Is My Back Pain a Medical Condition?

Here’s a scene that plays out every day, all over the world: Someone thinks they have a little back strain. Perhaps they lifted something wrong or moved the wrong way. It was just a twinge, so they waited it out a few days for the pain to go away. It doesn’t, so they head to their doctor. Turns out, they hadn’t lifted anything wrong at all. It was the start of a kidney infection, or a UTI, or pancreatitis.

How do you know when the root cause of back pain is elsewhere in your body? There are two types of pain we look at, explains Matthew Crooks, MD, a pain specialist at Pinnacle Pain and Spine in Scottsdale, Arizona: visceral pain and somatic pain. “Visceral pain is pain from an organ or internal pain that can radiate to the spine with conditions like pancreatitis, ulcerative colitis or Crohn’s disease, gall stones, cancers, kidney pain, and urinary tract infection,” says Dr. Crooks.

What’s more, thanks to aging, injury, or a sedentary lifestyle, almost everyone has some wear and tear in the spine and pain in the musculoskeletal system (that’s somatic pain). When you do develop visceral pain, it can flare up your somatic pain. “And that’s separate from the pain that’s radiating from an organ,” says Dr. Crooks. “It can be activated from overall inflammation and the stress of the body dealing with the medical issue.” It’s the BOGO (buy-one-get-one) special that you never want.

How to Tell a Back Strain from a More Serious Medical Condition

So, how can you be sure that the pain in your back isn’t the result of some weekend gardening but rather a more serious medical condition? Most of the time when Dr. Crooks sees patients, they’ve had their medical issue diagnosed and they’re dealing with the secondary effects of that problem in their musculoskeletal system.

However, he has seen patients who’ve come to him for back pain only to find something on an imaging study MRI such as a kidney stone or even cancer, which is more unusual.

Here are the most common medical conditions that can mimic musculoskeletal back pain and how you can help tell the difference:

Kidney Infections and Kidney Stones

Kidneys are the bean-shaped organs located in the posterior half of the body toward the middle of the back that filter waste products from the body, regulate bodily fluids, and perform other important functions. “It’s very easy for kidney infections and kidney stones to mimic a sprain or strain [in the back],” says Dr. Crooks.

Where’s the pain? Mid or upper back

What are the other possible symptoms? Fever, nausea, and malaise, burning sensation when you urinate

What does the pain feel like? Pain may feel higher and deeper in the back vs. lower back pain. You can also have side and groin pain. Note, the pain typically doesn’t go away when you shift positions, lie down or rest.

Urinary Tract Infection (UTI)

An upper urinary tract infection (in the kidneys or ureters) can cause intense back pain. Upper UTIs occur when a lower UTI (in the bladder or urethra) gets overlooked or doesn’t respond to antibiotic treatment. The infections can happen at any age, and women and elderly men may be more susceptible. UTIs can also turn serious and may need immediate medical attention.

Where’s the pain? Lower back and groin area

What are the other possible symptoms? Pain in flanks or lower abdomen, fever, vomiting, burning on urination, frequent urination of small amounts, strong urge to urinate, foul-smelling or cloudy urine, fatigue

What does the pain feel like? Cramping pain, pressure, or soreness

Urinary tract infections are frequently mistaken for spine conditions.

Pancreatitis

What are the other possible symptoms? Pain in flanks or lower abdomen, fever, vomiting, burning on urination, frequent urination of Pancreatitis is an inflammation of the pancreas, the long, flat organ sits in the upper abdomen tucked behind the stomach that helps with digestion and sugar management. The American Pancreatic Association says acute pancreatitis makes people feel very sick with moderate to severe dull abdominal pain that radiates to the back and worsens after meals.

Where’s the pain? Upper to middle back

What are the other possible symptoms? Abdominal pain that radiates to your back, abdominal pain after eating, fever, nausea, vomiting, tenderness in the abdomen

What does the pain feel like? Some patients report the pain feels like a pulled muscle or joint pain. It can wax and wane at first, and come on stronger after eating or lying down

Inflammatory Bowel Diseases (IBD)

Ulcerative colitis and Crohn’s disease are inflammatory bowel diseases (not to be confused with irritable bowel syndrome). Ulcerative colitis affects the colon, whereas Crohn’s is characterized by both healthy areas of the intestine and inflamed areas anywhere along the bowel. Both can cause radiating back pain. In fact, a study in the American College of Rheumatology found 25% of IBD sufferers have chronic back pain.

Where’s the pain? Lower back

What are the other possible symptoms? Abdominal pain and cramps, urgent need to move bowels, diarrhea, constipation, rectal bleeding, fatigue, loss of appetite, weight loss

What does the pain feel like? Cramps in lower right abdomen wrapping around lower back may be mild or severe and occur in cycles when there’s a flare-up, then get better

Metastatic Cancers

Breast, Lung, Abdomen, Colon, Pancreas, Gallbladder

These types of cancers can metastasize to the spine and cause back pain. “Also with abdominal cancers, pancreatic and gallbladder cancers, you can get the referred visceral pain even before they metastasize,” says Dr. Crooks. When cancers do spread to the spine, you can have severe spinal pain.

Depending on the type of cancer, treatments like intrathecal pain pumps can deliver medicine like an anesthetic, nerve pain medicine, or a narcotic in small doses straight to the spine without negative effects like tolerance, addiction, and overdose. Stimulation to the spinal nerve root and spinal blocks are also effective treatments for spinal pain.

Where’s the pain? Depending on the type of cancer, back pain can be in the upper, mid, or lower spine

What are the other possible symptoms? Fatigue that doesn’t improve with rest, unexplained weight loss or gain, loss of appetite, nausea, vomiting, swelling or lumps, skin changes, hoarseness, persistent cough, change in bowel habits, vision or hearing problems, headache, and others

What does it feel like? Back pain can range from mild to severe depending on the type of cancer and location and may not respond to OTC pain relievers

It’s important to know your body and not push through back pain or ignore it. “See your doctor if any back pain is going on for more than a week,” says Dr. Crooks. A well-trained pain specialist may be a good idea if you have chronic back pain from a continued medical issue like Crohn’s disease, recurrent UTIs, or chronic pancreatitis.

While your primary care doctor or specialist helps keep your medical issue in check, a pain specialist can improve chronic musculoskeletal pain that stems from inflammation and overstimulated nerves that can occur when you have one of these conditions.