Back pain is still a medical mystery

In spite of the fact that a large majority of adults are subject to back pain at some point and to some extent, and the fact that a huge amount of research has been done on the subject, there is still a lot we don’t know about the causes and the most effective treatments.

The pathophysiology (defined as “the functional changes that accompany a particular syndrome or disease”) of back pain is complex, to say the least. A human back is made up of many interconnected parts including muscles, tissue, bones and nerves.

Muscles are subdivided into different types, bones are of various shapes and angles, and of course nerves are present in all parts, and nerves are how the body sends signals that something is wrong; pain is the body’s warning signal.

The causes of back pain, in particular, can be very hard to diagnose, partly because there are often psychological factors involved; there may be no discernible injury or trauma and no obvious reason for back pain. There is evidence that chronic back pain can be self-perpetuating; in other words the body’s reaction to pain generates spasms that result in a kind of vicious circle of continuing discomfort/pain.

Strains and sprains of the lower back involve injury to spinal muscles and ligaments, respectively; they are difficult to differentiate and treated in basically the same way. Commonly, these ailments are pre-dated by poor posture and lack of muscle conditioning in the patient.

Physicians and researchers often refer to ‘uncomplicated’ or ‘non-specific’ back pain when symptoms are not seen to be caused by obvious injury or by a disease such as endometriosis or kidney stones, for example. Lower back pain is often a result of simple tissue damage, as in a strain or sprain, but in many cases it results from degeneration of the vertebral disks and facets.

The lower back, where the larger lumbar vertebrae connect to the sacral spine, is the area that gets the most mechanical stress during ordinary activity. When degeneration of disks takes place, as it does with aging (and other factors), there is less space for nerve roots. When they are compressed the result is usually painful.

Back pain that radiates into the legs is often the result of degeneration of the lumbar disks, where herniation (or protrusion) into the spinal canal takes place and puts added pressure on nerves that causes pain symptoms in one or both legs.