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{{Back pain}} {{CMG}}
{{Back pain}}  
{{CMG}} {{AE}} {{ZMalik}}
 
==Overview==
[[Back]] [[pain]] can be broadly classified into [[inflammatory]], mechanical, [[degenerative]], [[oncologic]] and [[infectious]]. [[Lumbar disc disease]] have been linked to [[genetic]] involvment. The risk of developing [[lumbar disc disease]] increases if found in other close relatives. [[Genes]] involved in the [[pathogenesis]] of [[back]] [[pain]] include, [[HLA-B27]], [[SOX5]], [[CCDC26]]/GSDMC, and DCC.


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==Pathophysiology==
==Pathophysiology==
Muscle strains (pulled muscles) are commonly identified as the cause of back pain, as are muscle imbalances. Pain from such an injury often remains as long as the muscle imbalances persist. The muscle imbalances cause a mechanical problem with the skeleton, building up pressure at points along the spine, which causes the pain. [[Ligament]] strain is a very common cause of back pain as well.<ref name="urlLigament Pain, Stretched, Torn Or Strained, Prolotherapy">{{cite web |url=http://wehelpwhathurts.homestead.com/ligamentpain.html |title=Ligament Pain, Stretched, Torn Or Strained, Prolotherapy |format= |work= |accessdate=2013-03-05}}</ref> Another cause of acute low back pain is a meniscoid occlusion. The more mobile regions of the spine have invaginations of the synovial membrane that act as a cushion to help the bones move over each other smoothly. The synovial membrane is well supplied with blood and nerves. When it becomes pinched or trapped it can cause sudden severe pain. The pinching causes the membrane to become inflamed, causing greater pressure and ongoing pain.
*The exact [[pathogenesis]] of [[back]] [[pain]] depends on the underlying cause.
*[[Back]] [[pain]] can be broadly classified into [[inflammatory]], mechanical, [[degenerative]], [[oncologic]] and [[infectious]].<ref name="pmid24994051">{{cite journal| author=Patrick N, Emanski E, Knaub MA| title=Acute and chronic low back pain. | journal=Med Clin North Am | year= 2014 | volume= 98 | issue= 4 | pages= 777-89, xii | pmid=24994051 | doi=10.1016/j.mcna.2014.03.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24994051  }} </ref><ref name="pmid23307577">{{cite journal| author=Goode AP, Carey TS, Jordan JM| title=Low back pain and lumbar spine osteoarthritis: how are they related? | journal=Curr Rheumatol Rep | year= 2013 | volume= 15 | issue= 2 | pages= 305 | pmid=23307577 | doi=10.1007/s11926-012-0305-z | pmc=3606549 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23307577  }} </ref><ref name="pmid16294986">{{cite journal| author=Ross MD, Bayer E| title=Cancer as a cause of low back pain in a patient seen in a direct access physical therapy setting. | journal=J Orthop Sports Phys Ther | year= 2005 | volume= 35 | issue= 10 | pages= 651-8 | pmid=16294986 | doi=10.2519/jospt.2005.35.10.651 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16294986  }} </ref><ref name="pmid18973732">{{cite journal| author=Chien JJ, Bajwa ZH| title=What is mechanical back pain and how best to treat it? | journal=Curr Pain Headache Rep | year= 2008 | volume= 12 | issue= 6 | pages= 406-11 | pmid=18973732 | doi=10.1007/s11916-008-0069-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18973732  }} </ref>
{| class="wikitable"
|'''Type of back pain'''||'''Pathophysiology'''
|-
|[[Inflammatory]]||[[Inflammation]] of [[joints]] ([[sacroiliitis]]), [[inflammation]] of [[enthesis]] ([[spondyloarthritis]])
|-
|Mechanical||[[Trauma]], [[muscle]] [[sprain]], extra weight on [[muscles]] ([[pregnancy]], [[heavy lifting]]),
|-
|[[Oncologic]]||[[Lytic]] [[lesions]] in [[spine]], [[nerve]] [[compression]] due to [[mass effect]], [[pathologic]] [[fracture]] due to weakened [[bone]]
|-
|[[Degenerative]]||[[Cartilage]] degradation and [[bone]] remodeling decreases [[elasticity]] and causes [[pain]] , [[fractures]] can also occur due to [[osteoporosis]],
|-
|[[Infectious]]||[[Infection]] involving [[spine]], [[disc]], [[joints]], [[abscess]] formation.  
|}


