The following is excerpted and adapted from Ending Back Pain.
The odd sensation started in her lower back, a little to the right. An avid runner, Kathryn chalked it up to her long jaunt that morning down to the beach and back. She popped some ibuprofen to try to settle the dull sensation. The feeling resembled one of a pinched or agitated nerve, and she assumed this could be another sciatic episode. Or perhaps she had strained a muscle. Whatever it was, she didn’t think twice about her growing discomfort and lower back’s tenderness. If she worried about anything, it was that this escalating soreness would disrupt her run the next morning, and she’d have to take a few days off. By bedtime, she sensed that something wasn’t right. She took another round of ibuprofen and decided that a good long sleep—off her feet—would be the cure.
At one o’clock in the morning, Kathryn awakened with a high fever, chills, and a serious sweat. She forgot about the backache and now thought that maybe she was suffering from food poisoning, vowing to grin and bear it. She did her best to sleep through the night, but it wasn’t easy. By morning, it was clear that whatever Kathryn was fighting wasn’t going to go away soon enough. It was time to call the doctor.
Flash forward a couple of hours. Kathryn is sitting in her primary-care physician’s office. Everything hurt, including her joints and muscles. Her overall discomfort eclipsed the throbbing ache still in her lower back. As her doctor scrolled through her medical history and asked a series of questions to help nail down exactly what could be wrong with her, Kathryn remembered how it all started: with a nagging twinge in her lower back, just to the right.
“You should be in the emergency room,” he told her. “This has nothing to do with your back.” His instincts were right on target. That afternoon, after giving Kathryn a powerful dose of antibiotics, it was confirmed that she had a case of acute bacterial pyelonephritis— a bacterial infection in her kidneys that was making its way to her bloodstream. It took her two weeks to recover and get back on the running trails.
A case like Kathryn’s is dramatic but short and to the point: The diagnosis can be made relatively quickly and a remedy is waiting. I learned about her story through her physician, who happens to be a colleague. Kathryn’s case occurred the same week I saw a patient with similarly agonizing flank pain radiating from her lower back. My patient’s story had a different ending, though. It turned out that she had a kidney stone, which was confirmed by a CT scan and treated with a course of pain medication until the stone passed. Though she first said that her main problem was “back pain,” I later learned that her pain was localized more toward her flank than the small of her back.
This instantly ruled out a lot of potential culprits of back pain and clued me in to a host of conditions that mimic low back pain, including kidney stones. Problems with the kidneys can cause back pain, since the kidneys are located in that general region of the body. The kidneys themselves are perched high on the back, just under the lower ribs, but complications such as stones moving down and out of them or an infection in the ureter can feel like back pain. For this reason, it’s important to map pain’s geography and identify the difference between, for example, pain isolated to the lower back and pain that’s felt on one’s side. In turn, this helps a doctor figure out what’s actually causing the pain.
For both of these women, though, the turning point in their cases came when we doctors could isolate exactly where their pain originated—to get to the source as quickly as possible and then hunt down further clues to arrive at an accurate diagnosis. Kathryn didn’t have the luxury of time, given her rapidly blooming bacterial infection, which could have done serious damage not only to her kidneys but elsewhere as it moved through her bloodstream. Had she not recalled that seemingly minor pain “in her back,” and been specific about its odd sensation over “to the side,” accompanied by a fever and chills, it may have taken much longer to pinpoint the offending cause as she awaited a litany of clinical and laboratory tests.
Bottom line: It’s important to identify the source of your pain. Where is your pain emanating from, exactly? The answer to this single question will help you decode the real reason for