Back pain: where does back pain come from?

We talk about back pain as the evil of the century, as this disorder is widespread.

To know everything about this evil, discover now our complete sheet below.

Back pain, what is it?

We talk about back pain as the evil of the century, as this disorder is widespread.

However, back pain does not designate a particular disease, but rather a set of symptoms that can have multiple causes, serious or not, acute or chronic, inflammatory or mechanical, etc.

This sheet is not intended to list all the possible causes of back pain, but rather to offer a summary of the various possible attacks.

The term rachialgia, which means « spinal pain », is also used to refer to all back pain. Depending on the location of the pain along the spine, we speak of:

Lower back pain: low back pain

when the pain is localized in the lower back at the level of the lumbar vertebrae. Low back pain is the most common condition.

Upper back pain: neck pain

When the pain affects the neck and cervical vertebrae, see the sheet on muscle disorders of the neck.

Pain in the middle of the back: back pain

When the pain affects the dorsal vertebrae, in the middle of the back, it is called back pain

The vast majority of back pain is “common”, that is to say that it is not linked to a serious underlying illness.

How many people experience back pain?

Back pain is extremely common. According to studies, it is estimated that 80-90% of people will experience back pain at least once in their lifetime.

At any given time, about 12-33% of the population complains of back pain, and low back pain in most cases. Over a period of one year, it is considered that 22 to 65% of the population suffers from low back pain. Neck pain is also very common.

In France, back pain is the second cause of consultation with the general practitioner. They are involved in 7% of work stoppages and are the leading cause of disability before the age of 45. In Canada, they are the most common cause of workers’ ^compensation .

It is a very debilitating public health problem all over the world.

The causes of back pain

Many factors can cause back pain.

These may be traumas (shocks, fractures, sprains, etc.), repeated movements (manual handling, vibrations, etc.), osteoarthritis, but also cancerous, infectious or inflammatory diseases. It is therefore difficult to address all the possible causes, but note that:

In 90 to 95% of cases, the origin of the pain is not identified and we speak of “common or non-specific spinal pain”. The pain then comes, in most cases, from lesions at the level of the intervertebral discs or vertebral osteoarthritis, that is to say from wear of the cartilage of the joints. Neck pain, in particular, is very often linked to osteoarthritis.

In 5 to 10% of cases, back pain is linked to a potentially serious underlying disease, which must be diagnosed early, such as cancer, infection, ankylosing spondylitis, cardiovascular or pulmonary problem, etc. .

To determine the cause of back pain, doctors give importance to several criteria :

the seat of pain;
the mode of onset of the pain (gradual or sudden, following a shock or not, etc.) and its evolution;
whether the pain is inflammatory or not. Inflammatory pain is characterized by nocturnal pain, rest pain, nocturnal awakenings and a possible feeling of stiffness in the morning on rising. In contrast, purely mechanical pain is rather aggravated by movement and relieved by rest;
medical history.

As back pain is « non-specific » in the majority of cases, imaging tests such as X-rays, CT scans or MRIs are not always necessary.

Here are some other diseases or factors that can be responsible for back pain :

ankylosing spondylitis and other inflammatory rheumatic diseases;
vertebral fracture;
osteoporosis;
lymphoma;
infection (spondylodiscite) ;
« intra-spinal » tumor (meningioma, neuroma), primary bone tumors or metastases;
spinal deformity.

Back pain : in addition to the causes listed below, pain in the middle of the back can potentially be linked to something other than a spinal problem, in particular a visceral disorder and should lead to a consultation quickly.

They can thus be the result of a cardiovascular disease (infarction, aortic aneurysm, aortic dissection), a pulmonary or digestive disease (gastric or duodenal ulcer, pancreatitis, cancer of the esophagus, stomach or pancreas).

Low back pain: low back pain can also be linked to a kidney, digestive, gynecological, vascular disorder…

Back pain: evolution and possible complications

The complications and evolution obviously depend on the cause of the pain.

When it comes to back pain without underlying disease, the pain can be acute (4 to 12 weeks), and resolve in a few days or weeks, or be chronic (when it lasts more than 12 weeks).

There is a significant risk of « chronicization » of back pain. It is therefore important to consult your doctor quickly to prevent the pain from becoming permanent. However, several tips can help limit this risk (see the Low back pain and neck muscle disorders sheets).

Symptoms differ depending on back pain type and cause.

To discover the complete list of back pain symptoms, consult this sheet.

