Different types of back pain signals usually travel in response to nociception – the perception of pain within or outside the body, often caused by unwanted (“noxious”) stimuli. These signals travel through the nervous system to the brain, and pain’s typical function is to warn us of danger. The problem is immensely useful and one of the most important senses to surviving out in the world. But pain can become a warped sense, a burden rather than a blessing.
Chronic pain in particular – which is pain that has far outstayed its welcome – negatively affects roughly 50 million American adults every year and contributes to a staggering $635 billion in healthcare costs. Impairing chronic lower back pain is the most common kind of severe chronic pain, occurring in about 10 percent of people. Understanding how and why it happens helps us understand how pain itself is characterized and diagnosed.
Acute Back Pain
Acute pain describes any pain that immediately derives from damage or injury. Acute pain can last several weeks and is considered sensitive so long as the original injury or damage to the tissue is still healing. The line between acute and chronic pain can be blurry at times.
For example, when healing from particularly invasive surgery, one might consider weeks and weeks of pain to be “chronic,” but that would typically still be acute pain (until the pain continues to persist far past the expected recovery period). Acute back pain can be caused by:
- Direct damage to the back or spine (trauma or impact)
- Acute inflammation around the spine (in response to injury)
- Minor slipped/herniated disc.
- Muscle strain
- Kidney pain (infection or kidney stones)
- Back pain related to the ovaries and uterus (uterine fibroids, ovarian cysts, etc.)
- Post-surgical pain
- Short-term nerve compression
These are examples of the types of back pain that can be resolved with immediate treatment. Some of these types of back pain can be linked to other conditions that may cause chronic pain, and they may develop into chronic pain (or become recurring injuries).
Chronic Back Pain
Chronic back pain is described as a pain sensation that lasts or recurs for more than 4-6 months. Different sources will define different exact timeframes – some consider a source of pain to be chronic within three months, while others wait for six – and it depends on whether the basis of the pain can be identified as something requiring treatment for chronic pain (such as fibromyalgia, cancer, or arthritis), or not.
Chronic back pain can be a complicated issue to treat because the pain’s origin can vary greatly. Common examples of different types of back pain conditions include:
- Spine curvatures (scoliosis, kyphosis)
- Osteoarthritis (disc degeneration)
- Rheumatoid arthritis
- Psoriatic arthritis
- Spinal stenosis
- Ankylosing spondylitis
- Scar tissue around the spine
- Chronic fatigue syndrome
Some of these can be caused by continuous trauma and stress to the spine, through overuse or improper lifting techniques, as well as lifestyle habits that weaken or further degenerate bone and cartilage, including a low-calcium diet, a vitamin D deficiency, smoking, obesity, or sedentary living. Other causes are inherited, such as most cases of excessive spine curvature and fibromyalgia. Sometimes, chronic pain in other parts of the body (such as the legs, arms, hands, and feet) can originate in the back.
Some causes of chronic pain may be concurrent. Someone with excessive spine curvature may be more likely to experience disc degeneration or a form of arthritis. Each of these conditions has its variables to consider for treatment, and some are more likely to require invasive treatment than others. Some conditions, including many forms of arthritis, are deemed life-long and require pain management and continuing therapy, rather than a short-term treatment plan.
Neuropathic Back Pain
With the spinal cord running through the back, it is no wonder that many forms of chronic back pain end up being caused by some form of neuropathic pain. Where nociceptive pain is pain described by the nerves to the brain due to tissue damage, neuropathic pain is caused by damage to those nerves, either through compression, trauma, lack of blood flow, infection, etc. The most common cause of neuropathic back pain is a swollen or herniated disc.
Discs are jelly-filled shock absorbers between each bony vertebrae, and they can be herniated (swollen/ruptured), bulging, thinning, or degenerative (becoming weaker). Because the spinal cord and its many nerve roots run throughout the spine and connect to the peripheral nervous system throughout the body, it’s easy for these swollen or damaged discs to press on one of these nerve roots, causing pain, weakness, tingling, and other symptoms in various parts of the body.
The most common of these conditions is sciatica, wherein swollen discs in the lower back compress the sciatic nerve’s nerve roots. The result is pain running through the buttocks and thigh, all the way down into the foot. Swollen or degenerating discs are not always the cause of nerve compressions in the back. Other causes include tense muscles, inflammation due to injury or infection, and cancer. These nerve compressions can occur all along the spine.
Spinal stenosis, which describes a narrowing of the spine’s spaces, can compress the spinal cord and its nerves at different points throughout the back, causing various symptoms such as loss of strength and control and severe pain. Direct damage to the nerve or its surrounding tissue can result in neuropathic pain due to scarring. Demyelination is another massive cause of neuropathic pain in the back.
Some causes of demyelination include alcohol abuse, oxygen deficiency (due to a stroke), nutritional deficiencies, multiple sclerosis, metabolic disorders (such as lysosomal storage disorders), and autoimmune conditions (such as lupus). Neuropathic chronic back pain can be difficult to treat depending on its origin and may require several diagnoses.
Types of Back Pain Associated With Mental Health Problems
Some types of back pain are not just an expression of physical discomfort. It impacts mood and mental health – and in turn, how we feel and digest our emotions while in pain can influence just how much pain we are experiencing. Chronic pain can exacerbate depressive conditions and lead to occasional episodes of depression in those who have not previously been diagnosed with a mental health disorder.
Furthermore, improving mental health – by finding healthy ways to cope, spending time with loved ones, engaging in enjoyable activities, and more – can reduce pain perception by a significant margin. A pain management plan will have to consider physical and mental needs and improve both physiologically and emotionally. This is especially important in chronic pain cases, where a multimodal approach to pain management is critical.
In some cases, talk therapy, group therapy, and mood disorder medication may further help reduce pain in the long-term. Back pain is an encompassing feeling of discomfort but can be caused by an overwhelmingly long list of conditions, injuries, and activities. It is essential to seek professional help to figure out where your back pain is coming from sooner rather than later and address the problem while still manageable.