Brief overview
- abstract: disease of civilization, almost everybody is affected at least once in his life especially by back pain in the lower back, women more frequently, classification among others according to localization (upper, middle or lower back), duration (acute, subacute and chronic back pain) and cause (specific and non-specific back pain).
- Treatment: For specific back pain, treatment of the cause. For non-specific back pain, among other things, correct bending and lifting, exercise and back-friendly sports, back school, back-friendly workplace, relaxation techniques, heat treatment, medicinal plants, possibly medications and alternative healing methods.
- When to see a doctor? If back pain occurs untypically, persists and/or increases, a visit to the doctor is advisable.
What is back pain?
Back pain is a multifaceted affliction and has various names such as lifting, low back pain, lumbago, stiff back or simply “having it in the back”. Sometimes it presses in the back, sometimes it pulls in the neck. Sometimes the back pain moves to the side of the back, arms or legs. The complaints are persistent or occur only intermittently.
Back pain is a disease of civilization, almost everyone is affected at least once in life, especially by lower back pain. Usually not just once either. Women in all age groups are also more frequently affected by back pain than men – a phenomenon that is also evident in other types of pain.
Doctors classify back pain according to different factors, including:
- Duration: How long does the back pain last? Acute: Up to six weeks. Subacute: Between six and a maximum of twelve weeks. Chronic: Longer than three months. Recurrent: Recurring within six months.
- Cause: Is a definite cause detectable (specific back pain) or not detectable (nonspecific/non-specific back pain)?
What are the causes of back pain?
For the vast majority of all cases of back pain, no specific causes can be found. Specific back pain has a clearly identifiable cause. Depending on the cause, back pain sometimes occurs in different places, although it is not always due to diseases of the spine.
Back pain – upper back
Upper back pain is pain that occurs at the top of the spine (neck region). It often radiates to the shoulders, arms and/or back of the head. Triggers for neck pain include:
Muscle tension
As a result, muscles shorten or harden, which may cause tension and pain. Muscle tension sometimes also leads to a pinched nerve, causing back pain.
Herniated disc
When the gelatinous core slips and breaks through the fibrous sheath, a herniated disc is present. It causes severe back pain when the jelly mass escaping from the slipped disc presses on the neighboring nerves. In the neck and upper chest area, this also leads to radiating pain in the shoulders, arms and/or hands, among other things.
Blockage (vertebral blockage, vertebral malposition)
Vertebral blockages sometimes cause pain in the muscles, vertebral joints or the exit channels of the nerves from the spinal cord and often occur on one side. Blockages in the upper back, for example, lead to a stiff neck, pain in the neck or shoulder area. Sometimes the pain radiates into the arms.
Pancoast tumor
Back pain – middle back
Back pain in the thoracic spine is rarely caused by injuries. More often, they are triggered by irritations (irritations) of large muscle groups in this area or by dysfunctions of the rib-vertebral joints.
Just as in the upper back, muscle tension, herniated discs or blockages sometimes cause pain in the middle back. In addition, other possible causes of pain in the middle back include:
This refers to chronic rheumatic inflammation of the spine and the joint that connects the spine to the ilium (sacroiliac joint).
The progressive disease triggers deep-seated back pain in the middle and lower back and often causes the joints to become increasingly stiff over time. Doctors also refer to ankylosing spondylitis, which translates as “stiffening vertebral inflammation.”
Osteoporosis (bone loss)
Even the preliminary stage of osteoporosis – osteopenia – is already accompanied by back pain in some cases. It is possible that osteoporosis leads to a hunchback. The vertebral bodies of the thoracic as well as the lumbar region are particularly affected.
Diseases of the esophagus
Inflammation of the esophagus (reflux disease) primarily causes burning pain behind the breastbone (heartburn). These sometimes radiate to the middle and upper back.
In addition, esophageal spasm also leads to mid-back pain. In this case, spasms of the esophageal muscles occur – spontaneously or triggered by swallowing. The food can then not be transported further towards the stomach. It backs up, causing severe pain behind the sternum as well as radiating to neighboring regions of the body such as the back.
Heart disease
Also, in the case of a heart attack, the pain that occurs in the heart area often radiates to other regions of the body, for example, between the shoulder blades into the back. Sometimes back pain masks inflammation of the heart muscle or the pericardium. Triggers of such inflammations are usually viruses or bacteria.
Dilatation of the aorta (aortic aneurysm)
Diseases of the lungs
In addition to cough and fever, back pain is sometimes due to inflammation of the lungs. The cause of the inflammation is usually bacteria. In a collapsed lung (pneumothorax), air collects in the narrow space between the lung and the chest wall (pleural space or pleural fissure).