Back pain: symptoms

Back pain symptoms differ depending on the back pain type and cause.

The pain can be inflammatory or mechanical, sharp or throbbing, localized or diffuse, constant or fluctuating, etc. The intensity of the pain is not proportional to the severity of the attack.

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Some symptoms are considered « red flags » by doctors, that is to say, they are warning signs that could potentially hide a serious condition. They justify the realization of complementary examinations (biology and imagery).

These signs are, among others:

deterioration in general condition or unexplained weight loss;
onset of pain after age 55 or before age 20;
mainly nocturnal pain;
progressive worsening of pain, lack of relief by rest;
history of cancer;
fever or recent infection;
associated neurological signs (paralysis or sensory disturbances, such as the sensation of anesthesia in an area, in an area of the body);
associated chest pain;
radiating pain in one of the thighs (sciatica or cruralgia, herniated disc).

While back pain can affect anyone, some people are more prone to this type of pain.

Find out more in this sheet.

Back pain: who is at risk?

While back pain can affect anyone, some people are more prone to this type of pain, including:

workers forced to carry heavy loads, or perform repetitive movements that put strain on their backs;
pregnant women ;
people over the age of 40 (between 40 and 80) ;
overweight or obese people;
people who do little or no physical activity.

Back pain: the risk factors

Several factors increase the risk of back pain becoming chronic. These factors are ^multiple11 :

low level of education and resources;
job dissatisfaction;
apprehension of movement and attitude of avoidance (when one does not move for fear of hurting oneself);
negative family events (mourning, divorce, etc.);
stress, anxiety or depression;
lack of physical exercise.

Certain preventive measures and treatments can be put in place to prevent the onset of back pain.

Discover them in this sheet.

Back pain prevention

It is difficult to give general prevention advice as the possible causes of back pain are numerous.

If it is a common back pain, without serious pathology, certain measures of hygiene of life and postures make it possible to limit the risk of occurrence and aggravation of pain.

See the fact sheet on low back pain and neck muscle disorders for more information. These tips are also valid for non-specific back pain.

Among these tips:

maintain minimal physical activity;
avoid prolonged bed rest;
pull or push the loads rather than lifting them, maintain the alignment of the vertebrae (do not arch the back and bend the knees);
adjust your workstation properly (in front of the computer, in particular);
practice regular physical activity and an activity to relax the back (yoga, relaxation, etc.).

Back pain: effective treatments

The treatment of non-specific back pain is based on medication, if necessary at the time of painful crises, but above all on non-pharmacological measures (education, muscle building and flexibility exercises, massages, etc.).

Multidisciplinary programs combining pain management, education and counseling sessions, physical exercise and psychological support are the most effective.

In the vast majority of cases, back pain disappears within a few weeks. However, a certain proportion of them become chronic (about 7%). There is then, very often, a vicious circle: the more it hurts, the less the back is strained, the more the muscles weaken, the less they support the spine, and… the more it hurts.

Here is an overview of frequently recommended treatments and measures for non-specific acute and chronic pain.

pain medication

When the pain is intense, several drugs can relieve it, paracetamol (acetaminophen), an analgesic (painkiller) being recommended first. It is important to treat pain effectively as soon as it appears.

Acute back pain

The painkiller treatment can be followed for a few days and involves:

paracetamol (1 g 3 or 4 times a day maximum) or a higher-level analgesic if the doctor deems it necessary (codeine, dextropropoxyphene, tramadol, dihydrocodeine, etc.);
if necessary, the painkiller can be combined with a nonsteroidal anti-inflammatory drug (NSAID) and/or a muscle relaxant (benzodiazepine) if the pain is, at least in part, related to muscle contracture.

Chronic back pain

If the pain becomes chronic (more than 12 weeks), the doctor may prescribe analgesics as a “basic treatment”. Beware, however, of self-medication: painkillers and NSAIDs are not insignificant; nor should they be associated without medical advice.

In some cases, epidural infiltrations of corticosteroids may be proposed, especially during painful flare-ups associated with sciatica or cruralgia. They reduce inflammation.

Finally, tricyclic antidepressants have an anti-pain action and they can be prescribed against chronic low back pain, especially in case of associated depressive syndrome.

Exercises, physical manipulations and massage therapy

In case of back pain, bed rest is never recommended (except in the very painful acute phase, and no more than a few days in this case).

