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Chapter 016. Back and Neck Pain (Part 3)

Local pain is caused by stretching of pain-sensitive structures that compress or irritate sensory nerve endings. The site of the pain is near the affected part of the back. Pain referred to the back may arise from abdominal or pelvic viscera. The pain is usually described as primarily abdominal or pelvic but is accompanied by back pain and usually unaffected by posture. The patient may occasionally complain of back pain only. Pain of spine origin may be located in the back or referred to the buttocks or legs. Diseases affecting the upper lumbar spine tend to refer pain to the lumbar. | Chapter 016. Back and Neck Pain Part 3 Local pain is caused by stretching of pain-sensitive structures that compress or irritate sensory nerve endings. The site of the pain is near the affected part of the back. Pain referred to the back may arise from abdominal or pelvic viscera. The pain is usually described as primarily abdominal or pelvic but is accompanied by back pain and usually unaffected by posture. The patient may occasionally complain of back pain only. Pain of spine origin may be located in the back or referred to the buttocks or legs. Diseases affecting the upper lumbar spine tend to refer pain to the lumbar region groin or anterior thighs. Diseases affecting the lower lumbar spine tend to produce pain referred to the buttocks posterior thighs or rarely the calves or feet. Provocative injections into pain-sensitive structures of the lumbar spine may produce leg pain that does not follow a dermatomal distribution. This sclerotomal pain may explain some cases of back and leg pain without evidence of nerve root compression. Radicular back pain is typically sharp and radiates from the lumbar spine to the leg within the territory of a nerve root see Lumbar Disk Disease below . Coughing sneezing or voluntary contraction of abdominal muscles lifting heavy objects or straining at stool may elicit the radiating pain. The pain may increase in postures that stretch the nerves and nerve roots. Sitting stretches the sciatic nerve L5 and S1 roots because the nerve passes posterior to the hip. The femoral nerve L2 L3 and L4 roots passes anterior to the hip and is not stretched by sitting. The description of the pain alone often fails to distinguish between sclerotomal pain and radiculopathy. Pain associated with muscle spasm although of obscure origin is commonly associated with many spine disorders. The spasms are accompanied by abnormal posture taut paraspinal muscles and dull pain. Knowledge of the circumstances associated with the onset of back pain is important