A pulmonary embolism (pulmonary infarction) occurs when a blood clot that has washed up blocks the blood flow in a pulmonary artery. The result is chest pain that continues backward, as in pneumothorax, and sometimes back pain in the mid-chest area (thorax).
Spinal tumor and rib tumor
The cause of back pain in some cases is also a spinal tumor or rib tumor. Sometimes such tumors are benign, sometimes malignant. In the second case, they are almost always daughter tumors of cancerous tumors in other parts of the body, such as breast or lung cancer.
Inflammation of the pancreas (pancreatitis)
Diseases of the kidneys
Renal pelvic inflammation often triggers lateral back pain when pressure is applied (tapping pain). Doctors call this flank pain, which is pain on the left or right side of the spine, or lateral pain at the level of the kidney bed.
Triggers are usually bacteria and often affected by it, especially women. Especially if the inflammation of the renal pelvis is chronic, it causes long-lasting back pain.
The result is renal colic, which, depending on the location of the kidney stone, causes, among other things, wavelike, cramping and stabbing pain in the middle of the back.
Back pain – lower back
Back pain is most commonly located in the lower back. This is because the lumbar spine (LS) is more prone to injury and damage than the cervical and especially thoracic spine. Possible causes include:
Muscle tension
Sacroiliac Joint Syndrome (ISG Syndrome)
Sacroiliac joint syndrome is an example of vertebral blockage and is quite common. Here, the articular surfaces of the sacroiliac joint shift against each other and block due to increased muscle tension. This sometimes causes back pain.
Herniated disc
In addition to the cervical spine, herniated discs occur primarily in the lumbar spine, and less commonly in the thoracic spine. Most often, people pinch the sciatic nerve. This thickest and longest nerve in the body runs down the back of the thigh to the foot after multiple branching.
Wear and tear of the spine (osteoarthritis of the spinal joints, facet syndrome).
Occurs most often in the lower back (lumbar facet syndrome). As we age, the spinal joints in the body wear out. If this age-related wear and tear on the joints goes beyond normal levels, doctors refer to it as osteoarthritis. Such osteoarthritis of the spinal joints also causes back pain.
Spinal stenosis (spinal canal stenosis)
Spinal curvature
Scoliosis, the lateral curvature of the spine, also occurs in the lower back. The lateral curvature of the spine may cause lower back pain, tension and possible misalignment of the pelvis.
Spinal inflammation (ankylosing spondylitis).
In addition to pain in the mid-back, this chronic rheumatic disease also causes pain in the lumbar region.
Slipped vertebrae (spondylolisthesis)
Many sufferers have no or hardly any complaints. Sometimes, however, back pain is experienced, for example, during stress and certain movements. If a displaced vertebra presses on a nerve root, sensory disturbances or paralysis are also possible.
Osteoporosis (bone loss)
Osteoporosis also causes pain in the lower back when the bones become increasingly brittle.
Pregnancy
In addition, the growing unborn child shifts the woman’s center of gravity. To compensate, many pregnant women fall into a hollow back. This also sometimes leads to back pain. In addition, preterm labor and early labor are also associated with back pain.
Shingles (herpes zoster)
Acute prostatitis (inflammation of the prostate gland)
In addition to pain and burning during urination, acute inflammation of the prostate gland (prostatitis) also causes back pain in men.
Risk factors for back pain
There are several factors that increase the risk for back pain. Chief among these are:
- Work-related psychosocial conditions: People who are dissatisfied with their jobs or do monotonous work all day, as on an assembly line, are more prone to back pain. Social conflicts at work and high work effort without adequate rewards (money, recognition, opportunities for promotion) also promote back pain.
The course of existing back pain can also be influenced by unfavorable conditions, such as psychological factors. These include, for example, unrealistic fears about back pain, depressiveness, and passive or overactive behaviors – i.e. pronounced protective posture or too much activity.
What helps against back pain?
The treatment of back pain depends on whether a specific cause can be identified or not.
In the case of specific back pain, the doctor treats the cause of the discomfort if possible. For example, in the case of a herniated disc, conservative (non-surgical) therapy is usually sufficient, such as:
- Heat applications
- Physiotherapy
- Relaxation techniques
- Medication: painkillers and/or muscle relaxants as tablets or injections
Surgery is rarely necessary. If inflammation of the renal pelvis causes the back pain, the doctor usually prescribes antibiotics. In most cases, bacteria are the cause of the inflammation.
Therapy of non-specific back pain (unknown cause)
Sometimes non-specific back pain is so severe that doctors also prescribe medication.
In some cases, home remedies or alternative healing methods are also applicable. Be careful, however, about the many guidebooks that circulate, especially on the Internet. It is best to always discuss a method with a doctor before trying it.
