Detailed guides to painful problems, treatments & more

The worst possible causes of back pain (is a very popular topic)

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Recently, my page about scary causes of back pain — When to Worry About Low Back Pain — has shot up in the search ranks, becoming one of the most read pages I’ve ever published, with a grand total of about 1,300,000 visitors and counting (fast).

•mind blown• What an immense responsibility.

It had humble beginnings. After publication in 2009, it rarely got more than 3 visitors per day … for months. It gradually built up to a hundred per day by the end of 2013, then up to a few hundred per day in 2014, and then, “suddenly,” it did this:

Dramatic graph showing huge growth over 2015.
Last week this article pulled in about 4,000 readers per day! Which is kind of scary, because that is a lot of scared people hoping to find good quality information about back pain. And they are reading carefully, an average of more than six minutes reading time.

Although I have maintained the article over the years, it needed work (of course), so I sunk a bunch more time into it over the last week, and I’ll be doing even more. In particular, I made this new table of scary back pain causes, and spent hours fine-tuning the phrasing for maximum readability and usefulness for the average person.

The worst possible causes of back pain
what is it? major features
cancer a tumor in or near the spine Many kinds of cancer can cause many kinds of back pain, but some strong themes are: the pain grows steadily and is mostly unaffected by position and activity, worse with weight bearing and at night, and comes with other signs of being unwell.
cauda equina syndrome pinching of the lowest part of the spinal cord Hard to mistake for anything else: hard to pee, fecal incontinence, numb groin, weak legs. Caused by ruptured discs, trauma, cancer, infection.
spinal infection infection in or near spinal structures Hard to detect, often for a long time. Usually there’s a well-defined tender spot and then, eventually, deep constant pain, a rigid spine, sometimes fever and illness but not always.
abdominal aneurysm ballooning of a large artery next to the spine Pain may throb in sync with pulse. Mostly occcurs in people at risk of heart disease: older, heavier, hypertensive smokers and diabetes patients.
ankylosing spondylitis inflammatory arthritis of spine and pelvis, mostly Long term back pain starting well before middle age and progressing slowly and erratically, improves with activity but not rest, prolonged morning stiffness, possible involvement of other areas. More common in men.
Thanks to Dr. Jim Eubanks of Ability Science for his kind assistance checking my work.