Radiographic abnormalities of the low back may occur in patients without pain.<ref name="pmid8208267">{{cite journal| author=Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS| title=Magnetic resonance imaging of the lumbar spine in people without back pain. | journal=N Engl J Med | year= 1994 | volume= 331 | issue= 2 | pages= 69-73 | pmid=8208267 | doi=10.1056/NEJM199407143310201 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8208267  }} </ref><ref name="pmid19532001">{{cite journal| author=Cheung KM, Karppinen J, Chan D, Ho DW, Song YQ, Sham P et al.| title=Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. | journal=Spine (Phila Pa 1976) | year= 2009 | volume= 34 | issue= 9 | pages= 934-40 | pmid=19532001 | doi=10.1097/BRS.0b013e3181a01b3f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19532001 }} </ref> SPECT/CT can identify lesions in some patients and these patients may be more likely to have responses to treatment.<ref name="pmid25469075">{{cite journal| author=Lee I, Budiawan H, Moon JY, Cheon GJ, Kim YC, Paeng JC et al.| title=The value of SPECT/CT in localizing pain site and prediction of treatment response in patients with chronic low back pain. | journal=J Korean Med Sci | year= 2014 | volume= 29 | issue= 12 | pages= 1711-6 | pmid=25469075 | doi=10.3346/jkms.2014.29.12.1711 | pmc=PMC4248596 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25469075 }} </ref>
==Genetics==
* [[Gene|Genes]] involved in the [[pathogenesis]] of [[ankylosing spondylitis]] (AS) include [[Human leukocyte antigen|Human Leukocyte Antigen–B2]]7([[HLA-B27]]).<ref name="pmid9710228">{{cite journal |vauthors=Fiorillo MT, Greco G, Maragno M, Potolicchio I, Monizio A, Dupuis ML, Sorrentino R |title=The naturally occurring polymorphism Asp116-->His116, differentiating the ankylosing spondylitis-associated HLA-B*2705 from the non-associated HLA-B*2709 subtype, influences peptide-specific CD8 T cell recognition |journal=Eur. J. Immunol. |volume=28 |issue=8 |pages=2508–16 |date=August 1998 |pmid=9710228 |doi= |url=}}</ref>
*[[Lumbar disc disease]] have been linked to [[genetic]] involvment. The risk of developing [[lumbar disc disease]] increases if found in other close relatives.<ref name="pmid27617275">{{cite journal| author=Feng Y, Egan B, Wang J| title=Genetic Factors in Intervertebral Disc Degeneration. | journal=Genes Dis | year= 2016 | volume= 3 | issue= 3 | pages= 178-185 | pmid=27617275 | doi=10.1016/j.gendis.2016.04.005 | pmc=5016799 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27617275 }} </ref>  
*[[Genes]] involved in the [[pathogenesis]] of [[back]] [[pain]] include:<ref name="pmid30261039">{{cite journal| author=Suri P, Palmer MR, Tsepilov YA, Freidin MB, Boer CG, Yau MS | display-authors=etal| title=Genome-wide meta-analysis of 158,000 individuals of European ancestry identifies three loci associated with chronic back pain. | journal=PLoS Genet | year= 2018 | volume= 14 | issue= 9 | pages= e1007601 | pmid=30261039 | doi=10.1371/journal.pgen.1007601 | pmc=6159857 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30261039 }} </ref>
**SOX5
**CCDC26/GSDMC
**DCC


