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Back pain

SYMPTOMS

What is low back pain?

As the name suggests, it refers to pain in the lower back, which may be caused by local inflammation of the tissues, trauma, or diseases of nearby organs (such as the kidneys or pelvis). Low back pain is not a disease itself but rather a symptom caused by various conditions. Due to the wide range of diseases that can lead to low back pain, its nature is relatively complex [1].

Where exactly is the lower back?

The lower back refers to the area from the lowest pair of ribs to the top of the pelvis on the back of the human body. When touching the lower back, one can feel the spine (backbone), the firm parallel muscles beside the spine, and the softer outer muscles and other soft tissues [2].

What are the manifestations of low back pain?

Low back pain may have the following characteristics [3]:

  1. It can occur on one side of the lower back or both sides simultaneously, sometimes radiating to the abdomen or lower limbs.
  2. The pain may feel sore, dull, or colicky.
  3. It can persist for a long time or be short-lived, resolving on its own or improving with changes in posture, medication, or other treatments.
  4. The severity varies—mild cases may go unnoticed, while severe cases can cause difficulty moving, restlessness, and trouble sleeping.

Is low back pain common?

Yes. Studies show that the annual prevalence of low back pain among adults in China is 20.88%–29.88% (meaning 2,088–2,988 out of 10,000 adults experience it yearly), while the global prevalence ranges from 13.1% to 20.3% [4].

What non-disease factors may cause low back pain?

  1. Smoking: The mechanism is unclear, but some studies suggest nicotine may impair nutrient supply to intervertebral discs, leading to degeneration [5].
  2. Psychological factors: Stress, depression, and anxiety may contribute to low back pain, though the exact mechanism remains unknown [5].
  3. Obesity: Excess weight puts pressure on joints and intervertebral discs, increasing the risk of low back pain [5].
  4. Heavy physical labor: Repetitive pushing, pulling, or lifting heavy objects can accelerate disc degeneration and strain muscles and ligaments, leading to pain [5].

TREATMENT

How to Relieve Back Pain?

Conditions causing back pain range from mild to severe and require systematic treatment. During treatment, the following rehabilitation measures can help alleviate symptoms:

  1. The glute bridge exercise strengthens the muscles in the lower back and hips, reducing pain.

  1. The lunge and iliopsoas stretch helps prevent lower limb muscle tension during exercise while reducing lumbar spine strain caused by prolonged sitting.

Additionally, pay attention to the following:

  1. For acute back pain or severe symptoms, patients can take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac sodium as directed. Common side effects include nausea, vomiting, and diarrhea. Topical pain-relief patches can also be used if there is no skin damage, but patients with coronary heart disease should use them with caution [3];
  2. Avoid overly soft beds (those that noticeably sag when lying down). Instead, use a mattress of moderate firmness (neither sagging nor overly hard) to reduce lumbar curvature and worsening pain;
  3. Use a lumbar brace for support;
  4. Maintain proper sitting posture, keeping the back against the chair when sitting for long periods, and take breaks to stand or stretch;
  5. Schedule work reasonably, take adequate rest, and avoid overexertion or maintaining the same posture for too long;
  6. Keep warm and avoid excessively damp living environments;
  7. Maintain a balanced diet with fresh fruits and vegetables, and prevent excessive weight gain.

If these measures fail to relieve back pain or if symptoms worsen, seek medical attention promptly to identify the underlying cause and receive appropriate treatment to avoid delaying recovery.

DIAGNOSIS

Under what circumstances should you seek medical attention for back pain?

Back pain alone sometimes cannot determine the cause, let alone guide treatment, so it often needs to be evaluated alongside accompanying symptoms.

  1. History of trauma, severe pain, persistent back pain with spinal deformity, and limited mobility. Bruising, tenderness, or percussion pain at the injury site may indicate spinal fracture or dislocation.
  2. Severe back pain accompanied by chills, high fever (≥ 39.1°C), loss of appetite, fatigue, or other systemic symptoms may suggest pyogenic spondylitis.
  3. Persistent back pain unrelieved by rest or medication, with a history of primary tumors (e.g., prostate cancer), may indicate spinal tumors.
  4. Chronic recurrent low back and leg pain, accompanied by leg pain or numbness, may suggest lumbar disc herniation.
  5. Morning back pain with restricted spinal movement and stiffness, relieved by light activity or tapping, may indicate degenerative spondylitis.
  6. Persistent back pain aggravated by bending and relieved by rest or stretching, often seen in those with prolonged standing or heavy lifting, may suggest lumbar muscle strain.
  7. Recurrent back pain with high fever (≥ 39.1°C), frequent urination, incomplete voiding, painful urination, or ipsilateral abdominal pain, unrelieved by bed rest, may indicate a urinary tract infection.
  8. Chronic back pain with menstrual irregularities, dysmenorrhea, or excessive vaginal discharge may be related to cervicitis, pelvic inflammatory disease, or ovarian/adnexal inflammation/tumors.
  9. Other severe, persistent, or progressive symptoms.

If the cause is unclear or symptoms are severe, or if the condition appears serious, seek medical attention at a hospital.

Which department should you visit for back pain?

Generally, visit the spine surgery or orthopedics department. If accompanied by urinary symptoms (e.g., frequency, urgency, pain), consult urology or nephrology.

What tests are needed for back pain?

  1. Physical examination: Initial assessment to observe spinal abnormalities (e.g., scoliosis, kyphosis) and check for tenderness in vertebrae or soft tissues [6].
  2. Blood tests: Evaluate infection or acute disease activity, including but not limited to complete blood count (CBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).
  3. Imaging tests: X-ray, CT, or MRI to examine the spine, lumbar region, and adjacent organs for abnormalities.

POTENTIAL DISEASES

What are the common causes of low back pain?

Low back pain is not a disease itself but rather a symptom caused by various conditions. Common diseases that lead to low back pain include [6]:

  1. Spinal disorders: Spinal fractures or dislocations due to direct or indirect trauma; bacterial infections of the spine, such as tuberculous spondylitis or pyogenic spondylitis; primary or metastatic tumors (e.g., prostate cancer metastasis); degenerative spinal diseases (more common in middle-aged and elderly individuals); lumbar disc herniation (more common in young adults).
  2. Soft tissue disorders near the spine: Lumbar muscle strain caused by long-term poor posture, improper positioning, or excessive activity; non-bacterial inflammation due to damp or cold environments, such as lumbar fibrositis. The most common cause of low back pain in young people is muscle spasms or strain.
  3. Spinal nerve root disorders: Intraspinal tumors or herniated discs compressing spinal nerve roots; irritation of nerve roots by subarachnoid hemorrhage.
  4. Retroperitoneal or pelvic organ disorders:
    • Nephritis, pyelonephritis, renal tumors, kidney rupture, or hydronephrosis—pain mainly results from stretching of the renal capsule;
    • Prostatitis, cervicitis, pelvic inflammatory disease, etc. The sensory nerve fibers of these organs and those of certain areas of the lower back share the same spinal nerve root, leading to referred low back pain.