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There are many causes for back pain, and all back pain is not the same. Back pain can result from something being wrong with the back but also can result from something being wrong in the abdomen.

Therefore, when referring to back pain it also is important to note where the pain is not felt, as well as other characteristics of pain.

We often refer to back pain as any pain that occurs between the rib cage and the pelvis. That said, back pain can start in the back but spread to the buttocks and/or legs.

Problems within the abdominal cavity sometimes can cause back pain. Some common abdominal problems that can cause back pain are kidney stones, aortic aneurysms and endometriosis. Abdominal problems that cause back pain often present as constant pain that is unrelated to physical activities.

Kidney stones can present as a sudden onset of severe back pain, which is unrelated to activity and does not improve with rest. Another sign of kidney stones causing back pain is blood in the urine, or hematuria.

Aortic aneurysms, which can be a rare cause of back pain, usually present as a sudden onset of back pain. Unfortunately, aortic aneurysms can result in death if not diagnosed and treated quickly.

Pelvic conditions such as endometriosis can cause back pain that will vary with a woman’s menses. That is, the back pain is worse during the patient’s menses and less painful other times of the month. This type of back pain is often unrelated to activities.

Back pain caused by spinal conditions can be divided into two broad categories — mechanical back pain and nerve-related back pain. Mechanical conditions include conditions such as arthritis, fractures, tumors, infections and degenerative disc disease.

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Although all these conditions can cause back pain, they all do it in different ways. For example, arthritis and a degenerative disc will cause back pain that is worse in the mornings, with cold or humid weather; improves during the day and with rest; and worsens by the end of the day.

In contrast, tumors and infections tend to cause back pain that is unrelated to activities and is associated with other complaints such as night pain, weight loss, fevers and feeling ill. Common tumors that go to the spine include thyroid, breast, lung, prostate and kidney. Multiple myeloma, a blood cancer, can commonly go to the spine and can cause back pain as it weakens the spine and causes fractures.

Nerve-related back pain usually is constant and often is associated with leg and buttock pain. This type of back pain is worse with activities, especially walking and standing, and gets better with sitting.

Patients with nerve-related back and leg pain will report that the pain gets much worse the longer they walk or stand, to the point where they need to stop walking or standing and sit down to improve their pain.

This type of back pain is caused by the nerves that go to the back muscles and the leg muscles being compressed in the spine. These patients also will complain of buttock pain that worsens with standing and walking and is relieved by sitting down.

Patients sometimes complain of leg fatigue and/or weakness. Compression fractures also are a common cause of back pain in elderly patients. As we age, we lose bone mass and strength, so our bones get weaker and are more susceptible to fractures.

In the spine, as the vertebral bones weaken, compression fractures can occur leading to back pain. These compression fractures can be caused by even the most minimal of activities, such as sneezing or bending over to pick up a piece of paper.

In conclusion, not all back pain is the same. The next column will address the various treatment options that are available for the different types back pain.

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Dr. Dwight S. Tyndall, FAAOS, is an outpatient spine surgeon practicing in the Region. His column covers a wide range of health and medical issues.

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