My answer to How do you know if back pain is serious?

Back pain can be so intense when it strikes that it feels like something very serious has happened to our spines, which may cause some people to run from doctor to doctor looking for answers. 

What most people don’t understand is that the spine is the most powerful structure in the body. If someone did have a serious structural issue with their spine they wouldn’t be able to get to a standing position.  

When you walk into a doctor’s office under your own power the physician may assume that it is just common stress related back pain. This is sometimes diagnosed as “non specific acute low back pain" and if it becomes chronic, it may be called “benign persistent back pain". 

The doctor may order an MRI if the patient has certain red flags that could indicate an organic cause such as:

• Fever
• Recent trauma
• Pain at night or at rest
• Progressive motor or sensory deficit
• Saddle anesthesia
• Unexplained weight loss
• History of cancer or strong suspicion of cancer
• History of osteoporosis or chronic steroid use
• Immunosuppression

There is usually little point to scheduling an MRI or other imaging tests if no red flags are present, but each doctor will make their own determination about imaging based on their exam and other medical information about the patient.

Generally, the pain is caused by a lack of oxygen due to contracted muscles, which reduce blood supply. Surrounding tissues send pain signals when they aren’t properly oxygenated. This loop of tension, muscle contraction and pain is called Tension-Based Pain.

The body compensates for our stressful lifestyles as long as it is able and when it can’t anymore, our autonomic nervous system prepares us to flee by tensing our muscles, but we don’t flee, and the contraction and pain continue.

This was posted on Quora.

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