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