Indeed, many studies ¹³ have shown that prolonged bed rest tends to aggravate pain, by increasing stiffness, decreasing muscle strength but also by fueling fear and establishing an attitude of avoidance (the person has fear of pain, so she avoids potentially painful gestures, and these become even more so).

Osteopathy, physiotherapy (physiotherapy) and massage therapy are effective treatments for back pain, especially when it persists for more than two weeks.

Combining manipulations, bodybuilding exercises (paravertebral and abdominal muscles), exercise rehabilitation, and sometimes electrical stimulation, massage, heat, etc., these techniques make it possible to relax the muscles and improve posture, and prevent the return pain.

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Psychotherapy and education

Certain psychotherapy approaches, such as mind-body approaches, can help break the vicious cycle of chronic pain.

In addition to reducing the intensity of pain, they help to better manage stress, learn to relax and have a more positive attitude. Cognitive-behavioral therapy is one of the most widely used approaches.

More specifically, some patient education programs specifically target chronic back pain (eg back schools).

These programs inform and educate people with back pain, to help them physically remobilize their back without fear, and to learn how to manage pain by adopting good postures and good « hygiene ». lumbar or cervical.

Surgical intervention

Few people with chronic back pain require surgery, but it may be offered for pain associated with sciatica or cruralgia, or for abnormalities or malformations accessible to surgery.

In the event of back pain, certain complementary approaches make it possible to treat it in a more natural way.

Check out the detailed list below.

Back pain: effective complementary approaches

Important. Consult a doctor first to discover a possible physical cause of your back pain. The following unconventional treatments have been tested in people with back pain that was not related to a specific disease.

Most have been evaluated on patients with chronic low back pain. As for the sheet on muscular disorders of the neck, it specifically lists the complementary treatments tested for neck pain.

Osteopathy

Several studies15,16 have shown the effectiveness of osteopathy and chiropractic in cases of persistent back pain. Beware, however, the effectiveness of chiropractic and spinal manipulations is controversial, some studies have not shown any improvement following these techniques, compared to sham manipulations17.

However, doctors advise against spinal manipulation, whether osteopathic or chiropractic, during the acute phase. They can be recommended in the subacute phase (4 to 12 weeks) or chronic.

Yoga

A recent meta-analysis of 10 studies and more than 900 patients with chronic lower back pain indicates that yoga is an effective way to relieve back pain in the short and long term.

Hydrotherapy (spa cures)

The European League Against Rheumatism (EULAR) analyzed 19 clinical trials of balneotherapy and confirmed its usefulness for chronic low back pain, among other joint ailments.

Massage therapy

Several researchers have studied the therapeutic effects of massage in the treatment of back pain. A recent systematic review bringing together 9 publications indicates that the studies20, although insufficient, show some effectiveness of massage in relieving low back pain in the short term.

Consult our Massotherapy sheet.

Acupuncture

With regard to chronic lower back pain, acupuncture seems to be an interesting treatment option, according to a recent meta-analysis

As part of its quality approach, Passeportsanté.net invites you to discover the opinion of a health professional on back pain.

To find out more about back pain, Passeportsanté.net offers a selection of associations and government sites dealing with back pain.

Also, you will be able to find additional information and contact communities or self-help groups allowing you to learn more about the disease.

Back pain: our doctor’s opinion

« It is important to bring your back to life by practicing sports to build it up and keep it flexible. Without this, over the years, the ligaments and tendons will tend to stiffen and if you don’t maintain it, the back freezes and causes pain…

Look at old people who haven’t taken care of it, they tend to stoop. Yoga, dance, gymnastics, think of your back as the axis of your body, the house you live in, the most precious of all. He deserves your attention! »

Back pain: sites of interest

United States

Spine-health.com

A classical medicine resource for all back problems. The content of the site is completely reviewed by a group of doctors.

Canada

Back schools

Back schools are often affiliated with a hospital or clinic. There are truly interactive back schools on the Internet.

The University of Quebec in Abitibi-Témiscamingue designed one with the help of an interdisciplinary team of specialists from Quebec, France, Belgium and China. Free and very comprehensive.

There is a virtual clinic, lots of practical suggestions, a discussion forum, etc. www.ecoledudos.uqat.ca

Canadian Fitness and Lifestyle Research Institute (CFLRI)

Founded in 1980, CFLRI’s mission is to improve the well-being of Canadians by encouraging lifestyle research and adopting an integrated approach. The “Tips to be active” section contains several publications, some of which relate to back pain. www.cflri.ca