Referred pain occurs when pain is felt at a location different than the source of the pain. Disease processes that can present with back pain include pancreatitis, kidney stones, severe urinary tract infections and abdominal aortic aneurysms. Risk factors
Heavy lifting, obesity, sedentary lifestyle and lack of exercise can increase the risk of back pain. Cigarette smokers are more likely to experience back pain than are nonsmokers. Poor posture and weight gain in pregnancy are also risk factors for back pain. In general, fatigue can worsen pain.A few studies suggest that psychosocial factors such as work-related stress and dysfunctional family relationships may correlate more closely with back pain than do structural abnormalities revealed in X-rays and other medical imaging scans. While back pain physical effects can range from muscle aching to a shooting, burning, or stabbing sensation. It can radiate pain down the legs and have pain increased by bending, twisting, lifting, standing, or walking. While the physical effects of back pain are always at the forefront back pain also has other psychological effects. Back Pain has been linked to depression, anxiety, stress, and avoidance behaviors due to mentally not being able to cope with the physical pain. “Both acute and chronic back pain can be associated with psychological distress in the form of anxiety (worries, stress) or depression (sadness, discouragement).
Psychological distress is a common reaction to the suffering aspects of acute back pain, even when symptoms are short-term and not medically serious [35]’( (IASP, 2021)

Diagnosis
Initial assessment of back pain consists of a history and physical examination. Important characterizing features of back pain include location, duration, severity, history of prior back pain and possible trauma. Other important components of the patient history include age, physical trauma, prior history of cancer, fever, weight loss, urinary incontinence, progressive weakness or expanding sensory changes, which can indicate a medically urgent condition.Physical examination of the back should assess for posture and deformities. Pain elicited by palpating certain structures may be helpful in localizing the affected area. A neurologic exam is needed to assess for changes in gait, sensation and motor function. Determining if there are radicular symptoms, such as pain, numbness or weakness that radiate down limbs, is important for differentiating between central and peripheral causes of back pain. The straight leg test is a maneuver used to determine the presence of lumbosacral radiculopathy, which occurs when there is irritation in the nerve root that causes neurologic symptoms such as numbness and tingling. Non-radicular back pain is most commonly caused by injury to the spinal muscles or ligaments, degenerative spinal disease or a herniated disc. Disc herniation and foraminal stenosis are the most common causes of radiculopathy.Imaging of the spine and laboratory tests is not recommended during the acute phase. This assumes that there is no reason to expect that the patient has an underlying problem.