Referred pain
It is of utmost importance to bear in mind that neck and back pain can
originate from a pathologic process that is not located in the spinal
column.6,10,11 For example, acute myocardial
infarction or ischemia of the posterior wall of the myocardium can cause
thoracic interscapular pain that can be accompanied by dyspnea,
sweating, and palpitations.12 Dissection of an aortic
aneurism can cause thoracic or lumbar pain that develops suddenly or
gradually.13,14 Signs of ischemic shock or tachycardia
will not always appear immediately, and weak or absent pulses in the
upper or lower extremities may be the first early
sign.14 A pulmonary embolism can cause the sudden
appearance of thoracic back pain as well as pulmonary bulla, pleuritis,
pneumothorax, and empyema.14 Lung cancer especially
that expands to the posterior thorax can cause back
pain.15 Intra-abdominal pathologies, such as
pancreatic cancer6 with or without bone metastases,
can cause lumbar back pain that typically radiates to the abdomen in a
”belt-like” manner. Posterior perforation of a peptic ulcer can cause
the sudden appearance of back pain and the gradual development of signs
of sepsis.14 Renal pathologies6,14may cause back and flank pain that radiates to the groin and that may be
accompanied by urinary symptoms, fever, chills, nausea, and headaches.
Various gynecological problems and menstrual cramps can also cause back
pain. Brain stem tumors can present as neck pain with or without
neurological abnormalities or gait abnormalities.16Inflammation of the sacroiliac joint can cause poorly localized buttock
pain that can be confused with lumbar pain17 and
sometimes even be accompanied by radiating pain to the thigh and leg
with neurological manifestations due to involvement of the lumbosacral
plexus.18