What causes low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Most commonly, diagnoses of acute painful spinal conditions are nonspecific, such as neck or back strain, although injuries may affect any of several pain-sensitive structures, which include the disk, facet joints, spinal musculature, and ligamentous support. [17, 18] The origin of chronic back pain is often assumed to be degenerative conditions of the spine; however, controlled studies have indicated that any correlation between clinical symptoms and radiological signs of degeneration is minimal or nonexistent. [6, 17, 18, 19, 20, 21] Inflammatory arthropathy, metabolic bone conditions, and fibromyalgia are cited in others as the cause of chronic spine-related pain conditions. [17, 18]

Although disk herniation has been popularized as a cause of spinal and radicular pain, asymptomatic disk herniations on computed tomography (CT) and magnetic resonance imaging (MRI) scans are common. [21, 22, 23, 24] Furthermore, there is no clear relationship between the extent of disk protrusion and the degree of clinical symptoms. [25] Degenerative change and injury to spinal structures produce lower back and leg pain that vary proportionally. A strictly mechanical or pathoanatomical explanation for LBP and sciatica has proved inadequate; therefore, the role of biochemical and inflammatory factors remains under investigation. In fact, this failure of the pathological model to predict back pain often leads to an ironic predicament for the patient with LBP.


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