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Understanding Back Pain: 10 Causes and Why Intensity Is Not the Best Indicator of Severity 🧠💡

  • Jan 6
  • 6 min read

Discover and understand the top 10 causes of back pain and why intensity isn’t always a reliable indicator of severity. Learn from Dr. Boisvert, chiropractor, and help spread awareness about pain management.



Pain—it’s something nearly 100 million people across Europe and Canada live with daily. But here’s an eye-opener: the intensity of pain doesn’t always reveal how serious the condition is. Let’s dive into this essential topic, guided by Dr. Boisvert, chiropractor. 🩺

The Myth of Pain Intensity: What Matters More? 🤔


A pain rated 10/10 on the intensity scale may be less critical than one at 7/10. How is that possible? 🤷‍♂️ It comes down to contextual clues and red flags:


• Severe headaches, nausea, or dizziness

• Sudden incontinence or nocturnal pain 🌙

• Loss of strength, sensation, or unexplained weight loss


These symptoms often hold the real key to diagnosing a condition’s severity.


A pain rated 10/10 on the intensity scale may be less critical than one at 7/10. How is that possible? 🤷‍♂️ It comes down to contextual clues and red flags: • Severe headaches, nausea, or dizziness • Sudden incontinence or nocturnal pain 🌙 • Loss of strength, sensation, or unexplained weight loss These symptoms often hold the real key to diagnosing a condition’s severity.

The Top 10 Causes of Chronic Pain Explained



10. Abdominal Aortic Aneurysm (AAA) 🫀

Abdominal aortic aneurysms are abnormal enlargements of the wall of the aorta, the largest artery in the body that runs through the abdomen. The aorta carries oxygen-rich blood from the heart to the rest of the body. Abdominal aortic aneurysms are more common in men aged 50 to 80 years and can be hereditary. They are also more frequent in people with high blood pressure, especially if they smoke. Although this condition may be discovered incidentally during radiological exams, often due to atherosclerosis (fat buildup in the arteries), it is important not to panic. An aneurysm does not require surgical treatment unless it exceeds a dangerous size. If the aneurysm is detected early, it is crucial to monitor its progression closely, as premature surgery could pose more risks than benefits.

Abdominal aortic aneurysms are abnormal enlargements of the wall of the aorta, the largest artery in the body that runs through the abdomen. The aorta carries oxygen-rich blood from the heart to the rest of the body. Abdominal aortic aneurysms are more common in men aged 50 to 80 years and can be hereditary. They are also more frequent in people with high blood pressure, especially if they smoke.


Although this condition may be discovered incidentally during radiological exams, often due to atherosclerosis (fat buildup in the arteries), it is important not to panic. An aneurysm does not require surgical treatment unless it exceeds a dangerous size. If the aneurysm is detected early, it is crucial to monitor its progression closely, as premature surgery could pose more risks than benefits.

9. Urinary Tract Issues 🚽

Certain urinary tract conditions, such as kidney infections (infections of the kidneys, the organs that filter waste from the blood), kidney stones (small stones formed in the kidneys), or prostate infections (a gland located beneath the bladder in men), as well as certain pelvic conditions (problems related to the organs in the lower abdomen), such as ectopic pregnancy (when the embryo develops outside the uterus) or pelvic inflammatory disease (an infection of the female reproductive organs), can also cause pain. As a result, this pain may sometimes be felt in the lower back, as the body can “refer” the pain to this area.

Certain urinary tract conditions, such as kidney infections (infections of the kidneys, the organs that filter waste from the blood), kidney stones (small stones formed in the kidneys), or prostate infections (a gland located beneath the bladder in men), as well as certain pelvic conditions (problems related to the organs in the lower abdomen), such as ectopic pregnancy (when the embryo develops outside the uterus) or pelvic inflammatory disease (an infection of the female reproductive organs), can also cause pain.


As a result, this pain may sometimes be felt in the lower back, as the body can “refer” the pain to this area.

8. Paget’s Disease of Bone 🦴

Paget’s disease of bone is a chronic condition that affects the bones, causing abnormal remodeling of bone tissue. This leads to thickening and weakening of the bones in certain areas, making them more fragile. While this disease can affect any bone, it primarily impacts the pelvis, femur (thigh bone), and skull. The bones of the legs, spine, collarbones, and arms are less commonly affected. It affects about 2 to 3% of people over the age of 55, and its frequency increases with age. The exact cause of the disease is unknown, but it may be hereditary. Around 10% of cases are linked to specific genetic abnormalities, and viruses may also play a role, although there is no evidence to suggest that the disease is contagious.

Paget’s disease of bone is a chronic condition that affects the bones, causing abnormal remodeling of bone tissue. This leads to thickening and weakening of the bones in certain areas, making them more fragile. While this disease can affect any bone, it primarily impacts the pelvis, femur (thigh bone), and skull. The bones of the legs, spine, collarbones, and arms are less commonly affected.


It affects about 2 to 3% of people over the age of 55, and its frequency increases with age. The exact cause of the disease is unknown, but it may be hereditary. Around 10% of cases are linked to specific genetic abnormalities, and viruses may also play a role, although there is no evidence to suggest that the disease is contagious.

