In the United States, back pain is a very common condition, with most adults experiencing it during their lifetimes [1]. While some forms of back pain cease quickly, others persist for months and can lead to chronic impairment and decreased quality of life [1]. Not all types of back pain are equal: for instance, lower back pain and upper back pain occur at different rates and are often the product of distinct causes [1]. Understanding the nuances of each condition is a meaningful first step to identifying someone’s condition and being able to treat them.
Lower back pain is the most common form of back pain. In fact, research indicates that chronic lower back pain afflicts as many as 23% of adults in the world [2]. Most of the time, it is caused by injury to the back’s tendons or muscles [3]. This may be the result of a strain or a sprain —for example, from lifting an extremely heavy object or lifting it incorrectly [3]. Major accidents, like vehicular crashes, can also result in fractures that then produce lower back pain [3]. And patients with conditions like osteoporosis and spondylolysis may be especially at risk of fractures and thus carry a heightened risk of back pain [3].
There are also other, non-injury-based causes of lower back pain. For example, osteoarthritis can lead to lower back pain by gradually breaking down the cartilage between the back joints [4]. Other diseases, such as abdominal aortic aneurysms, kidney stones, degenerative disk diseases, and various types of cancers can produce lower back pain [3]. Beyond diseases, people who suffer structural back problems —such as spinal stenosis, which is characterized by the spinal column being so narrow in comparison to the spinal cord such that the cord may be pinched in a painful matter— are also at risk of developing lower back pain [3].
In comparison to lower back pain, upper back pain is observed less frequently in the general population [5]. This is not to say, however, that upper back pain is a rare condition: one study suggested that as many as 20% of women and 10% of men could suffer from upper back pain [5].
As with lower back pain, there are many different causes of upper back pain. Underusing or misusing one’s muscles is a common culprit: poor posture or repetition of movement has been associated with upper back pain [5]. Unsurprisingly, traumatic injuries, such as falls or work-related accidents, can also cause upper back pain [5]. And, in more rare cases, lung cancer can cause back pain when a tumor presses on a nerve or spreads to the spine [5, 6].
Although upper and lower back pain are notably different conditions, in some instances, they can have the same causes. A herniated disk, traumatic injury, osteoarthritis, and pinched nerves can all cause either condition [3, 5]. Nevertheless, the significant structural differences between these two areas of the back —compared to the lower back, the upper back is relatively stationary and stabilized because of the cushioning provided by the ribs— help explain why lower back pain is much more common [7]. With the causes of these respective types of pain in mind, practitioners will be better equipped to identify and treat these conditions.
References
[1] “About Back Pain,” Stanford Medicine. [Online]. Available: https://med.stanford.edu/pain/about/chronic-pain/low-back-pain.html.
[2] V. E. Casiano et al., “Back Pain,” StatPearls, Updated February 20, 2023. [Online]. Available: https://www.ncbi.nlm.nih.gov/books/NBK538173/.
[3] “Lower Back Pain,” Cleveland Clinic, Updated January 18, 2021. [Online]. Available: https://my.clevelandclinic.org/health/diseases/7936-lower-back-pain.
[4] “Spinal Arthritis (Arthritis in the Back or Neck),” Johns Hopkins Medicine. [Online]. Available: https://www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-arthritis.
[5] J. Johnson, “What are the most likely causes of upper back pain?,” Medical News Today, Updated October 2, 2023. [Online]. Available: https://www.medicalnewstoday.com/articles/323839.
[6] L. Eldridge, “Is Upper Back Pain a Sign of Lung Cancer?,” Verywell Health, Updated March 12, 2023. [Online]. Available: https://www.verywellhealth.com/back-pain-as-a-symptom-of-lung-cancer-2249303.
[7] “Upper Back Pain,” Cleveland Clinic, Updated April 26, 2022. [Online]. Available: https://my.clevelandclinic.org/health/symptoms/22866-upper-back-pain