All Back Pain is Not the Same

Consider this: Back pain is a symptom, not a diagnosis.

A symptom is defined by Miriam-Webster as the “subjective evidence of disease or physical disturbance; broadly: something that indicates the presence of bodily disorder.”

A diagnosis is defined by M-W as “the art or act of identifying a disease from its signs and symptoms.”

The difference between a sign and a symptom is that symptoms are things we feel, and signs are things that can be seen or measured. For example, if you went to see a doctor because you were having chest pain (a symptom), your blood pressure would be measured (a sign). When taken into account with other signs and symptoms, a diagnosis is reached.

There are several reasons someone will experience chest pain. They range from being relatively harmless to potentially deadly. Chest pain can be a symptom of heartburn, a panic attack, a heart attack, as well as several other conditions. A health care provider first needs to know why a person is experiencing chest pain before they can prescribe the proper treatment.

For example, if your chest pain was brought on by exertion, and in addition to having elevated blood pressure you had abnormal blood tests and an abnormal EKG, your doctor would then conclude that you were having a heart attack and would treat you accordingly.

Low back pain can come from several sources. These sources can be divided into visceral (related to the organs), non-mechanical (inflammation, infection or other disease processes) and mechanical (occurring when pressure or tension is placed on a pain sensitive structure of the spine.)

Examples of visceral causes of low back pain include kidney stones or an abdominal aortic aneurysm. Examples of non-mechanical causes of low back pain include systemic arthritis or cancer that has spread to the spine.

Mechanical sources account for 97% of cases of low back pain.1

Mechanical low back pain is broadly divided into two categories: Specific and non-specific.

Specific low back pain can be attributed to a particular anatomical structure, whereas non-specific low back pain does not have a readily identifiable cause.

An example of specific low back pain is a lumbar disc herniation causing compression of a nerve root. Compression of the nerve root leads to a predictable pattern of pain, numbness, weakness and loss of reflex. These findings often correlate with MRI findings.

Estimates are that about only 15% of cases of mechanical low back pain have a readily identifiable cause. This leaves the vast majority of cases without an easy explanation, despite the use of MRIs and other routine medical tests.

While most cases of low back pain defy a ready explanation that does not mean they are all the same.

More advanced (and invasive) tests are sometimes used to identify sources of low back pain. The intervertebral disc, facet (or “zygapophyseal”) joint and sacroiliac joint can be injected with an anesthetic. If an anesthetic injection of one of these structures alleviates a person’s back pain then the pain can be attributed to it. The results of these tests can be predicted by a health care provider trained in advanced evaluation techniques.

What does that mean for a person with low back pain? While movement and education based strategies are generally recommended, there is no one size fits all treatment.

For someone living with low back pain that stops them from enjoying the things they do, I perform a comprehensive and clinically-reasoned evaluation to understand their condition. This leads to an individualized treatment plan with the goal of getting that person moving better and feeling better.

Jarvik, Jeffrey, and Richard Deyo. “Diagnostic Evaluation of Low Back Pain with Emphasis on Imaging.” Annals of Internal Medicine 2002; 137: 586-597.