7. Rheumatologic Conditions 🔥

Reactive arthritis, often triggered by a sexually transmitted infection, is a condition where arthritis is caused by an infection, typically bacterial, elsewhere in the body, such as a sexually transmitted or intestinal infection. In response to the infection, the immune system mistakenly attacks the joints, leading to pain and inflammation. Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine. It progressively transforms ligaments into bone, permanently altering the spinal curves and limiting movement. In severe cases, those affected often have difficulty sleeping on their back or stomach.

Reactive arthritis, often triggered by a sexually transmitted infection, is a condition where arthritis is caused by an infection, typically bacterial, elsewhere in the body, such as a sexually transmitted or intestinal infection. In response to the infection, the immune system mistakenly attacks the joints, leading to pain and inflammation.


Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine. It progressively transforms ligaments into bone, permanently altering the spinal curves and limiting movement. In severe cases, those affected often have difficulty sleeping on their back or stomach.

6. Spondylolisthesis 🔄

Spondylolisthesis is a condition where a vertebra (one of the bones in the spine) slips forward in relation to the one below it. This slippage often occurs in the lower back (lumbar region) and is more common in adolescents and young adults, particularly athletes, or in older adults. In young people, it is typically caused by a congenital malformation (present at birth) or repeated injuries that weaken the vertebra. In older adults, it is mainly associated with the wear and tear of the discs (the cushions between the vertebrae) or osteoarthritis (joint degeneration).

Spondylolisthesis is a condition where a vertebra (one of the bones in the spine) slips forward in relation to the one below it. This slippage often occurs in the lower back (lumbar region) and is more common in adolescents and young adults, particularly athletes, or in older adults.


In young people, it is typically caused by a congenital malformation (present at birth) or repeated injuries that weaken the vertebra. In older adults, it is mainly associated with the wear and tear of the discs (the cushions between the vertebrae) or osteoarthritis (joint degeneration).

5. Compression Fractures 💥

A vertebral compression fracture often occurs when the bones become brittle due to osteoporosis, a condition that reduces bone density with age. The vertebrae (spinal bones) are particularly vulnerable to this loss of density. In a compression fracture, the vertebra collapses, sometimes compressing nearby nerves. These fractures typically occur in the upper or middle back and cause pain in these areas. However, intense trauma, such as a high fall onto the heels, can also lead to this type of fracture.

A vertebral compression fracture often occurs when the bones become brittle due to osteoporosis, a condition that reduces bone density with age. The vertebrae (spinal bones) are particularly vulnerable to this loss of density. In a compression fracture, the vertebra collapses, sometimes compressing nearby nerves. These fractures typically occur in the upper or middle back and cause pain in these areas. However, intense trauma, such as a high fall onto the heels, can also lead to this type of fracture.

4. Degenerative Processes 🏋️‍♀️

It is important to understand that, while degenerative processes rank fourth in this video, one should be cautious of overdiagnosis. Many patients are given diagnoses of degenerative processes in various parts of the body, often without any associated symptoms. In the spine, this can include conditions such as osteoarthritis, herniated discs, or even signs of stenosis (narrowing of the canals), but without any real functional impact. This also applies to joints in the shoulders, hips, knees, and others. Degenerative processes are mainly considered risk factors that may increase the likelihood of experiencing sensitivity in the affected area, but this does not necessarily mean they cause symptoms. Therefore, receiving such a diagnosis should not lead to a pessimistic view of your health: a gradual return to movement and strengthening exercises can, in the long term, help improve your condition and quality of life.

It is important to understand that, while degenerative processes rank fourth in this video, one should be cautious of overdiagnosis. Many patients are given diagnoses of degenerative processes in various parts of the body, often without any associated symptoms. In the spine, this can include conditions such as osteoarthritis, herniated discs, or even signs of stenosis (narrowing of the canals), but without any real functional impact.


This also applies to joints in the shoulders, hips, knees, and others. Degenerative processes are mainly considered risk factors that may increase the likelihood of experiencing sensitivity in the affected area, but this does not necessarily mean they cause symptoms. Therefore, receiving such a diagnosis should not lead to a pessimistic view of your health: a gradual return to movement and strengthening exercises can, in the long term, help improve your condition and quality of life.

3. Fibromyalgia 🌧

In third place, we find fibromyalgia, but it’s important to remain cautious: this diagnosis is common, largely due to overdiagnosis. Fibromyalgia is sometimes seen as a “catch-all” diagnosis, a diagnostic dumping ground. For example, if someone experiences diffuse pain (in the back, knees, neck, shoulders) but all tests (blood tests, X-rays, MRIs) show no signs of inflammatory or chronic disease, a diagnosis of fibromyalgia might be made by default. However, it is entirely possible to experience chronic pain without it being fibromyalgia, as it remains a diagnosis of exclusion. To diagnose fibromyalgia, only a rheumatologist can assess this condition using a very precise set of criteria. Furthermore, this condition is complex and is often diagnosed after the age of 30, making it difficult to distinguish between chronic pain and decreased muscle and joint tolerance due to inactivity. Over time, inactivity can reduce our physical endurance, making joint pain more intense and frequent.

