4 Serious Causes of Referred Back Pain

Back pain is back pain, right? Not so fast. Sometimes a pain in your back may be coming from an entirely different region of your body, and it could be serious.

What Is Referred Back Pain?

Referred pain is pain felt in an area that is located at some distance from its cause. This common condition is often the result of problems in abdominal and thoracic organs. For example, infection of the kidneys, which are located in the abdominal cavity, may cause referred pain to the flank.

Read on to learn about the most common non-spine related health problems (many of them quite serious) and the role back pain plays in each.  

1

Kidney Stones and Back Pain

Diagram of the urinary system and kidney stones.
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Kidney stones are hard pieces that form in the organ and may cause pain, including sharp lower back pain.

A common health concern, the National Institute of Diabetic and Digestive and Kidney Diseases reports that over 1 million visits to health providers are made every year for kidney stones. This includes 300,000 emergency room visits.  

The medical term for the kidney stones themselves is renal calculi; when you have the condition, this is called urolithiasis. Urolithiasis refers to the condition of having kidney stones anywhere in the urinary system. If your kidney stones are located in the ureters, this is called ureterolithiasis.

What makes up a kidney stone? Basically, they are concentrated forms of certain substances in your urine. (Examples include calcium and phosphorus.) 

The Function of the Kidneys

While the function of the kidneys may not make the best conversation starter, it does play an important role in your overall health. So let's talk about that.

Most people have two kidneys that work constantly to transform blood into urine. These organs act like filters that remove out potentially harmful waste materials from your blood. Because of this, they can have a positive effect on your general health and well-being. Their tasks include regulating your blood pressure, keeping your electrolyte levels stable, and keeping your bones strong. But when the filtering process provided by your kidneys goes awry, your health may suffer.

And, kidneys are located in the abdominal cavity, at the level of the lower back area, just below the ribs.  

Note that the kidneys are not the only organs that comprise the urinary system. The urinary system also has two ureters, one bladder, and a urethra.

Symptoms of Kidney Stones

When you have kidney stones you may notice blood in your urine (called hematuria.) Other symptoms to be on the lookout for include pain while urinating, severe pain and/or in your abdominal area, your side and/or in your groin.  

Pain due to kidney stones can be short or long lasting. You may also experience some nausea and/or vomiting.

And of course, there's the sharp pain in your lower back I mentioned a bit earlier.

If there's any good news when it comes to kidney stones, it's that small ones often pass through your urinary system unnoticed — with no symptoms at all.

Can You Prevent Kidney Stones?

While diet may play a role in the formation of kidney stones, scientists have not identified any specific food that out and out causes them. That said, experts agree that dehydration may raise your risk because it results in concentrated urine.

2

Prostate Problems and Back Pain

Medical consultation about prostate
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Back pain is often a tell-tale sign of a serious prostate problem. Even with this obvious signal, getting routine prostate checkups may save your life. Why? Because the symptoms of a prostate problem, especially back pain, generally show up so late in the process that your opportunity for a speedy and thorough healing may be behind you.

Another reason is that sometimes there are no symptoms of prostate problems, and your back pain is really coming from your back. As with late symptoms, this may result in a missed opportunity for timely treatment.

Prostate Cancer 

Similarly, most men with prostate cancer do not experience symptoms, especially in the early stages. Symptoms related to difficult or painful urination may present themselves once cancer starts to block the urethra or the neck of the bladder, but again, that’s more likely to occur later on.

In other words, back pain can be a sign that prostate cancer is advanced and has spread. The same is true of fractures.

In fact, in his article entitled "Prostate Cancer" published on the Emedicinehealth website, Dr. Kevin Zorn warns that when cancer spreads to the spinal vertebra, it can weaken these bones, which may cause them to collapse, compressing the spinal cord.

In this case, symptoms include (but are not limited to) difficulty walking and weakness in your legs, as well as difficulty controlling your bladder or bowels. This condition is known as cauda equina syndrome. When you have these symptoms, you may first experience a centralized pain in your back (for a few days or weeks) before they make themselves known.

Note: The situation described above is a medical emergency. Failure to seek immediate medical attention may lead to permanent spinal cord damage with paralysis, Zorn says.

Enlarged Prostate

A common condition in older men, an enlarged prostate is usually benign. Back pain is not a known symptom of an enlarged prostate; rather symptoms tend to relate to difficulty and pain in urination.

Prostatitis 

Prostatitis, an inflammation of the prostate gland, is a benign but very common condition. Unlike enlarged prostate, prostatitis strikes men of all ages equally.

