Dr Chua Soo Yong
Back pain may involve any area of the back including the lower back, middle back or upper back. It may be a result of nerve and muscular problems, degenerative disc disease or arthritis.
As you get older, the discs in your back may begin to wear away, which can cause the bones in your spine to rub together uncomfortably.
The sacroiliac joint connects your spine and pelvis, and can sometimes become inflamed after an injury or infection. It may sometimes be due to an inflammatory arthritis such as ankylosing spondylitis. It can cause pain and swelling in your lower back.
Scoliosis is a condition that is usually present from birth. It causes a curve in the spine, making it turn into an 'S or 'C' shape. Mild scoliosis doesn't usually cause problems. More severe curves can put pressure on surrounding discs, muscles, ligaments and nerves.
Poor posture when sitting at the desk, lifting heavy objects, wearing high heels, being overweight, not exercising and smoking may all contribute to back pain.
Back pain is a very common occurrence among the general population. It is estimated that 95% of the population would have sought a consultation for back pain at some point in their lives.
Since back pain is so common, how do we decide if our back pain is not typical or harmless?
Here are some symptoms that you should pay attention to:
Our nerves supply the functions of sensation and strength. When back pain is associated with these symptoms, it usually indicates an element of nerve compression. Hence this needs to be properly evaluated as chronic compression on neural elements may lead to permanent damage and an irrecoverable situation. Nerve compression could be due to a prolapsed disc (fall out of place), fracture, infection, cancer or severe degeneration of the spine.
When the back is afflicted with pain that is associated with fever or night sweats, this could indicate an infective or inflammatory condition of your back muscles. Infective causes of back pain are typically from bacterial infection or tuberculosis, which if left untreated, may lead to collapse of the spine and eventual paralysis or neurological damage. Inflammatory causes like an auto-immune disease for instance, ankylosing spondylitis or rheumatoid arthritis, can cause fever with back pain, especially when the disease is flaring up.
Usually, our pain improves with rest, and may subside when we sleep. This is typical of muscular pain as the muscles are no longer in spasms in our restful state. Back pain that persists at night or at rest typically implies pain that results from a destructive process in the spine. Typically it is due to cancer or tumour, or infection that is eroding away the spinal structure.
Back pain is unlikely to persist and result in prolonged loss of weight or appetite. Usually when there are these latter symptoms, there is a root cause of the weight or appetite loss. Typically in late stage cancer, our body loses weight and we lose appetite, due to the terminal stage of the disease. In such a situation, it is not uncommon that the cancer has also spread to the spine, which explains the accompanying back pain.
Usually, back pain occurs in isolation if it is due to a muscular cause. When back pain is accompanied by other joint pains, it may indicate a larger cause of these combined pains ongoing in the entire body. Typically this is due to an auto-immune disease that affects multiple joints in the body.
'Regular' harmless back pain usually resolves within 2 – 4 weeks. Pain that persists for longer than 6 weeks typically requires further evaluation. Conditions that can result in back pain that lasts this long are fractures, cancer, infection or auto-immune disease. These conditions need to be evaluated by a physician or surgeon.
If you experience any of the above symptoms, or if your back pain lasts more than 6 weeks, it is time to take your back pain seriously and visit an orthopaedic specialist.