Back Pain and Dizziness: Causes and Treatments

Vertigo

The inner ear contains a system of tube loops and sacs called the labyrinth, as well as vestibular nerves that send information to your brain. These all help control your balance and hearing.

Inflammation of the labyrinth in the inner ear creates a condition called labyrinthitis and is most commonly caused by a viral infection. Symptoms include dizziness, nausea and sickness, sudden hearing loss, ringing in the ears (tinnitus), blurry vision and feeling light-headed. You may experience vertigo, where it feels like you are in constant motion or the room is spinning (it feels a bit like you’re on a boat in a stormy sea.)

Endometriosis

Endometriosis is a very common problem where deposits of the endometrium (the inner lining of a woman’s womb) grow outside of the womb, which can cause pain - including back pain - and other symptoms such as dizziness. The exact number of women with endometriosis is unclear because there are sometimes no symptoms, but estimates vary from 10% to 50% of women in the UK and it also frequently runs in families. It’s rare in women after menopause. The endometrium consists of glands, lots of blood vessels and other supportive tissues and during the menstrual cycle, hormones cause the endometrium to thicken in order to nourish an embryo if a pregnancy occurs.

Endometriosis is an inflammatory condition where there is repetitive irritation from the deposits that are present outside of the womb. These deposits vary greatly in size from tiny to large, and can cause inflammation, and eventually scarring. This causes parts of pelvic organs to stick together, increasing the sensitivity of nerves and leading to chronic pain. The cervix (the neck of the womb) is commonly affected.

Ectopic pregnancy

An ectopic, or ‘misplaced’ pregnancy is one where the fertilized egg attaches itself outside the womb. This affects around 1% of all pregnancies, and most occur in one of the Fallopian tubes between the ovaries and the womb – called a ‘tubal’ ectopic. More rarely one can occur in other places such as the abdomen or in the ovary. There are several risk factors that increase the chances of this occurring. These include previous surgery to, or infection of, the Fallopian tubes, a past history of ectopic pregnancy, and becoming pregnant while using the contraceptive coil or mini-pill. However, many women with an ectopic pregnancy do not have any of these risk factors.

The usual symptoms are an overdue period (which suggests possible pregnancy anyway), low abdominal pain that may be acute or develop over several days and vaginal bleeding. There may also be fainting spells but if the Fallopian tube suddenly ruptures and causes internal bleeding there is collapse, shock and severe pain – this is a medical emergency.

Osteoarthritis

Osteoarthritis is a disease affecting the joints and affects almost everybody as they get older. Around 8 out of 10 people over the age of 50 are affected. The process starts with cartilage becoming thin and uneven and then over time, perhaps wearing out completely. At the same time, the joint capsule becomes thicker and more synovial (lubricating) fluid is manufactured which makes the joint swell. In addition to cartilage degeneration, bony spurs grow causing inflammation in the surrounding tissues.

Osteoarthritis can involve all joints of the body, but is most commonly found in the fingers, knees, hips and spine. Symptoms include;

• Joint stiffness and pain. This improves with activity, but is often worse again after a period of rest.
• Backache.
• Reduced range of movement in affected joints.
• Possible swelling of affected joints.
• Possible grating of the joint on movement.
• It is not usually associated with redness or heat of the affected joint.
• If there is osteoarthritis in the neck (cervical) bones, this can cause pain in the neck and upper back as well as dizziness.

Fibromyalgia

Fibromyalgia is a long-standing condition that causes pain all over the body. It can be a lifelong condition, although there are treatments that help to relieve pain and make living with the symptoms much easier. The name fibromyalgia comes from the words fibrous tissue (fibro), muscles (my) and pain (algia). It’s a syndrome (FMS), which means it can cause a collection of symptoms. Alongside pain, these include tiredness, headaches, bowel symptoms (bloating, constipation, diarrhoea), difficulty concentrating and remembering, sleep disturbance (including restless leg syndrome), muscle stiffness and increased sensitivity to pain. However, fibromyalgia is not a type of arthritis and so joints are not usually affected but many areas of the body can feel tender when pressed.

About 1 in 25 people develop fibromyalgia at some time, and it’s much more common in women than in men. It typically begins between the ages of 25 and 55, and has often been present for a long time before it’s diagnosed.

Sciatica

The most common type of back pain is simple backache, where the pain is usually in the lower back and occasionally spreads to the thighs or buttocks. It is caused most often by a sprain or minor tear to a ligament or muscle in the back, usually from awkward or heavy lifting, twisting or bad posture (such as sitting at an incorrectly designed workstation or desk). Usually called nonspecific low back pain, there is no specific problem or disease that can be identified as the cause of the pain. The severity of the pain can vary from mild to severe.

A smaller number of cases are due to a nerve being trapped as it comes out from the spinal cord and this can be due to a slipped disc, a bad muscle tear or other problems such as arthritis. This type of nerve root pain is often called sciatica and pain is felt along the course of the nerve. Therefore, you typically feel pain down a leg, sometimes as far as to the calf or foot, and the pain in the leg or foot is often worse than the pain in the back. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot. In cases where sciatica is caused by a slipped, or prolapsed disc in the back, part of the inner softer part of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc and the prolapsed part of the disc can press on a nerve nearby and cause the pain.

