vegetables containing copper….. The patients were discharged with the recommendation on diet to avoid consumption of pesticide-treated vegetables. PMID: 16778371

Toxins – chemical weapons


chemical exposures during deployment have been associated in epidemiologic studies with altered central nervous system functioning in veterans with Gulf War illness - GWI. … Here, we screened the serum of 20 veterans with GWI and 10 non-veterans,  symptomatic with low back pain………….. These results confirm the continuing presence of neuronal injury/gliosis in these veterans and are in agreement with the recent reports indicating that 25years after the war, the health of veterans with GWI is not improving and may be getting worse. PMID: 28286177

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:

The association of spinal epidural haematomata with warfarin therapy has been described and, in 1956, Alderman stated that this diagnosis should be entertained in any patient receiving anticoagulants presenting with low back pain or sciatic pain. The purpose of this case report is to increase the awareness of this entity among medical personnel and to stress the urgency of management.  PMID:  12855034

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:

Recently, consumption of drugs designed to target human cells and not microbes, such as anti-diabetics (metformin), proton pump inhibitors (PPIs), nonsteroidal anti-inflammatory drugs and atypical antipsychotics (AAPs), has been associated with changes in microbiome composition. A larger cohort study suggested that medication can alter gut microbiome composition more generally.
….Here, we screened more than 1,000 marketed drugs against 40 representative gut bacterial strains, and found that 24% of the drugs with human targets, including members of all therapeutic classes, inhibited the growth of at least one strain in vitro. Particular classes, such as the chemically diverse antipsychotics, were overrepresented in this group. …. this is likely to be an underestimate owing to stringent thresholds for calling hits and the limited selection of bacterial strains screened.[ doi:10.1038/nature25979]

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

The current study was conducted on 365 patients with chronic pain. The participants were evaluated on their stool form (the Bristol stool form scale; BSFS), constipation state (the Cleveland clinic constipation score; CCCS), body mass index (BMI), and usual pain severity (numerical rating scale; NRS). …… The Cleveland clinic constipation score showed a significant and positive association with the pain severity of the total patients and patients with low back and/or lower limb pain………….studies showed that stool consistency and constipation were associated with gut microbiome (GM) composition, and enterotype, dysbiosis. … The GM may regulate multiple neurochemical and neurometabolic pathways. Chronicity of the pain is actively modulated at the molecular to the network level by means of several neurotransmitters. The GM to some extent can affect pain perception.  PMID: 30250817

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. 

Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended as the first-line pharmacologic therapy for subacute or chronic low back pain, with opioids reserved for patients who fail on NSAIDs. CYP2D6, CYP2C9, and CYP2C19 genes have variants that place patients using analgesics at risk for adverse events. PMID:  30233232

Also

Topical analgesics represent an alternative treatment modality for patients experiencing acute pain who cannot or choose not to take oral therapies.  PMID:  24547600

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

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