Your health care provider usually can identify conditions that commonly cause low back pain through the
features of your history. Typical characteristics of the more common, identifiable causes of low back pain are outlined in the table below.
Unfortunately, for most people with low back pain, no definitive cause is ever found. In these cases, there are rarely any "red flag" symptoms, such as numbness or tingling in a leg, that would point to a life-threatening cause. The pain is nonspecific — meaning there is no strong suggestion from your symptoms that any one condition is the cause of your pain. In addition, the pain tends to improve on its own or with
conservative treatment, such as rest, within a few weeks. However, low back pain of uncertain cause may also become
chronic, persisting for months or years. In these cases, low back pain can be a major source of suffering and frustration.
As for whether low back pain (or other types of pain) may be psychological in origin, there is no easy way to know. But a reasonable approach is to accept all pain as genuine, even if its source is difficult to identify.
Relieving pain, regardless of its source, should be the ultimate focus. If your symptoms persist, reassessment over time and regular follow-up with your health care provider may lead to a new or more specific diagnosis or to a change to a treatment that is more effective.
Cause | Onset | Description | Location | Accompanying leg pain | Relief when leaning forward or sitting | Morning stiffness* that improves with exercise | Age group most commonly affected | Comment |
Muscle or ligament strain | Often sudden, but onset is highly variable | Highly variable | One or both sides | Absent | No | No | Any age, but especially common in young or middle-aged people | Muscle spasm may worsen with pressure on the involved muscles or with specific movements. It is also worse after exercise. |
Degenerative joint disease | Gradual | Dull; affected by position or exercise; often worse at night | Middle | Absent (unless complicated by nerve injury) | No | No | Older than 50 | Low back pain generally worsens very slowly. |
Disk disease | Sudden | Sharp; may be worse at night or with bending, coughing or sneezing | Usually one side | Present | No | No | Any age, but more common in older people | Numbness and tingling are common in the affected leg. Disk disease may lead to sciatica. |
Spinal stenosis | Gradual | Dull; worse with standing or walking | Variable | Absent or present (possibly one or both legs) | Yes | No | Older than 50 | Leg pain may be worse than back pain. |
Spondylolisthesis | Gradual | May be severe | Middle | Present (often includes thighs, hips or back of legs) | No | No | Young adults and older | Back pain is more common in athletes (especially football players, weight lifters and gymnasts) and the elderly. |
Osteoporosis with fracture | Sudden | Dull, but severe | Middle | Absent | No | No | Older than 60 | Back pain may occur in younger persons, especially those with risk factors for osteoporosis. |
Inflammatory arthritis (rare) | Gradual | Dull or achy; worse in the morning; better with exercise | One or both sides | Absent | No | Yes | 20 to 50 | Diarrhea, psoriasis, burning with urination or conjunctivitis may be present. |
Cancer (rare) | Gradual | Constant, but progressively worsening; worse at night | Middle, but variable | Absent (unless complicated by nerve compression) | No | No | Older than 60 | Back pain is often accompanied by weight loss, poor appetite and a history of cancer elsewhere in the body. Cancer may cause bowel or bladder incontinence or leg weakness. |
Infection (rare) | Gradual | Variable | Middle | Absent | No | No | Any age | Back pain is often accompanied by fever and weight loss. There are usually associated risk factors, such as intravenous drug use, a prior medical condition, use of drugs that suppress the immune system or recent injury or surgery. |
Kidney stone | Sudden | Severe, sharp | One side; spreads into the groin | Absent | No | No | Any age | Blood in the urine may be present. |
