Medical Back Pain

Medical back pain is back pain that is caused by a disease or medical condition that affects joints throughout the body or multiple organ systems. Always with back pain, the three questions that you and your doctor are going to have about your conditions are:
  1. What are the symptoms of the condition?
  2. What are the causes of the condition?
  3. What are the appropriate treatments for the back pain condition that will be the least invasive and produce the best results?
These are important questions to ask, and doctors will want to assess two things before proceeding in the direction of treating the patient. Doctors when evaluating patients presenting with back pain, either in a clinic or the emergency room, will quickly want to assess whether the back pain is a symptom of a serious medical condition that must be treated immediately. Some conditions that require immediately medical attention and/or treatment are cases where there is evidence of moderate to severe neurologic impairment in the extremities (arms and legs) or the loss of bowel or bladder control. In cases such as these, the neurologic impairment will want to be quickly diagnosed and treated so that the nerve damage does not become permanent.

Doctors will also want to make the important determination of whether the back pain symptoms are mechanical or medical in nature.

IS IT MECHANICAL OR MEDICAL?
The determination of whether the cause of back pain is mechanical or medical will be important in terms of the diagnostic procedures ordered, the treatments or medications prescribed, and the ultimate prognosis.

Mechanical Back Pain: Mechanical back pain is back pain in which the pain generator (the cause of the) can be traced back to specific structures in the spine, or structures that support the spine. These include conditions in which the cause of symptoms are associated with structures in or around the spine that have become injured, either due to trauma, the wearing out of the joints over time, ligament laxity that develops due to poor posture, etc. This type of pain contrasts with conditions such as medical disorders or medical back pain, which may attack joints throughout the body due to systemic inflammatory disease. Examples of mechanical back pain would be herniated discs, compression fractures of the vertebrae, and arthritis of the facet joints.



Medical Back Pain: Of course all back pain is medical. But in this case, we are defining medical back pain as pain that is a symptom of disease, rather than due to injury in the structures of the back/spine. Medical back pain is caused by medical disorders that globally affect joints throughout the body, or caused by diseases that affect multiple body sections and organ systems, including the musculoskeletal system. Medical disorders that affect joints globally include systemic diseases that change our immune system to attack our own joint tissues, causing destruction to the joints if the resulting joint inflammation is not treated. Examples of inflammatory conditions that affect joints throughout the body include rheumatoid arthritis, Ankylosing spondylitis, Psoriatic arthritis, Reactive arthritis, Arthritis with inflammatory bowel disease, and IBD-associated spondyloarthropathy.

Back pain, caused by medical disorders cause symptoms throughout the body and are not limited to pain and discomfort in the back. Medical back pain also doesn't get better with rest or activity. Back pain caused by diseases also affects multiple organs or organ systems, such as the blood vessels, lymph nodes, gastrointestinal system, bladder, kidneys, and brain. Diseases that affect these organs can also cause back pain, with each organ system causing a certain type of pain. When back pain originates in a structure other than the spine, the unique signature of the pain can help doctors to determine which organ system has become impaired or diseased.

There are several back pain symptoms that produce "red flags" indicating the likelihood of non-mechanical back pain:
  • Severe bone pain in the middle of the back
  • Fever
  • Unexplained loss of weight
  • Morning stiffness that lasts well into the morning or day
  • Pain that is brought on by urinating, eating, or during the menstrual cycle