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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Using Your History


July 08, 2013

Low Back Pain
29816
Assess Your Health
Using Your History
Using Your History
htmPinpointCauseLBP
Identifying the cause of your low back pain.
339495
InteliHealth
2009-04-02
t
InteliHealth/Harvard Medical Content
2011-04-02

Reviewed by the Faculty of Harvard Medical School

Using Your History

 

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 fever, that could point to a serious or even 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.

 

*For at least 30 minutes.

 

 

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