Back Pain and Related Conditions

Back pain is a symptom of disease. This symptom of disease may or may not be traced back to an actual structural problem in the back. Back pain may be due to an arthritis condition in the back or a structural instability problem in the back. Back pain may also be a symptom of disease that affects multiple organ systems. Here is a list of back pain and related conditions, including bone fracture, osteoporosis, multiple myeloma, lumbar disc herniation, and degenerative disc disease.

Bone Fracture: Typically, breaks in the continuity of the bones in the body are an unlikely cause of back pain, except in individuals with certain diseases, or those who have been in a severe accident. Individuals who have bone that are prone to fracture include people with diseases that reduce their bone mineral density, such as those with osteoporosis and HIV. Bone mineral density is the density of minerals such as calcium than is embedded bone. The higher the bone mineral density, the stronger the weight bearing bones will be to prevent against fracture in the event of a fall or even just simple activities.

In our human spines, the vertebral bodies of the vertebra are the weight-bearing portions of the bones that must hold their form as forces are applied to it such as when we land on a hard surface or carry heavy goods. These vertebral bodies are normally strong enough to hold their form against the forces of gravity well into old age. Unfortunately, changes medical changes in patients such as the taking of medications that reduce bone density and the onset of menopause in women may cause changes in bone density, to the point where they become vulnerable to fracture.

In the human spine, changes in the bones that make them weaker may lead to compression fractures of the vertebrae, in which the brick shaped vertebral bodies collapse in on themselves. As the vertebral bodies collapse in on themselves, they may take on a wedge shape, which may affect the other structures of the spine. Compression fractures if uncorrected may affect the shape of the spine, causing a person to lose height or develop a noticeable hump in their back.



Vertebral compression fractures may occur during routine events, such as walking or getting out of bed, or they may occur while lifting heavier objects than patients are used to. Shortly after these injuries occur, patients experience sudden back pain. This acute back pain may subside to a more achy pain around the level of the back where the compression fraction occurred. Besides achy pain, other clinical symptoms include height loss, limited spinal mobility, and pain that lessens significantly when lying down. Other symptoms of a vertebral fracture include disability and deformity, pain that becomes worse when walking or standing, and a sudden onset of back pain.

Diagnosis and Misdiagnosis: Because some of the symptoms related to a spine fracture share the same symptoms of other back conditions; it is initially misdiagnosed in about one third of all cases. Some reasons why spine fractures are not diagnosed correctly include being missed on X-Rays, and because back pain in elderly patients is often attributed to arthritis, muscle pain, or the inevitable pains associated with aging. In order to diagnose this condition correctly, doctors must obtain a complete medical history, administer a thorough physical exam, and perform additional medical testing. Additional medical tests other than the X-Ray which may be used to diagnose spine fractures include CT Scans and MRIs.

Medical Tests that may be performed in order to measure a patient's bone mineral density (and thus vulnerability to spine fractures) include Dual-energy X-ray absorptiometry (DEXA), Peripheral dual-energy X-ray absorptiometry (P-DEXA), Dual photon absorptiometry (DPA), and uantitative computed tomography (QCT).

Multiple Myeloma: Multiple Myeloma is a cancer of plasma cells, which are white blood cells that are responsible for the production of our antibodies. The antibodies are white blood cells which recognize bacteria, viruses, and other foreign particles in our bodies that are not supposed to be there. With the condition multiple myeloma, abnormal plasma cells build in the bone marrow, where all plasma cells are created, and they hamper the production of normal blood cells. This condition may also result in the accumulation of paraproteins, which are abnormal antibodies which may affect the functioning of the kidneys. This condition may also result in the development of bone lesions, which may cause bone pain or bone fractures. This condition may affect the vertebral bones of the spine.

Multiple myeloma may be diagnosed by medical tests such as X-rays, urine protein phoresis, a bone marrow biopsy, and blood tests, Blood tests to discover the presence of multiple myeloma include the serum free kappa/lambda light chain assay and (serum protein electrophoresis. In order to prevent fractures related to this condition, patients may consume treatment medications and supplements, including biophosphates (e.g. zoledronic acid or pamidronate).