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Back Pain: Upper, Mid Back, Low and Lower Back
Back pain is one of the most common reasons people self-treat and seek medical care. It will affect approximately three in four adults during their lifetime. When we speak about “back pain” we mean pain that originates in the spine anywhere between the upper and lower back.
Besides back pain, other symptoms may present. There are many different types of pain.
- Acute back pain is defined as severe but lasting a short period of time.
- Chronic back pain usually occurs every day. It can be severe, but may be characterized as mild, deep, achy, burning, or electric-like.
- Back pain that travels into another part of the body, such as the leg may be consider radicular pain, particularly when it radiates below the knee. This scenario is commonly called a lumbar radiculopathy. Fortunately, not all occurrences of back pain include leg pain!
It is not unusual for back pain to be accompanied by other symptoms, such as numbness and tingling sensations, stiffness, achiness, and weakness.
Certain activities may increase or aggravate back pain. Sitting, walking, standing, bending over, and twisting at the waist are a few of the movements that can make back pain worse. Of course, that is not true for every patient. Rather, it depends on what level of the spine is affected and the diagnosis, or cause.
If you see a doctor for back pain, he (or she) may use terms such as thoracic, lumbar, lumbosacral, or sacrum. The point is, back pain is a large topic covering many different regions (or levels) of the spine.
- Thoracic spine is the upper and mid back areas, and where your ribs attach to the spinal column.
- Lumbar refers to your low back.
- Lumbosacral is the low back, sacrum, and possibly the tailbone (called the coccyx).
- Sacrum is the part of the spine that is at the back of your pelvis.
Back pain is a big topic because between the upper back and tailbone, there are 17 vertebral bodies, many joints, the sacrum and tailbone. Plus fibrous and muscular supporting structures, intervertebral discs, spinal cord and nerve roots, and blood vessels. A simple injury, such as a back sprain/strain from lifting and twisting simultaneously, can cause immediate and severe pain that is typically self-limiting.
Of course, not all incidences of back pain are injury or trauma-related. Many back problems are congenital (found at birth), degenerative, age-related, disease-related, and may be linked to poor posture, obesity or an unhealthy lifestyle such as smoking.
Sometimes the back pain is worse than the severity of the injury or disorder. That statement raises the question, “When should I seek medical attention for back pain?”
- You cannot stand upright.
- Fever accompanies pain.
- Loss of bladder or bowel function or control
- Leg pain and/or weakness progressively worsens.
- Pain is relentless or worsens.
Many patients with back pain have reported feeling afraid and anxious, which is normal. Most people who experience upper, low or lower back pain—even down into one or both legs—intuitively know when it’s time to seek medical care.
What to Expect from Your Doctor
Whether you back pain falls into the “seek urgent medical care” list above, or you are following your gut reaction that says, “Go see your doctor,” below is what you can expect.
- A review of your medical history, including immediate family members who have back problems. Some back problems (eg, scoliosis, osteoporosis) have a genetic potential.
- Discuss when back pain started, what you were doing when pain began, current pain severity and characteristics (eg, stabbing, burning), how pain may have changed since it began, and other questions. Your doctor wants to learn as much about your pain and symptoms before he examines you—while the exam may provoke pain, your doctor doesn’t want to make the process intolerable!
- Physical examination evaluates your vital signs (eg, heart rate). It is not unusual for your blood pressure to be elevated as a result of pain. The doctor examines your spine, feeling for abnormalities and areas of tenderness.
- Neurological examination involves assessing sensation and function. The doctor may employ the pin prick test to determine if feeling is the same on both sides of particular parts of the body (eg, legs). Function, flexibility and range of motion are assessed while you walk, bend forward and backward (if able to), and during other movements. The doctor tests your reflexes too.
After a thorough review, your doctor probably has come to one or two conclusions as to what is causing your back pain and other symptoms. To obtain more information about your back problem, and to help confirm the diagnosis, the doctor may order an x-ray, CT scan, or MRI. Sometimes lab tests are ordered too. Keep in mind that an accurate diagnosis is essential to a well-developed treatment plan.