Back Pain
MBChB (New Zealand), PGDipObstMedGyn, FRACP (New Zealand), FAMS (Rheumatology)
Back pain is a common musculoskeletal condition that can affect people of all ages. While many cases are related to muscle strain, mechanical problems or age-related changes and improve with conservative treatment, persistent back pain may be caused by inflammatory arthritis or another underlying medical condition. These conditions require specialist assessment and targeted treatment to address the underlying cause.
Early diagnosis is important as timely and appropriate treatment can help control inflammation, relieve symptoms and reduce the risk of long-term joint damage. At the Centre for Rheumatology & Arthritis, Dr Poh evaluates whether a rheumatic or autoimmune condition may be contributing to your symptoms and develops a personalised treatment plan based on your diagnosis.
Causes and Risk Factors of Back Pain
Back pain can have many causes, ranging from mechanical strain and age-related changes to inflammatory conditions affecting the spine. Common causes of back pain include:
Inflammatory Arthritis
Inflammatory conditions such as ankylosing spondylitis can cause inflammation in the joints and structure of the spine, leading to persistent back pain and stiffness. Unlike mechanical back pain, inflammatory back pain often improves with movement and may worsen after periods of rest or prolonged inactivity.
Degenerative Spinal Conditions
Age-related changes affecting the spinal discs and joints, including osteoarthritis and degenerative disc disease, can contribute to back pain, stiffness and reduced spinal mobility.
Muscle or Ligament Strain
Overuse, repetitive movements, heavy lifting or sudden twisting may strain or sprain the muscles and ligaments supporting the spine, causing pain and stiffness.
Fractured spine
A fracture of the spine, including a compression fracture can cause sudden or persistent back pain. Osteoporosis weakens the bones and may increase the risk of spinal fractures, sometimes following a minor injury. Symptoms may include localised back pain, tenderness and reduced mobility.
Herniated disc
A herniated disc occurs when the soft inner material of a spinal disc pushes through a weakened outer layer. This can irritate or compress nearby nerves causing back pain and sharp shooting pain that may radiate down one side of the buttock or leg (sciatica).
Symptoms of Back Pain
Back pain can present differently depending on its underlying cause. Symptoms may include:
Back Pain
Pain may affect the upper, middle or lower back and range from a dull ache to sharp or intense discomfort. The pain may be persistent or intermittent.Stiffness
Back stiffness may cause reduced flexibility or difficulty bending, twisting or standing upright. Symptoms may be more noticeable after prolonged periods of sitting, rest or inactivity.Pain Radiating to the Arms or Legs
Pain that travels from the back into the buttocks, hips or legs may indicate irritation or compression of a spinal nerve. Similarly, nerve irritation in the neck (cervical spine) may cause pain extending into the shoulders or arms.Numbness, tingling or Weakness
Nerve involvement may cause numbness, pins and needles, altered sensation or weakness in the arms or legs. These symptoms warrant medical assessment, particularly if they are persistent or worsening.Morning Stiffness
Persistent morning stiffness lasting more than 30 minutes, especially when associated with improvement after activity or exercise, may be a feature of inflammatory back pain. This can occur in autoimmune conditions such as ankylosing spondylitis and should be assessed by a rheumatologist.
When Should You See a Rheumatologist for Back Pain?
You may benefit from assessment by a rheumatologist if you experience any of the following:
- Back pain lasting more than three months
- Morning stiffness lasting more than 30 minutes
- Back pain that improves with exercise or movement rather than rest
- Alternating buttock pain
- A personal or family history of skin psoriasis, inflammatory bowel disease or uveitis
- Persistent or recurrent back pain despite conservative treatment
- Raised inflammatory markers or unexplained evidence of inflammation
These symptoms do not necessarily mean that your back pain is caused by an inflammatory rheumatic condition. However, they may warrant further assessment to determine the underlying cause.
How Do Rheumatologists Diagnose the Cause of Back Pain?
Diagnosing back pain involves a combination of clinical assessment and investigations to determine the underlying cause and identify conditions requiring specific treatment.