There are also methods that experts do not consider suitable for treating specific back pain. For example, they advise against cold treatment, magnetic field therapy and kinesio-taping for non-specific back pain. For acute non-specific back pain, it is also advisable for sufferers to avoid both massage and occupational therapy.
Medications for non-specific back pain
In such cases, the use of pain medication prescribed by a doctor is useful: it relieves the back pain to such an extent that physical activity is possible again. However, it is important to reduce the dose of medication over time. As the level of training increases, patients usually need less medication to be able to move (almost) pain-free.
In principle, various groups of active ingredients are available for the treatment of back pain. It depends on the type and severity of the complaints which preparation is most suitable in the individual case:
- Conventional painkillers (analgesics) such as ibuprofen or diclofenac
- Certain antidepressants, e.g., for chronic nonspecific back pain if the patient has concomitant depression or sleep disturbance
Muscle relaxants (muscle relaxants) are not recommended for non-specific back pain.
Herbal preparations are also used for back pain. For example, willow bark extracts (capsules, tablets, etc.) are said to provide relief for chronic non-specific back pain – in combination with activating measures such as exercise therapy.
Home remedies and tips for non-specific back pain
- Back-friendly workplace: If you sit a lot due to your work, it is important that your workplace is ergonomically designed. This means, for example, that the chair and table height are adjusted to fit your body so that tension in the neck and shoulder area or pain in the lumbar spine does not occur.
- Back-friendly sports: Back sports are especially recommended for subacute and chronic non-specific back pain. This does not so much mean specific sports, but rather a correct training dose and technique of training – then positive effects can be achieved with a wide variety of sports for back pain.
- Professional guidance: It is best to seek advice and guidance on the subject of sport from a sports doctor or an experienced trainer, for example as part of a back school.
- Drink plenty of fluids: The supply of nutrients to the intervertebral discs only works with plenty of fluids. This is the only way to keep the small shock absorbers between the vertebrae healthy and elastic. Studies also show how important it is to drink enough fluids when suffering from back pain.
- Attitude: Mental attitude has a great influence on health. Even though back pain can sometimes make it difficult, try to stay confident and take care of your mental health as well.
- Holistic exercise methods: Yoga, Qi Gong and Tai Ji Quan also have a relaxing effect. These holistic exercise methods are also suitable for preventing lumbago and slipped discs.
- Alexander Technique and Feldenkrais Method: Both methods are based on retraining unhealthy movement patterns and are another holistic option for painful muscle tension due to incorrect movement patterns.
Medicinal plants, Homöopathie and CO.
Supporting are with back pain also hom?opathische and alternative plant preparations to help.
Medicinal plants
There are combination preparations of ash and quaking aspen, which may relieve back pain.
In the case of stress-related nervous tension, which may be (partly) responsible for the back pain, some back pain sufferers drink valerian tea. This is said to relax both the mind and the muscles.
Aromatherapy, TCM & Ayurveda
Experts in traditional Chinese medicine (TCM) see lumbago and slipped discs as a weakness of the kidney qi or kidney yang. They therefore try to strengthen the patient’s kidney with acupuncture and herbal treatment. They also use acupuncture and moxibustion (spot heating) of the bladder meridian.
Low back pain (lumbago) can be seen as an excess of Vata from the point of view of an Ayurvedic expert. Vata-reducing oil massages and herbal oil enemas are supposed to provide relief.
Homeopathy, Schuessler salts & Bach flower therapy
In terms of Schuessler salts, Ferrum phosphoricum D6 is said to relieve acute back pain. For those who suffer from lumbago more frequently, some alternative practitioners or doctors recommend Calcium floratum D6. For the selection and dosage of the remedies, it is best to consult an alternative practitioner or doctor with experience in the field of Schuessler salts.
The concept of homeopathy, Schüssler salts and Bach flowers and their specific effectiveness are controversial in science and not clearly proven by studies.
Back pain in the child
Doctors do not divide back pain into upper (neck), middle (back chest pain) and lower back pain (low back pain) in children, as many of them find it difficult to make an exact local classification. In these patients, doctors also distinguish between specific and non-specific back pain, that is, whether or not it is due to a specific cause.
In contrast to adults, the guideline on back pain in children and adolescents recommends that treating physicians primarily pursue non-medicinal treatment for recurrent or chronic non-specific back pain. This includes various approaches such as physiotherapy (including manual therapy) as well as psychological support for the affected children and adolescents.
When to see a doctor?
Back pain is not always the sign of a more or less severe illness that requires a visit to the doctor. Often there are relatively harmless causes behind it, for example muscle tension due to lack of exercise or incorrect posture. Especially in the following cases, however, it is important to see a doctor to be on the safe side:
- If the back pain is atypical and, for example, not due to incorrect movement or heavy lifting.