===Back Pain During Pregnancy===
==Associated Conditions==
About 50% of women experience low back pain during pregnancy.<ref>Ostgaard HC, Andersson GBJ, Karlsson K. Prevalence of back pain in pregnancy. Spine 1991;16:549-52.</ref>Back pain in pregnancy may be severe enough to cause significant pain and disability and pre-dispose patients to back pain in a following pregnancy. No significant increased risk of back pain with pregnancy has been found with respect to maternal weight gain, exercise, work satisfaction, or pregnancy outcome factors such as birth weight, birth length, and Apgar scores.  
*Conditions associated with [[back]] [[pain]] include:<ref name="pmid17345822">{{cite journal| author=Jandrić S, Antić B| title=[Low back pain and degenerative disc disease]. | journal=Med Pregl | year= 2006 | volume= 59 | issue= 9-10 | pages= 456-61 | pmid=17345822 | doi=10.2298/mpns0610456j | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17345822  }} </ref><ref name="pmid21393649">{{cite journal| author=Nowotny J, Nowotny-Czupryna O, Brzęk A, Kowalczyk A, Czupryna K| title=Body posture and syndromes of back pain. | journal=Ortop Traumatol Rehabil | year= 2011 | volume= 13 | issue= 1 | pages= 59-71 | pmid=21393649 | doi=10.5604/15093492.933788 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21393649  }} </ref><ref name="pmid30010966">{{cite journal| author=Oliveira DS, Vélia Ferreira Mendonça L, Sofia Monteiro Sampaio R, Manuel Pereira Dias de Castro-Lopes J, Ribeiro de Azevedo LF| title=The Impact of Anxiety and Depression on the Outcomes of Chronic Low Back Pain Multidisciplinary Pain Management-A Multicenter Prospective Cohort Study in Pain Clinics with One-Year Follow-up. | journal=Pain Med | year= 2019 | volume= 20 | issue= 4 | pages= 736-746 | pmid=30010966 | doi=10.1093/pm/pny128 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30010966  }} </ref><ref name="pmid22435016">{{cite journal| author=Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A | display-authors=etal| title=Pregnancy-related low back pain. | journal=Hippokratia | year= 2011 | volume= 15 | issue= 3 | pages= 205-10 | pmid=22435016 | doi= | pmc=3306025 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22435016  }} </ref><ref name="pmid25396073">{{cite journal| author=Idris Z, Ghazali FH, Abdullah JM| title=Fibromyalgia and arachnoiditis presented as an acute spinal disorder. | journal=Surg Neurol Int | year= 2014 | volume= 5 | issue=  | pages= 151 | pmid=25396073 | doi=10.4103/2152-7806.143364 | pmc=4228496 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25396073  }} </ref>
**[[Heavy lifting]]
**[[Ligaments]] and [[muscle]] strain
**[[Back]] injuries/[[fractures]]
**[[Arthritis]]
**[[Osteoporosis]]
**[[Metastatic cancer]]
**[[Abnormal posturing]]
**[[Degenerative disc disease]]
**[[Depression]]
**[[Pregnancy]]
**[[Fibromyalgia]]
**[[Sciatica]]
**[[Spinal disc herniation]]
**[[Spinal stenosis]]


Biomechanical factors of pregnancy that are shown to be associated with low back pain of pregnancy include abdominal sagittal and transverse diameter and the depth of lumbar lordosis. Typical factors aggravating the back pain of pregnancy include standing, sitting, forward bending, lifting, and walking. Back pain in pregnancy may also be characterized by pain radiating into the thigh and buttocks, night-time pain severe enough to wake the patient, pain that is increased during the night-time, or pain that is increased during the day-time.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 13:42, 7 June 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

Back pain can be broadly classified into inflammatory, mechanical, degenerative, oncologic and infectious. Lumbar disc disease have been linked to genetic involvment. The risk of developing lumbar disc disease increases if found in other close relatives. Genes involved in the pathogenesis of back pain include, HLA-B27, SOX5, CCDC26/GSDMC, and DCC.

