Back pain is either neck, mid back or low back pain. Back pain lasting more than 3 months is considered chronic back pain.1 Back pain is caused by abnormalities of paravertebral muscles, facet joint and irritation of the spinal nerve. Paravertebral muscle spasm and facet joint abnormalities causes predominantly only backache. Irritation or pinch of spinal nerve causes backache and radicular pain.
Signs and Symptoms of Back Pain or Backache are:
1. General Symptoms
- Insomnia– Patient is unable to sleep on back if backache is caused by paravertebral muscle spasm or facet joint arthropathy. Sleeping habits of lying on back or side may influence the triggering of pain. Insomnia is because of sudden occurrence of severe pain.2
- Weight Loss– Patient suffering with severe back pain often complaints of loss of appetite resulting in loss of weight. Loss of weight is also secondary to inadequate food intake. Inadequate food intake is also secondary to narcolepsy caused by pain medications. Narcolepsy (sleeps all the time) results in decreased food intake and loss of weight.
- Fever– Fever is rare with back pain. Fever is observed if back pain is caused by disc infection (discitis), osteomyelitis of vertebra or epidural abscess. Fever suggests infection.
- Age– Severe back pain is common among elderly because of degenerative disease. Facet joint osteoarthritis is common among elderly and symptoms are equally divided in cervical (neck) and lumbar (lower back) spine.3
- Loss of Appetite– Loss of appetite is secondary to pain and generalized degenerative disease. Loss of appetite and loss of weight are linked.
- Nausea– Nausea is common because of opioid therapy. Nausea is also observed if cause of the pain is infection.
- Thirst– Patient complaints of increased thirst. Increased thirst is secondary to side effects of the medications either opioid or muscle relaxants.
- Constipation– Constipation is rarely caused by backache disease. Constipation mostly result from side effects of opioid therapy.
- Tiredness– Severe pain and inactive life style causes tiredness. Tiredness is also caused by side effects of pain medications or muscle relaxants.
2. Radicular Pain
Radicular pain is either acute (lasting 3 to 6 months) or chronic (continues after 6 months). Radicular pain is caused by either irritation or pinch of the spinal nerve. Spinal radicular pain is divided in cervical, thoracic and lumbar segments. Radicular pain is also known as radiculopathy when associated with tingling, numbness or weakness.
- Cervical radicular pain travels along the cervical nerve in neck, shoulder and upper arm.
- Pain may or may not be associated with tingling, numbness and weakness of upper extremity. Pain radiates along C5, C6, C7 and C8 nerve distribution.
- Thoracic radicular pain is also known as intercostal neuralgia.
- Pain is spread along the intercostal nerve mostly localized under the ribs.
- Intercostal muscle weakness is difficult to diagnose during clinical examination.
- Symptoms are observed along L1, L2, L3, L4 and L5 Nerves.
- Chronic pain symptom may be associated with sensory abnormal symptoms like tingling and numbness.
- Severe pain may be associated with abnormal motor symptoms like muscle weakness or abnormal joint reflexes.
- Pain may be distributed in one or more than one segment of lumbar spinal nerve.
- Weakness is observed in thigh, calf or feet muscles.
- Numbness and weakness in thigh muscles suggest L2 nerve is pinched or irritated. Similarly tingling, numbness or weakness with pain in knee joint and calf suggest L3 and L4 nerve abnormality.
- Weakness is also observed during ambulation and movements of lower extremities.
3. Tingling and Numbness
- Tingling– Tingling is caused by irritation or pressure over sensory nerve. Tingling symptoms following pain suggest nerve is pinched and treatment may improve the function of the nerve.4
- Numbness– Numbness could be permanent abnormality. Early treatment of the cause of the numbness may improve the symptoms. Severe pressure, squeeze or ischemia causes numbness and immediate removal of cause may prevent permanent numbness.
4. Weakness in Extremity
Weakness in upper or lower leg indicates abnormal function of motor nerve in neck and lumbar dermatome. There are 8 nerves in neck and 5 in lumbar dermatome. The weakness of particular muscles can guide the area of pinch nerve.
5. Autonomic Dysfunction
Bowel and bladder functional disturbances such as urinary and bowel incontinence are observed in few cases suffering with lower back pain.
6. Muscle Spasm
- Muscle spasm is observed in neck, mid back, lower back, upper or lower extremities. Spasm may be associated with weakness.
- Symptoms in specific muscles depend on the particular nerve injury. Location: Neck, mid-back or lower back.
7. Facet Joint Pain
- Facet joint pain is observed following degenerative bone disease or osteoarthritis of the joint.
- Pain may be secondary to trauma causing injury to joint or ligaments.
- Pain is localized over the diseased facet joint.
- Pain is frequent, predictable and recurrent.
- Pain is associated with tender spots over the joint in neck, mid back or lower back.
8. Pain Caused By Ligamentum Flavum Hypertrophy
- Ligamentum flavum hypertrophy is more often seen in male than female.
- Seen in middle to old age male population, rare in younger patients.
- Symptoms are localized over the dermatome of neck, middle back, or lower back.
Dermatomal Distribution of Symptoms:
- Chest wall
- Intercostal nerve.
Lower Back Lesions-
- Lower back