Many people complain of pain in the neck and lumbar spine. Bones, joints, ligaments and muscles form a stable and agile framework that is cushioned by the intervertebral discs. The causes of back pain may lie in any of these structures themselves or can occur when the spinal cord and nerves become irritated. In some cases, no cause can be found despite a thorough examination.

Warning symptoms

Persons experiencing back pain should see a doctor when the pain becomes acute and/or they are experiencing neurological problems (problems with movement, perception, strength, urination and bowel movements). Severe pain that radiates throughout the arms or legs, weakness and numbness or tingling in the hands or feet should be examined.

What will the doctor want to know?

It is important for the doctor to know how long the symptoms have been persisting, their location and whether the pain radiates into the extremities. It is important to know whether it may have followed a fall or injury or whether there are any other possible triggers. Whether the symptoms improve or worsen and whether the pain is also experienced when idle are indications of the possible cause.

Common causes

The most common cause of back pain is muscle tension and/or a blockage of the many small joints around the spine. Simple clinical examinations can identify whether back pain is due to pathologically elevated muscular tonicity so that it can be treated accordingly. This does not require imaging, which can sometimes even be harmful.

Wear on the spine combined with osteoarthritis can cause chronic back pain.

After a fall or a back or neck injury, a radiological examination should be performed to rule out any fracture of the vertebral bodies as the cause. Even minor injuries can cause this in older people with increased brittleness of the bones (osteoporosis).

When the pain also radiates throughout the arms or legs and causes discomfort or, at worst, paresis, the reason may be a herniated disk or constriction of the spinal canal. A herniated disc occurs when part of the disc presses against a nerve root. The irritation causes radiating pain, tingling and numbness in the nerve’s area of distribution.

Tumors – benign or malignant – can also occur in the spine and spinal cord or there may be secondary cancerous tumors (metastases). Such tumors can trigger pain and neurological deficits, but are relatively rare.

Inflammation (e.g. in the family of rheumatic disorders or acute bacterial infections) can also cause severe back pain.

Treatment possibilities

Acute back pain is usually temporary and the prognosis is good. More than 85% of back pain goes away on its own in less than three months. The examination serves to rule out any dangerous causes and to begin individual treatment with medications and other measures. Painkillers and anti-inflammatories are the basic course of treatment prescribed to help patients go about their everyday lives and get regular exercise.

The examination, assessment and treatment of chronic back pain is much more complex, with a wide range of medications prescribed as basic treatment here as well. Several other approaches may be taken as well (interdisciplinary, multimodal treatment). Consulting a doctor can help determine which of these make the most sense for the particular case.