In third place, we find fibromyalgia, but it’s important to remain cautious: this diagnosis is common, largely due to overdiagnosis. Fibromyalgia is sometimes seen as a “catch-all” diagnosis, a diagnostic dumping ground. For example, if someone experiences diffuse pain (in the back, knees, neck, shoulders) but all tests (blood tests, X-rays, MRIs) show no signs of inflammatory or chronic disease, a diagnosis of fibromyalgia might be made by default. However, it is entirely possible to experience chronic pain without it being fibromyalgia, as it remains a diagnosis of exclusion.


To diagnose fibromyalgia, only a rheumatologist can assess this condition using a very precise set of criteria. Furthermore, this condition is complex and is often diagnosed after the age of 30, making it difficult to distinguish between chronic pain and decreased muscle and joint tolerance due to inactivity. Over time, inactivity can reduce our physical endurance, making joint pain more intense and frequent.

2. Muscle and Ligament Injuries 💪

In second place are muscle and ligament injuries, such as grade 1, 2, or 3 sprains, which affect the muscles, tendons, or ligaments. These types of injuries are quite common and typically occur when there is excessive stretching or when a heavy load is lifted quickly, causing pain. Different Grades of Sprain Severity: Grade 1 (Mild): Involves overstretching or minor tearing of the ligament. There may be mild pain, swelling, and bruising, but the joint remains stable and functional. Recovery usually takes a few days to a week. Grade 2 (Moderate): This grade involves partial tearing of the ligament. Symptoms include moderate pain, swelling, bruising, and some joint instability. You may have difficulty moving the affected joint, and recovery typically takes a few weeks. Grade 3 (Severe): A grade 3 sprain involves a complete tear or rupture of the ligament. Severe pain, significant swelling, and bruising occur, along with instability in the joint. The affected joint may be unable to bear weight or function, requiring a long recovery period, often with surgical intervention. Sprain vs. Strain: It’s important to distinguish between sprains and strains, as they both involve different tissues: Sprain: A sprain is an injury to a ligament, the fibrous tissue that connects bones to other bones in a joint. Sprains occur when the ligament is stretched or torn, usually due to sudden movements or excessive force, such as twisting or falling. Strain: A strain, on the other hand, refers to an injury to a muscle or tendon, the tissue that connects muscles to bones. Strains occur when the muscle or tendon is overstretched or torn, often from overuse or lifting heavy objects incorrectly. Both sprains and strains can be painful and limit movement, but the treatment and recovery time may differ depending on the severity of the injury.

In second place are muscle and ligament injuries, such as grade 1, 2, or 3 sprains, which affect the muscles, tendons, or ligaments. These types of injuries are quite common and typically occur when there is excessive stretching or when a heavy load is lifted quickly, causing pain.


Different Grades of Sprain Severity:


Grade 1 (Mild):

  • Involves overstretching or minor tearing of the ligament.

  • There may be mild pain, swelling, and bruising, but the joint remains stable and functional.

  • Recovery usually takes a few days to a week.

Grade 2 (Moderate):

  • This grade involves partial tearing of the ligament.

  • Symptoms include moderate pain, swelling, bruising, and some joint instability.

  • You may have difficulty moving the affected joint, and recovery typically takes a few weeks.

Grade 3 (Severe):

  • A grade 3 sprain involves a complete tear or rupture of the ligament.

  • Severe pain, significant swelling, and bruising occur, along with instability in the joint.

  • The affected joint may be unable to bear weight or function, requiring a long recovery period, often with surgical intervention.


Sprain vs. Strain:


It’s important to distinguish between sprains and strains, as they both involve different tissues:

  • Sprain: A sprain is an injury to a ligament, the fibrous tissue that connects bones to other bones in a joint. Sprains occur when the ligament is stretched or torn, usually due to sudden movements or excessive force, such as twisting or falling.

  • Strain: A strain, on the other hand, refers to an injury to a muscle or tendon, the tissue that connects muscles to bones. Strains occur when the muscle or tendon is overstretched or torn, often from overuse or lifting heavy objects incorrectly.


Both sprains and strains can be painful and limit movement, but the treatment and recovery time may differ depending on the severity of the injury.


1. Non-Specific Pain ❓


Surprisingly, the most common type of chronic pain has no clear cause. It might arise from poor sleep, awkward postures, or “false movements.” While uncomfortable, it’s rarely dangerous. For more information regarding non-specific pain, please watch the video bellow:



Pain Management: The Takeaway 🎯


Remember, pain is a protective response, not just a symptom. Identifying the root cause is essential for effective treatment.


Don’t forget to check out our video where we discuss how to avoid the 5 biggest mistakes that can turn acute pain into persistent chronic pain. This applies to your back, neck, shoulders, knees, hips—anywhere! It’s a video you definitely don’t want to miss.



🌟 If you found this guide helpful, don’t forget to subscribe, leave a comment, and share it with others!


In the meantime, share your story, comments, suggestions, or simply reach out if you still have questions! Because an informed person is a person in control of their health! 💪💖



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