Most symptoms of prostatitis relate to urination, for example, pain or burning, difficulty ejaculating, etc. But along with these, you may experience pain in the area between the scrotum or rectum (pelvic floor) and/or your low back.

The type of prostatitis may determine the type of pain. For example, pelvic and low back pain are typical symptoms of an acute prostate infection, as are achy muscles. (An acute infection of the prostate is similar to flu.) On the other hand, with chronic non-bacterial prostatitis, which is the most common type of prostatitis, nerves are affected. This can lead to augmented pain sensitivity and perception — in other words, a chronic pain condition that affects men's pelvises.

3

Abdominal Aortic Aneurysm and Back Pain

abdominal aortic aneurysm on CT
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Most common after the age of 60, abdominal aortic aneurysm is an otherwise rare condition in which the aorta enlarges. (The aorta is the body's largest artery. It branches off from the heart and travels centrally down where it branches again into arteries that go all over the body.)

Dr. Emile Mohler, III in his 2014 UpToDate article entitled "Patient information: Abdominal aortic aneurysm (Beyond the Basics)" says that when abdominal aortic aneurysms remain intact, they generally do not cause health problems. But larger aneurysms can burst, and when they do, bleeding into the abdomen, which is a medical emergency requiring immediate treatment, may result.

That said, most aneurysms are so small that they are not likely to burst. Mohler reports that almost 90% of the aneurysms identified by screening are less than 3.5 centimeters in diameter.

Symptoms of Abdominal Aortic Aneurysms

While most enlargements present few, if any, symptoms, when they rupture suddenly, two of the most obvious symptoms are sudden onset of severe abdominal pain and sudden onset of severe back pain. The pain may spread to your groin and buttocks, and may radiate down your leg, as well

It can be hard to get rid of this kind of pain, even with adequate rest.  

According to the NIH, other symptoms of abdominal aortic aneurysm include. 

  • Passing out
  • Clammy skin
  • Dizziness
  • Nausea and vomiting
  • Rapid heart rate
  • Shock

Be aware that these are not symptoms of typical back pain. If you have any of the symptoms listed above seek medical attention immediately. Surgery is often required as a life-saving measure, so the sooner you can get the appropriate help, the better.

4

Gallstones and Back Pain

Internal Organs
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Similar to kidney stones, gallstones are hard pieces that form in the organ. When gallstone symptoms make themselves known, they can include, among other things, pain under your right shoulder blade.  

What Are Gallstones?

Gallstones are pieces — large or small — of solid matter that form in the gallbladder. In case you've forgotten what you learned in high school science class, the gallbladder is an oblong-shaped organ attached to the underside of the liver. It is the storage site for bile, which is a fat-digesting fluid made by the liver. 

How Gallstones Are Formed

When substances in the bile combine, crystals may form. These crystals may stay in the gallbladder and over time become gallstones. Sometimes a gallstone gets stuck in the duct through which bile travels on its way to the small intestine. When this happens, the ensuing blockage may create inflammation — in the gallbladder, the duct or possibly even the liver or pancreas.

While experts still aren't sure of what causes gallstones, they have found that most contain cholesterol. Experts also agree that diet may be a factor in the formation of gallstones, especially one that is high in animal fats.

Symptoms of Gallstones

Gallstones are often asymptomatic. But when symptoms do make themselves known, they will likely include severe pain in your upper abdomen on the right side that starts suddenly and lasts for at least a half hour. And, as mentioned above, you may also have pain under your right shoulder blade.

If you get indigestion after eating a high fat or high protein meal (which includes desserts and/or fried foods, of course) this may be a sign of a gallstone, as well.

A 2006 Scandinavian study questioned 220 patients with gallstones and found that 63% had referred back pain related to this condition. The survey also found that for 5% of participants, the back pain was their most pronounced symptom.

Gallstone Treatment

Gallstones that don't cause symptoms (called "silent" gallstones) are generally left alone. But if you have symptoms your doctor will likely suggest surgery. The Norwegian study reports that pain is usually the "indication" for surgery, i.e. the reason why the surgical treatment route is initiated in the first place.

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Article Sources
  • Abdominal aortic aneurysm. Medline Plus. U.S. National Library of Medicine. NIH.
  • Chodak, G., M.D., et. al. Prostate Cancer. 
  • Mohler, E., M.D. Patient information: Abdominal aortic aneurysm (Beyond the Basics).
  • Prostatitis: inflamed prostate can be a vexing health problem. Harvard Medical School and Harvard Health Publications. 
  • Zorn, K., M.D. Prostate Cancer Emedicinehealth.