Dehydration

Our body is mainly water – 70% is made up of it and it is vital for all aspects of the normal functioning of the body including healthy functioning of joints and skin, digestion, waste product removal and muscle and nerve function. Provided enough fluid is drunk each day the body remains hydrated and, in the absence of illness, the body functions as it should. However, if more fluid is lost from the body than is absorbed then dehydration occurs and this may be mild, moderate or severe depending on how much fluid is lost. The symptoms it causes also depend on the severity of the dehydration, ranging from mild thirst to coma or death.

We get around two-thirds of the fluid we require from drinks, with the rest coming from fluid in foods and as a result of normal chemical reactions in the body. Most people lose between two and three litres every day through our normal bodily functions such as breathing, urination and defecation, and sweating. Factors that can increase fluid loss include sweating in hot weather or with a high temperature, diarrhoea and vomiting, diabetes, exercise, excessive alcohol intake and simply not taking enough fluid during the day. Oral rehydration products are available here.

For most people, the first symptom of dehydration is feeling thirsty but others often develop before this such as fatigue, headache, and a dry mouth. Following thirst comes dizziness, weakness and passing less urine which is also often more concentrated and darker yellow than usual. As dehydration worsens, other symptoms may occur including a raised pulse rate, sunken eyes, an absence of sweating and extreme thirst. Blood pressure may fall and ultimately delirium and loss of consciousness occurs. People who have low-level chronic dehydration are more prone to conditions such as kidney stones, chronic fatigue and kidney stones.

Anaemia

Anaemia is the term used to describe any condition where there are less than the usual numbers of red blood cells in the blood. This leads to reduced amounts of the oxygen-carrying pigment haemoglobin – the pigment that actually makes blood red – and it is this level of haemoglobin that is measured in a simple blood test called the full blood count. A low red blood cell count is therefore usually associated with a low haemoglobin level, the commonest cause being bleeding (such as with heavy periods or stomach ulcers) or a poor diet with a low vitamin and iron intake. Other causes can include pregnancy, a low level of Vitamin B12, a lack of dietary folate or bone marrow problems such as leukaemia.

Tiredness is the usual symptom of anaemia which is typically chronic, constant and even the mildest exertion may seem an effort. Paleness sometimes occurs as can palpitations and shortness of breath when walking, and dizziness is also common. Many people become accustomed to feeling tired since it often develops slowly and so do not think anything untoward has happened. If the full blood count test confirms an anaemic picture, most investigations will then look at its cause, usually trying to see where blood has been lost from. Other possible causes involving the bone marrow – where the blood cells are made – sometimes require a sample of this marrow being taken and looked at under a microscope.

The best way to prevent back pain is to keep your back strong and supple. Regular exercise, maintaining good posture and lifting correctly will all help. Other general points that are useful in preventing back pain include losing weight if overweight, wearing flat shoes with cushioned soles, avoiding sudden movements and staying active with regular exercise such as walking and swimming.

A major cause of back injuries and pain is lifting or handling objects incorrectly. Learning and following correct methods for lifting and handling objects can help prevent this so always think before you lift a heavy object.

• Keep your feet apart, with one leg slightly forward to maintain balance, and then when let your legs do the work - bend your back, knees and hips slightly, but do not stoop or squat. Keep the load as close to your body for as long as possible with the heaviest end nearest to you
• Avoid twisting your back or leaning sideways, particularly when your back is bent - your shoulders should be level and facing in the same direction as your hips; turning by moving your feet is better than lifting and twisting at the same time
• Keep your head up - once you have the load secure, look ahead, not down at the load
• Know your limits - there is a big difference between what you can lift and what you can safely lift. If in doubt, get help
• Push rather than pull - if you have to move a heavy object across the floor, it is better to push it rather than pull it
• Distribute the weight evenly - if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body.

If you have back pain associated with dizziness, the treatment of this will depend on the cause. If your back pain is due to injury, then rest and physiotherapy exercises can help to heal this, but if you have persistent dizziness, then your doctor is able to prescribe medication to help reduce this. This can include the use of antihistamines, available here.

With a sudden ‘acute’ episode of back pain, avoid prolonged bed rest as this may make it worse. Take regular painkillers or anti-inflammatory tablets, as this will allow regular exercise to occur. Occasionally muscle relaxants are prescribed if there is a lot of muscle spasm in the back, and some people find that manipulation of the back by an osteopath or chiropractor speeds up their recovery. Treatment may vary, and the situation should be reviewed by a doctor if the pain becomes worse, or if the pain persists beyond 4-6 weeks, or if symptoms change. To prevent future back pain, exercise regularly (swimming is probably best), lose weight and avoid standing, sitting or walking in a stooped posture. Avoid bending the back when lifting, and sleep on a firm mattress.

However, once the pain has eased or gone it is common to have further bouts of pain (recurrences) from time to time in the future. Also, it is common to have minor pains on and off for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. This is called chronic back pain.

Most cases of back pain are nothing to worry about and will improve within a few weeks. However, there are certain circumstances when you should seek medical attention:

• if your back pain has not started to improve after 6 weeks
• if your back pain started after a significant fall or accident
• if you have a history of cancer
• if you have sciatica affecting both legs, numbness around your bottom or problems with your bowel or bladder control
• if you are feeling generally unwell with a fever, and no other flu-like symptoms
• if you’ve been taking steroid tablets for several months
• if the pain travels up the back or into the chest
• if you’re aged under 45 and get severe back pain and stiffness first thing in the morning every morning, lasting for 30 minutes or more, and this has persisted for 3 months or more - often movement will make it feel better
• if you’re losing weight for no obvious reason