Pathophysiology

Type of back pain Pathophysiology
Inflammatory Inflammation of joints (sacroiliitis), inflammation of enthesis (spondyloarthritis)
Mechanical Trauma, muscle sprain, extra weight on muscles (pregnancy, heavy lifting),
Oncologic Lytic lesions in spine, nerve compression due to mass effect, pathologic fracture due to weakened bone
Degenerative Cartilage degradation and bone remodeling decreases elasticity and causes pain , fractures can also occur due to osteoporosis,
Infectious Infection involving spine, disc, joints, abscess formation.

Genetics

Associated Conditions


References

  1. ↑ Patrick N, Emanski E, Knaub MA (2014). "Acute and chronic low back pain". Med Clin North Am. 98 (4): 777–89, xii. doi:10.1016/j.mcna.2014.03.005. PMID 24994051.
  2. ↑ Goode AP, Carey TS, Jordan JM (2013). "Low back pain and lumbar spine osteoarthritis: how are they related?". Curr Rheumatol Rep. 15 (2): 305. doi:10.1007/s11926-012-0305-z. PMC 3606549. PMID 23307577.
  3. ↑ Ross MD, Bayer E (2005). "Cancer as a cause of low back pain in a patient seen in a direct access physical therapy setting". J Orthop Sports Phys Ther. 35 (10): 651–8. doi:10.2519/jospt.2005.35.10.651. PMID 16294986.
  4. ↑ Chien JJ, Bajwa ZH (2008). "What is mechanical back pain and how best to treat it?". Curr Pain Headache Rep. 12 (6): 406–11. doi:10.1007/s11916-008-0069-3. PMID 18973732.
  5. ↑ Fiorillo MT, Greco G, Maragno M, Potolicchio I, Monizio A, Dupuis ML, Sorrentino R (August 1998). "The naturally occurring polymorphism Asp116-->His116, differentiating the ankylosing spondylitis-associated HLA-B*2705 from the non-associated HLA-B*2709 subtype, influences peptide-specific CD8 T cell recognition". Eur. J. Immunol. 28 (8): 2508–16. PMID 9710228.
  6. ↑ Feng Y, Egan B, Wang J (2016). "Genetic Factors in Intervertebral Disc Degeneration". Genes Dis. 3 (3): 178–185. doi:10.1016/j.gendis.2016.04.005. PMC 5016799. PMID 27617275.
  7. ↑ Suri P, Palmer MR, Tsepilov YA, Freidin MB, Boer CG, Yau MS; et al. (2018). "Genome-wide meta-analysis of 158,000 individuals of European ancestry identifies three loci associated with chronic back pain". PLoS Genet. 14 (9): e1007601. doi:10.1371/journal.pgen.1007601. PMC 6159857. PMID 30261039.
  8. ↑ Jandrić S, Antić B (2006). "[Low back pain and degenerative disc disease]". Med Pregl. 59 (9–10): 456–61. doi:10.2298/mpns0610456j. PMID 17345822.
  9. ↑ Nowotny J, Nowotny-Czupryna O, Brzęk A, Kowalczyk A, Czupryna K (2011). "Body posture and syndromes of back pain". Ortop Traumatol Rehabil. 13 (1): 59–71. doi:10.5604/15093492.933788. PMID 21393649.
  10. ↑ Oliveira DS, Vélia Ferreira Mendonça L, Sofia Monteiro Sampaio R, Manuel Pereira Dias de Castro-Lopes J, Ribeiro de Azevedo LF (2019). "The Impact of Anxiety and Depression on the Outcomes of Chronic Low Back Pain Multidisciplinary Pain Management-A Multicenter Prospective Cohort Study in Pain Clinics with One-Year Follow-up". Pain Med. 20 (4): 736–746. doi:10.1093/pm/pny128. PMID 30010966.
  11. ↑ Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A; et al. (2011). "Pregnancy-related low back pain". Hippokratia. 15 (3): 205–10. PMC 3306025. PMID 22435016.
  12. ↑ Idris Z, Ghazali FH, Abdullah JM (2014). "Fibromyalgia and arachnoiditis presented as an acute spinal disorder". Surg Neurol Int. 5: 151. doi:10.4103/2152-7806.143364. PMC 4228496. PMID 25396073.
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