Back Pain: Causes

Pathogenesis (development of disease)

In the majority of cases (about 85%), nonspecific back pain/cruciate pain is present, i.e., functional conditions, myofascial (affecting muscle and fascia) and ligamentous (affecting ligaments) pain, etc.. Specific back pain/cruciate pain is present in approximately 15% of cases, i.e., there are clear causes (e.g., fractures/bone breaks, tumors, etc.) and correlations with imaging studies. The pathogenesis is very diverse and can range from simple back pain due to poor posture to complicated back pain due to tumors or trauma.Herniated discs (prolapsus nuclei pulposi, discus prolapse) and degenerative changes (spondyloarthritis) are common, leading to pain.

Etiology (causes)

The following causative factors are known to be involved in back pain or low back pain:

Biographic causes

• Genetic stress
  • If both parents suffered from back problems, the adult children were more likely than average to also have this problem
  • Genetic diseases
    • Marfan syndrome – genetic disorder that can be inherited both autosomal-dominantly or occur sporadically (as a new mutation); systemic connective tissue disorder that is most notable for tall stature, spider-limbedness, and hyperextensibility of the joints; 75% of these patients have an aneurysm (pathological (abnormal) bulge in the arterial wall).
    • Spina bifida occulta
• Professions: Professions with
  • Heavy labor (e.g., construction).
  • Carrying and lifting heavy loads (eg, construction, parcel services).
  • Impacts of vibrations on the body (eg, rammers, drills).
  • Working in a seated position (eg, office workers).
  • Work with increased exertion or application of force.
  • Work in awkward posture (forced posture) (eg floor layers, screed layers, hairdressers, watchmakers, dentists).
  • Constantly repetitive work (eg, assembly line workers).

Behavioral causes

• Consumption of stimulants
  • Alcohol
  • Tobacco (smoking) – may be the cause of degenerative disc processes.
• Physical activity
  • Physical inactivity
  • Low physical condition
  • Excessive or incorrectly performed athletic activity
  • Heavy physical work that strains the back (e.g. carrying, lifting heavy loads).
  • Unilateral loads such as long sitting at work.
  • Postural deformities, incorrect loading, overuse
• Psycho-social situation [psychosocial risk factors have a high significance for the chronification of back pain (Evidence Grade (EG), Level A)]
  • Stress
• Overweight (BMI ≥ 25; obesity).

Disease-related causes

Respiratory system (J00-J99)

• Inflammation such as pneumonia (lung inflammation).

Endocrine, nutritional, and metabolic diseases (E00-E90).

• Obesity (overweight)

Cardiovascular system (I00-I99)

• Aortic aneurysm – outpouching (aneurysm) of the aorta.
• Heart and vascular diseases such as myocarditis (inflammation of the heart muscle) or angina pectoris (“chest tightness”; sudden pain in the heart area)/coronary artery disease (CAD; coronary artery disease).
• Vertebral artery dissection

Liver, gallbladder and bile ducts – Pancreas (pancreas) (K70-K77; K80-K87).

• Transfer pain in organ diseases such as pancreatic (pancreas) diseases – e.g., pancreatitis (inflammation of the pancreas), pancreatic cancer (cancer of the pancreas).

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

• Duodenal ulcer (duodenal ulcer).

Musculoskeletal system and connective tissue (M00-M99).

