Back pain is a common complaint, affecting most adults. While often attributed to musculoskeletal issues like muscle strains or spinal disc problems, pain perceived in the back can frequently stem from other sources. Understanding that various conditions can mimic back pain is important for accurate diagnosis and effective management.
Referred Pain from Internal Organs
Referred pain occurs when discomfort originating from an internal organ is felt in a different area of the body, commonly the back. This phenomenon happens because the nerves transmitting pain signals from internal organs often converge with nerves from other body regions in the spinal cord, leading to a misinterpretation of the pain’s source by the brain.
Kidney Issues
Kidney issues, such as kidney stones or infections, often cause pain in the flank or lower back, just below the rib cage. This pain can be a dull ache or sharp and severe, sometimes radiating to the abdomen or groin. Accompanying symptoms like painful or frequent urination, cloudy or bloody urine, nausea, vomiting, or fever help distinguish kidney pain from typical back pain.
Pancreatitis
Pancreatitis, inflammation of the pancreas, causes severe upper abdominal pain that can radiate to the back, sometimes below the left shoulder blade. The pain may worsen after eating, especially fatty foods, and can be accompanied by nausea, vomiting, fever, or a fast heartbeat. Leaning forward or curling into a ball might offer relief, while lying flat can intensify discomfort.
Gallbladder Problems
Gallbladder problems, including gallstones or inflammation, can cause pain in the upper right abdomen. This discomfort may radiate to the right shoulder blade or upper back, especially after fatty meals. The pain can be sudden and sharp, or a persistent dull ache, often with nausea and vomiting.
Abdominal Aortic Aneurysm (AAA)
A dissecting or rupturing abdominal aortic aneurysm (AAA), a bulge in the main artery, can cause sudden, severe back pain. This pain is often described as a ripping or tearing sensation and is a medical emergency. While many AAAs cause no symptoms until large or ruptured, a persistent, deep ache in the lower back or a pulsing sensation near the belly button can be warning signs.
Heart Attack
A heart attack, though less commonly associated with back pain, can cause discomfort radiating to the upper back, especially in women. The back pain may feel like pressure or tightness and often presents alongside other symptoms such as chest pain, shortness of breath, unusual fatigue, or jaw pain.
Nerve-Related Conditions
Nerve irritation or damage can cause pain that is perceived in the back or radiates from it, distinct from primary structural back issues. The quality and distribution of this pain often provide clues to its neural origin.
Sciatica
Sciatica describes pain radiating from the lower back or buttock down one leg. While often linked to a herniated disc compressing the sciatic nerve, the pain is neuropathic, characterized by a burning, sharp shooting, or electric shock-like feeling. Accompanying symptoms can include numbness, tingling, or weakness in the affected leg.
Shingles
Shingles, caused by the reactivation of the varicella-zoster virus, can lead to a painful rash along a nerve pathway, often on one side of the body, including the back. Before the rash appears, or in rare cases, without a rash, individuals may experience burning, tingling, or itching pain in the affected area. This nerve pain is distinct from muscle or joint pain and can be intense.
Peripheral Neuropathy
Peripheral neuropathy involves damage to nerves outside the brain and spinal cord, often due to conditions like diabetes. This nerve damage can cause burning, tingling, numbness, or aching sensations, which can sometimes affect the back, though it is more commonly experienced in the hands and feet. The pain can be severe, often described as shooting or burning sensations radiating from the back to the legs or buttocks.
Systemic and Other Contributors
Broader body conditions or less obvious factors can also manifest as back pain, often with systemic symptoms or distinct pain patterns. Recognizing these can guide appropriate diagnostic approaches.
Infections
Infections, such as urinary tract infections (UTIs) or spinal infections, can cause back pain. Spinal infections, including osteomyelitis or discitis, often present with persistent, worsening back pain, especially at night or with movement, accompanied by fever, chills, and fatigue. UTIs can cause lower back or flank pain, often alongside urinary symptoms like painful urination, frequent urges, or cloudy urine.
Tumors
Tumors, benign or malignant, originating in the spine or metastasizing from other body parts, can lead to persistent back pain. This pain is often deep and aching, not associated with injury, and may worsen over time, particularly at night, disrupting sleep. As tumors grow and press on spinal nerves or the spinal cord, symptoms like numbness, tingling, muscle weakness, or loss of bowel or bladder control may develop.
Fibromyalgia
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, including back pain. The back pain is typically described as a deep, aching sensation felt throughout the entire back, accompanied by stiffness and tenderness at specific points. Unlike pain from injuries, fibromyalgia pain does not cause visible inflammation and is often accompanied by chronic fatigue, sleep disturbances, and cognitive difficulties, sometimes referred to as “fibro fog.”
Psychological Factors
Psychological factors, including stress, anxiety, and depression, can influence the perception and severity of back pain. Emotional distress can manifest as physical pain due to increased muscle tension and altered pain processing in the brain. Studies suggest that psychological factors can be more reliable predictors of chronic back pain than structural abnormalities seen on imaging tests. Individuals with certain beliefs about their pain may experience more severe symptoms and functional limitations.