Back Pain

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Signs and Symptoms

Pain can be constant or intermittent. Intensity can vary from a dull ache to searing agony. The onset may be sudden, with or without apparent reason, or gradual.

Most back pain resolves in a few days or weeks with or without treatment. However, some people have chronic pain that lasts months or years.

Severe pain lasting more than a few days without improvement may require medical attention. Anyone having difficulty passing urine; numbness in the back or genital area; numbness, pins and needles, or weakness in the legs; shooting pain down the leg; or unsteadiness when standing should see a physician immediately.

Localized pain is often described as aching, tight, stiff, sore, burning, throbbing, or pulling. The pain may worsen while bending, sitting, walking, or standing too long in one position. It may also be more prevalent at different times of the day, such as when a person wakes up in the morning.

Pinched nerves produce numbness or tingling, warm or cold sensations, and burning or stabbing pain that begins in the back and radiates down the leg (e.g., sciatica) or arm. Activities such as coughing, sneezing, or walking may increase pressure on the pinched nerve and aggravate the pain.

Compressed nerves cause numbness and weakness in the muscle associated with the nerve. The muscle may atrophy if the compression is not relieved. An infection affecting the spinal cord or nerves may produce fever and lethargy as well as symptoms of compression.

Diagnosis

Diagnosing the underlying cause of neck and back pain can be difficult. A medical history is taken and a complete physical examination, which may include a neurological examination, is performed.

Laboratory Tests
X-rays show the alignment of the cervical, thoracic, and lumbar spine; and may reveal degenerative joint disease, fracture, or tumor.

Magnetic resonance imaging (MRI scan) provides clear images of disc deterioration, pathologies of the spinal cord, spinal stenosis, herniated discs, spinal tumors, and abnormalities in nerves and ligaments. Contrast dye may be injected to highlight problematic areas.

Computerized tomography (CT scan) is an x-ray that utilizes computer technology and can be enhanced with contrast dye. It is used to show abnormalities in bones and soft tissue. CT scan can be used for patients who are unable to tolerate MRI.

Myelography is used to examine the spinal canal and cord. Contrast dye is injected into the cerebrospinal fluid to outline the spinal cord and nerve roots, thus allowing abnormal disc conditions or bone spurs to be visualized with x-ray or CT scan.

Electromyogram (EMG) uses tiny electrodes inserted into muscle tissue to test for abnormal electrical signals, which may indicate that a nerve root is pinched or irritated at the spine.

Spinal tap involves drawing a sample of cerebrospinal fluid and analyzing it for elevated pressure, infection, bleeding, or tumor.

Bone scan locates problems (e.g., fracture, osteoporosis) in the vertebrae. A radioactive tracer is injected into the patient and after several hours, x-ray will reveal bone undergoing rapid changes where large amounts of tracer accumulate.

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