Back pain is pain experienced in the back, ranging from a dull ache to sharp or shooting sensations. It may develop suddenly after an injury or gradually, and may remain localized or extend into the buttocks or legs. The term describes a symptom rather than a single underlying disease; several contributing factors may coexist. (niams.nih.gov)
Location and duration
The back contains vertebrae, intervertebral discs, muscles, tendons, ligaments, and nervous tissue. Problems involving these structures can produce pain. Upper-back pain involves the thoracic region, while lower-back pain involves the lumbar region and adjacent areas. (niams.nih.gov)
Low back pain is more specifically defined as pain between the lower edge of the ribs and the buttocks. The World Health Organization classifies it by duration as:
- Acute: less than six weeks.
- Subacute: six to twelve weeks.
- Chronic: more than twelve weeks.
These categories describe duration, not the underlying cause. (who.int)
Causes and associated symptoms
Approximately 90% of low back pain is classified as nonspecific: a particular disease or structural cause cannot be confidently identified to explain it. Specific low back pain is attributable to an identifiable condition, tissue injury, or pain referred from another organ. (who.int)
Recognized causes and contributing conditions include:
- Muscle and ligament injuries, including strains and sprains.
- Spinal structural disorders, such as a herniated disc, narrowing of the spinal canal, or displacement of a vertebra.
- Inflammatory disorders affecting spinal joints.
- Vertebral fractures, including those associated with osteoporosis.
- Other medical conditions, including kidney stones, spinal infections, and, less commonly, tumors. (niams.nih.gov)
Sciatica is a related presentation characterized by pain extending into the leg because of irritation of a nerve root in the lower back. Tingling or numbness may accompany it. It is distinct from pain confined to the back. (guysandstthomas.nhs.uk)
Clinical assessment
Diagnostic assessment includes the onset, location, duration, severity, and pattern of pain, together with injury history and effects on daily activities. Physical examination may assess spinal movement, muscle strength, sensation, and reflexes. (niams.nih.gov)
Imaging is not routinely required for uncomplicated low back pain. NICE guidance reserves imaging in specialist settings for circumstances in which the findings are likely to change management. When indicated, X-rays can show fractures and bony alignment; magnetic resonance imaging provides information about discs, nerve roots, and other soft tissues. Blood tests may help investigate suspected inflammatory or other medical conditions. (nice.org.uk)
Clinical warning features include significant trauma, unexplained weight loss, fever, or a history of cancer. New bladder or bowel dysfunction, loss of sensation around the genitals or anus, and bilateral leg weakness or numbness are particularly important features in emergency assessment. These findings raise concern for serious underlying conditions rather than establishing a diagnosis by themselves. (guysandstthomas.nhs.uk)
Treatment approaches
Treatment depends on the cause, symptom pattern, and functional limitations. For nonspecific low back pain, clinical care commonly includes information about the condition, exercise-based interventions, and physical and psychological approaches. NICE guidance places manual therapy within a treatment package that includes exercise, rather than treating it as a stand-alone intervention. (nice.org.uk)
Medication may be used for symptom relief, but suitability varies with other illnesses and treatment risks. Rehabilitation addresses mobility, strength, and participation in everyday activities. Surgery is reserved for selected conditions; examples include removal of herniated disc material or decompression for spinal canal narrowing. Persistent pain alone does not establish suitability for surgery. (niams.nih.gov)
Course and population burden
Many episodes improve within a few weeks, although symptoms can persist or recur. Back pain can interfere with sleep, daily activities, and work. (nhs.uk)
Low back pain is a major public health problem. WHO reports that it affected an estimated 619 million people worldwide in 2020 and was the leading cause of disability globally. Its effects extend beyond pain to reduced quality of life, restricted social participation, and lost work productivity. These estimates concern low back pain specifically, not every form of back pain. (who.int)
References
- Back Pain Symptoms, Types, & Causes | NIAMSniams.nih.gov
- Low back painwho.int
- Back Pain: Diagnosis, Treatment, and Steps to Takeniams.nih.gov
- Recommendations | Low back pain and sciatica in over 16s: assessment and management | Guidance | NICEnice.org.uk
- Low back pain - Overview | Guy's and St Thomas' NHS Foundation Trustguysandstthomas.nhs.uk
- Back pain - NHSnhs.uk