• Acute ligament or muscle pain in the spine.
• Acute irritation condition of the spine
• Acute reversible joint dysfunction – blockage of a joint that spontaneously recedes.
• Arthritis (inflammation of the joint) in the spine.
• Osteoarthritis (joint wear)
• Autoimmune diseases such as ankylosing spondylitis (ankylosing spondylitis; Latinized Greek: spondylitis “inflammation of the vertebrae” and ankylosans “stiffening”) – chronic inflammatory rheumatic disease with pain and stiffening of joints.
• Axial spondyloathritis (SpA) – best known subtype is ankylosing spondylitis (ankylosing spondylitis); first symptoms are deep-seated, often nocturnal back pain and stiffness of the spine; occurrence of the disease usually first in the second to third decade of life
• Costotransverse joint osteoarthritis (osteoarthritis of the vertebral-rib joints).
• Disc prolapse (disc prolapse / herniated disc) – in younger age as a cause of root compression.
• Disc protrusion (disc protrusion / protrusion of the intervertebral disc).
• Diszitis – inflammation of an intervertebral disc.
• Inflammatory diseases of the spine as in osteomyelitis (inflammation of the bone).
• Bekhterev’s disease (ankylosing spondylitis; Latinized Greek: spondylitis “inflammation of the vertebrae” and ankylosans “stiffening”) – chronic inflammatory rheumatic disease with pain and stiffening of joints.
• Scheuermann’s disease (osteochondrosis of the spine) – degenerative changes of bone / cartilage in the area of joints and epiphyses (joint end with bone core), characterized by sclerosis and irregular contouring.
• Osteomalacia (bone softening) with or without fracture (bone fracture).
• Osteomyelitis (bone marrow inflammation)
• Osteoporosis – disease with reduction of bone mass (bone loss) (in older age).
• Osteophyte formation – degenerative bone attachments.
• Osteosclerosis – disease with an increase in bone mass but reduced load-bearing capacity.
• Paget’s disease (synonyms: osteodystrophia deformans, Paget’s disease, Paget’s disease) – disease of the skeletal system in which there is a gradual thickening of several bones, usually the spine, pelvis, extremities or skull.
• Polymyalgia rheumatica (synonym: polymyalgia) – is a disease belonging to the vasculitides (vascular inflammation) with acute pain of the shoulder and pelvic girdle muscles.
• Scoliosis – crooked back due to a bent spine.
• Spina bifida – “open back” due to a defect in embryonic development.
• Spinal stenosis (spinal stenosis, spinal stenosis) – narrowing of the spinal canal.
• Spondylodiscitis (inflammation of the intervertebral disc and the two adjacent vertebral bodies), infectious.
• Spondylolisthesis (spondylolisthesis).
• Spondylosis – collective term for degenerative changes in vertebral bodies (and intervertebral spaces).

Neoplasms – tumor diseases* (C00-D48).

• Cervical carcinoma (cervical cancer).
• Testicular carcinoma (testicular cancer)
• Plasmocytoma (multiple myeloma)
• Skeletal metastases (daughter tumors) – breast carcinoma (breast cancer), prostate carcinoma, bronchial carcinoma (lung cancer), renal cell carcinoma, thyroid carcinoma, Pancreatic carcinoma (cancer of the pancreas), colorectal carcinoma (cancer of the colon), gastric carcinoma, hepatocellular carcinoma, ovarian carcinoma (cancer of the ovary) [listing in decreasing frequency].

Psyche – Nervous System (F00-F99; G00-G99).

• Epidural abscess – collection of pus in the area of the spinal cord membranes.
• Intercostal neuralgia – nerve pain (neuralgia) of the chest wall along an intercostal nerve.
• Sciatica – pain in the area of the sciatic nerve.
• Neuritis (inflammation of the nerve) in diabetes mellitus (diabetes).
• Mental illness – insb. depression
• Psychological factors such as stress

Injuries, poisonings and other consequences of external causes (S00-T98).

• Fracture (fracture of a bone) in the spine.
• Minor trauma (injury) such as contusion (bruise) or sprain (sprain) of the spine
• Vertebral fracture (vertebral fracture) – According to the Osteoporotic Fractures in Men (MrOS) study, less than 15% of all new vertebral fractures are diagnosed in men. Although they are detected radiologically late, they are often noticeable beforehand by back pain and activity limitations.

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

• Postural deformities, incorrect loading, overuse → muscular back pain.

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

• Adnexitis (inflammation of the so-called adnexa (Eng. : appendages), ie, the fallopian tubes and ovaries.
• Nephrolithiasis (kidney stones).
• Pyelonephritis (inflammation of the renal pelvis)
• Urolithiasis (urinary stone disease)

Medication

• Α4β7-integrin antagonist (vedolizumab).
• Glucocorticoids, systemic – osteoporotic fractures (fractures caused by bone loss).
• Opiates – in the withdrawal of opiates.
• Analgesics (painkillers) – in the withdrawal of analgesics.

Operations

• After surgical interventions on the spine: e.g. disc surgery (intervertebral disc surgery) → about 10% postdiscectomy syndrome (Engl. failed back surgery syndrome (FBSS): persistent pain after spinal surgery or pain that occurred as a consequence of surgery postoperatively new.

Intoxications (poisonings).

• Intoxications – alcohol withdrawal, opiate withdrawal, painkiller withdrawal.

Other causes

• Stimulation (Simulant)
• Spinal malalignment: lumbar spine hyperlordosis (“hollow back”); the cause of hyperlordosis is the shortening of the quadriceps femoris muscle (synonyms: four-headed thigh extensor, four-headed thigh muscle) and the accompanying muscular imbalance between agonists and antagonists

* If chronic back pain is present, it must be remembered that it is tumor-related if any of the following are present.