Emergency Situations - Why Does Your Back Hurt: Back Pain

Content provided by the Faculty of the Harvard Medical School

Emergency situations

Low back pain may also develop as a result of a tumor, an infection, a fracture of the vertebral bone, or a severe nerve compression condition called cauda equina syndrome that involves the nerves of the bladder and rectum. These conditions are all unusual causes of back pain, but when they occur they should be treated promptly.

Tumors

Spinal cancer is rare, affecting fewer than 1 in 100 people with back pain. But when malignant — and even benign — tumors grow in the back, they can be quite painful. Most spinal tumors develop after the spread (metastasis) of cancer that originated elsewhere, especially in the breast, lung, or prostate gland. Less often, tumors originate in the tissues (including bones and ligaments) of the spine, while others start in the spinal cord or nerve roots.

Depending on its location, a spinal tumor may mimic, at least for a time, almost any other cause of back pain, including a strain or sprain, a disk problem, or a fracture. However, the discomfort caused by a tumor is often constant and progressive. Bed rest and the other measures that give at least temporary or partial relief to people with the common forms of backache tend not to be helpful for tumor pain.

Because such tumors are relatively rare and their symptoms can be so similar to those of other back ailments, the correct diagnosis is sometimes delayed.

Infection

A rare cause of low back pain is bacterial infection involving a disk (diskitis), the bone of one or more vertebrae (osteomyelitis), or the facet joints (infectious arthritis). Bacteria can reach the spine from various sites via the bloodstream. The source might be a boil or other skin infection, a urinary tract infection, an abscessed tooth, or an unsterilized hypodermic needle. You're more likely to develop a spinal infection if your resistance is compromised by a condition such as liver failure, diabetes, or AIDS, or by medications that interfere with your immune system, such as steroids or anticancer drugs.

Back pain caused by a spinal infection is often severe, and its symptoms may include back muscle spasms, fever, and tenderness around the infected vertebrae.

Vertebral fractures

A sudden fall or impact that places extraordinary pressure on the spine can fracture vertebrae in the back. Such fractures may also occur in older people, even in the absence of an injury (see "Osteoporosis"). The pain may be severe and disabling, and is usually located in the area of the injured vertebra.

It is wise to seek help quickly if you suspect you have suffered a vertebral fracture. Treatment depends on the location and nature of the fracture; in some cases, a wait-and-watch approach is best, but in other cases surgery may be necessary.

Cauda equina syndrome

On rare occasions, when disk herniation is very large and more nerves are compressed, your bladder and bowel function may be disturbed, resulting in severe weakness in one or both legs and even "saddle anesthesia," which is numbness in the anal and genital areas. If you have these symptoms, you should see a doctor immediately; this condition, known as cauda equina syndrome, may require immediate surgery.

Last updated:	January 23, 2007