Infections, bladder problems, even cancer – those aches and twinges in your back could be trying to tell you something

• Sometimes organs send pain signals to other body parts – notably the back

• For instance, kidney and bladder problems are easily mistaken as back pain

• GPs can’t fully explain why this happens, though they have some theories

Here, we examine some of the other causes of back pain

Michelle Law’s childhood was blighted by back pain. Her mother took her to the GP many times, only to be told that the constant gnawing ache in Michelle’s back was growing pains or a pulled muscle.

She’d be sent home with painkillers or muscle relaxants – none of which helped.

The pain between her lowest rib and pelvic bone on the right-hand side of her back dogged Michelle into adulthood.

When she was 35, a new GP referred her for investigations on her kidneys because of the site of the pain.

‘I had dozens of scans and tests over four years, but they couldn’t find anything wrong,’ says Michelle, who lives in Hastings, East Sussex, with her four children and is studying to be a veterinary nurse. ‘By that time I was relying on morphine for pain relief and had become house-bound.’

Apart from the pain, she had no other obvious symptoms, but for a couple of years she had developed cystitis-like symptoms – an increased need to urinate and occasional blood in her urine – but with no sign of infection.

The breakthrough came 18 months ago when Michelle was referred to a specialist in female urology at Eastbourne Hospital, who ordered tests on her bladder.

She was given a cystoscopy (where a tiny camera is inserted into the bladder) and biopsies under a general anaesthetic.

These revealed that Michelle had been suffering from interstitial cystitis, which attacks the lining of the bladder. When she came around from the anaesthetic, Michelle was told there was nothing the specialists could do to save it.

Her bladder was so badly scarred that it could not stretch or shrink as it should. Even a tiny amount of liquid – 20ml, or less than 4tsp – would cause it to empty (a healthy bladder should hold 700ml to 1,000ml).

‘I was told the tissue was so damaged it fell apart in the surgeon’s hands,’ she says.

Michelle’s only option was to have a new bladder surgically formed out of her bowel tissue. Today, she suffers from frequent infections (the bowel tissue produces mucus that attracts bacteria) and, because the new bladder has no muscle control, Michelle has to empty it using a catheter, further raising the risk of infection. In the future she may need to have a permanent catheter, as well as a urostomy (an external bag).

Though Michelle’s case is extreme, it is frighteningly common for back pain to mask the symptoms of other potentially serious health conditions.

Kidney, bladder and gallbladder problems can easily be mistaken as back pain, particularly in women, says Dr Zaki Almallah, consultant urologist at the Birmingham Bladder Clinic and the Queen Elizabeth Hospital in Birmingham. ‘I’ve seen patients complaining about their bed or talking about a fall and generally trying to find reasons to justify their back pain,’ he says.

‘Quite often patients will have gone back and forth, sometimes for months, with different diagnoses and treatments before they come to me.’

Sometimes the organs can send pain signals to other parts of the body – notably the back – by a process called ‘referred pain’.

Doctors cannot fully explain what happens, but believe strong pain messages running along nerves ‘leap’ or ‘overwhelm’ adjacent nerves, causing pain to be felt where that series of nerves originates.

Certainly, Michelle’s specialist believes her persistent back pain could have been caused by the diseased bladder sending pain signals to her right kidney or by pain triggered by urine being occasionally flushed up to the kidney by her shrinking bladder.

Back pain is a common symptom of pancreatic problems – pancreatitis (inflammation of the pancreas) and pancreatic cancer.

Dr Steve Pereira, a consultant gastroenterologist at the Royal Free Hospital, London, estimates 20 to 30  per cent of pancreatitis sufferers see their GP about back pain before they are properly diagnosed.

This condition, which causes inflammation of the pancreas, is believed to be triggered when a problem develops with some of the enzymes in the pancreas, which causes them to digest the organ.

Pancreatitis is often linked to gallstones (in women) and sometimes to excessive alcohol consumption (usually in men) and typically affects middle-aged and elderly people.

In fact, Dr Pereira is using the back pain trigger in a new screening programme to try to improve the early diagnosis of pancreatic cancer, a condition that is notoriously tough to treat, as it is usually spotted late.

‘In recent studies of 3,000 patients with pancreatic cancer, 17 per cent reported back pain as a prominent symptom,’ he says.

Dr Pereira is hoping back pain will be flagged up by GPs in conjunction with other possible symptoms of pancreatic cancer (such as weight loss, jaundice and sometimes abdominal pain or indigestion) to improve the speed of diagnosis.

More rarely, back pain is associated with other cancers such as lung, colon and very occasionally ovarian cancer if tumours grow large enough to press on nearby nerves or organs.

Andy Whitfield, who starred in the TV series Spartacus: Blood And Sand, saw no reason to worry about the back pain he noticed when he began training for the series.

The physical workload to build an authentic Spartan physique was intense and a certain amount of pain was to be expected.

But when filming finished and the back pain became more severe and constant, he went to see his doctor.

A scan revealed a large tumour pressing against his spine. He was diagnosed with non-Hodgkin’s lymphoma (which starts in the lymph nodes). He died 18 months later at the age of 39. Martin Ledwick, Cancer Research UK’s head information nurse, says: ‘For a small number of people, a dull ache in their back can be a symptom of some types of cancer, but it will usually be caused by something else.

‘If you notice any changes that are out of the ordinary, visit your doctor to rule it out. Cancers that are found early are the most easily treated.’

If you have back pain that does not have an obvious cause, a good GP will usually conduct other tests (such as a urine test) to screen for all possible causes, either direct pain or referred, says Dr Pereira.

But Dr Almallah stresses the importance of effective communication.

‘If you know you have done nothing to hurt your back, if your range of movement is unimpaired and yet painkillers are not helping, then it is important that you tell your GP about your concerns,’ he says.

Michelle Law wholeheartedly also urges those suffering from back pain to be persistent with their doctor.

‘If I had been properly diagnosed sooner, things wouldn’t have got this bad,’ she says.
‘I’m so angry with the doctors who failed me and devastated that I’ve missed out on years with any quality of life because of this misdiagnosis.’

Here, we examine some of the other causes of back pain.

Written by Louise Atkinson for the Daily Mail, November 11, 2013.

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