- When the pain intensity of back pain increases.
Which doctor is responsible?
Adults with back pain should first contact their family doctor. He or she will then refer you to appropriate specialists such as orthopedists, radiologists or neurologists as well as therapists for physiotherapy, pain therapy or psychotherapy if necessary.
How can back pain be diagnosed?
To clarify back pain, the doctor will first talk to you in detail to take your medical history (anamnesis). Possible questions to ask are:
- Where does the back pain occur?
- Does the back pain radiate to other areas of the body (for example, toward the flanks or down a leg)?
- How long has the current episode of pain lasted?
- Have there been previous episodes of back pain? What was the course of the pain?
- How has the back pain been treated so far (medication, massages, etc.)? Were the measures successful? Did side effects occur?
- What is the (daily) temporal course of the back pain? Are they strongest in the morning?
- How severe is your back pain? Do they interfere with everyday activities?
- Do you have any accompanying complaints or concomitant diseases of a mental or physical nature?
The physician also inquires about any psychosocial risk factors, such as stress, conflicts at work or a tendency to depression. These factors may have psychosomatic consequences. All this information can be used to assess how great the risk is that your back pain will develop into a chronic condition.
Examinations by the doctor
- Physical examination: The doctor looks for incorrect or relieving postures, for example. These often provide an important clue to the cause of the complaints. If shingles (herpes zoster) is the cause of the back pain, the doctor can recognize this from the typical skin rash.
- Orthopedic examination: This is mainly indicated for a more detailed clarification of low back pain (lumbago).
- Urinalysis: Analysis of a urine sample confirms or rules out the suspicion of kidney disease or acute prostatitis.
- Gynecological examination: In pregnant women, this can be used to check whether the back pain is possibly a sign of labor.
- Electroneurography (ENG): Examination of nerve conduction in the arms and/or legs may provide evidence of a herniated disc.
- Electromyography (EMG): Measuring the electrical activity of a muscle is also used to clarify a herniated disc as a possible cause of back pain.
- Ultrasound examination: If inflammation of the renal pelvis or kidney stones are causing the back pain, an ultrasound (sonography) provides certainty.
- Gastroscopy: If the doctor suspects a disease of the esophagus as the cause of the back pain, he performs a gastroscopy.
- X-ray: A simple X-ray examination provides information about various possible causes of back pain, such as pneumonia, pneumothorax, spinal wear, spinal inflammation (ankylosing spondylitis) or osteoporosis.
- Magnetic resonance imaging (MRI): This examination, also known as magnetic resonance imaging, makes it possible to investigate suspected herniated discs or inflammation of the spine (ankylosing spondylitis).
- Scintigraphy: In this nuclear medical examination, the physician determines the activity status of various tissues, such as bone tissue (bone scintigraphy: if ankylosing spondylitis is suspected) or lung tissue (lung scintigraphy: if pulmonary embolism is suspected).
- Cardiac ultrasound: Echocardiography is indicated if the examiner believes a heart muscle or pericarditis is responsible for the back pain.
- Cardiac catheterization: a cardiac catheter is placed if angina is suspected.
When which examinations are necessary
In the initial evaluation of acute and chronic back pain, physicians usually refrain from radiological examinations so as not to arouse the patient’s fear that there may be a serious cause behind the back pain. In some cases, the psychological stress of worrying about a serious illness causes acute back pain to become chronic (chronification).
Doctors also perform the other very specialized examinations, such as cardiac catheterization or scintigraphy, only in certain suspected cases in patients with back pain.
Frequently asked questions about back pain
What is the best remedy for back pain?
What is the most common cause of back pain?
The most common cause of back pain is muscle tension. They are often caused by incorrect posture or lack of exercise. Stress can also lead to painful tension in the back muscles. In rare cases, diseases such as herniated discs, osteoarthritis of the vertebral joints or osteoporosis can cause back pain.
Which doctor for back pain?
Which painkillers help with back pain?
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or diclofenac help with back pain. They not only relieve pain, but also have an anti-inflammatory effect. For very severe back pain, so-called opioids such as tramadol, tilidine or even more potent substances are prescribed.
What does the doctor do for back pain?
What to do for lower back pain?
If you have lower back pain, you should avoid heavy or monotonous exercise. However, light exercise is helpful, such as walking or backstroke. Keep the painful area warm; this relaxes the muscles. You should always seek medical advice for severe, sudden or persistent back pain.
How to sleep with back pain?
What to do for acute back pain?
Over-the-counter pain relievers such as ibuprofen, naproxen or diclofenac provide quick relief from acute back pain. This will allow you to continue to move easily. Relaxation exercises, local heat or a warm bath also often help because they relax the muscles. If the pain is very severe or persistent, you should seek medical advice.