Medical History and Symptom Assessment
A thorough medical history helps identify potential causes and contributing factors, including onset and pattern of pain, previous injuries, occupational or physical activities, associated symptoms and relevant personal or family medical history.
Physical Examination
A physical examination assesses spinal movement, muscle strength, joint function and neurological signs.
Blood Tests
Blood tests may be performed when an inflammatory arthritis, autoimmune disease, infection or another underlying medical condition is suspected.
Imaging Studies
X-rays, magnetic resonance imaging (MRI) or computed tomography (CT) scans may be recommended to assess the spine for conditions such as degenerative changes, fractures, disc abnormalities or features of inflammatory disease.
How Do Rheumatologists Treat Back Pain?
The management of back pain aims to relieve symptoms, improve mobility and address the underlying cause. Treatment is tailored to your diagnosis, the severity and duration of your symptoms and your overall health. It may involve a combination of medication, physiotherapy, exercise and longer-term management strategies.
Medications
Pain-relieving and anti-inflammatory medications can help reduce pain and improve function. In autoimmune conditions, disease-modifying anti-rheumatic drugs (DMARDs) or biologic therapies may be recommended to control inflammation and reduce the risk of disease progression.
Physiotherapy and Exercise
A structured exercise programme can help improve flexibility, strengthen the muscles supporting the spine and maintain mobility. Physiotherapy may also help restore movement, improve physical function and reduce the risk of recurrent symptoms.
Lifestyle and Activity Modifications
Maintaining an active lifestyle, avoiding prolonged periods of inactivity, maintaining a healthy weight and adopting a good posture can help support spinal health and complement medical treatment.
Managing Underlying Conditions
When back pain is associated with inflammatory arthritis, osteoporosis or another underlying medical condition, treatment focuses on managing the condition itself as well as relieving symptoms. Appropriate treatment can help improve function, reduce complications and support long-term spinal health.
Dr Poh Yih Jia
Senior Consultant Rheumatologist
Dr Poh Yih Jia is a senior consultant rheumatologist with more than 20 years of medical experience in
New Zealand and Singapore. She has extensive experience in the diagnosis and management of rheumatic,
autoimmune and musculoskeletal conditions that cause back pain, including inflammatory arthritis
affecting the spine.
Her commitment to patient-centred care has earned her multiple accolades, including the Singapore Health
Quality Service Award and the Service with a Heart Award. She remains dedicated to advancing
rheumatology through clinical practice, education and research, ensuring her patients receive the most
current, evidence-based care for inflammatory and autoimmune conditions affecting the spine.
FAQs on Back Pain
No. While age-related changes in the spine become more common with increasing age, persistent back pain should not simply be considered a normal part of getting older. Back pain can have many causes, including muscle or ligament strain, degenerative spinal conditions, nerve-related problems, vertebral fractures associated with osteoporosis and inflammatory arthritis.
Inflammatory back pain typically develops gradually, and often begins before the age of 45. It is more likely to improve with movement or exercise rather than rest and may be associated with morning stiffness lasting more than 30 minutes. Other features may include alternating buttock pain. Mechanical back pain may be worsened by particular movements or physical activity and improve with rest.
Depending on your symptoms, medical history and examination findings, a rheumatologist may assess for inflammatory and rheumatic conditions that can cause back pain such as ankylosing spondylitis and psoriatic arthritis. Other inflammatory, autoimmune or musculoskeletal causes of back pain may also be considered and, where appropriate, referral to another specialist may be recommended.
Yes. Most inflammatory causes of back pain are managed without surgery. Treatment may include medications to control inflammation, physiotherapy, regular exercise and lifestyle measures to help maintain mobility and function. Surgery is not usually required to treat the inflammatory arthritis itself.
Not all causes of back pain can be prevented, but certain measures may help reduce the risk of developing or experiencing recurrent back pain. Staying physically active, maintaining good posture, strengthening the muscles supporting the spine and maintaining a healthy weight can all contribute to spinal health. Managing underlying medical conditions, such as inflammatory arthritis or osteoporosis, is also important in reducing the risk of complications and recurrent symptoms.