The failure to consider other potential structures that may produce back pain can lead to significant mortality and morbidity. Pain may refer to the back from a number of organs situated in the retroperitoneum. Pancreatic pain in particular refers to the back and may be associated with pancreatic cancer and pancreatitis. Renal pain, which may be produced by stones in the renal collecting system or renal tumors, also typically refers to the back. More often than not this is usually unilateral; however, it can produce central posterior back pain. Enlarged lymph nodes in the preand para-aortic region may produce central posterior back pain and may be a sign of solid tumor malignancy, infection, or Hodgkin’s lymphoma. An enlarging abdominal aorta (abdominal aortic aneurysm) may cause back pain as it enlarges without rupture. Therefore it is critical to think of this structure as a potential cause of back pain, because treatment will be lifesaving. Moreover, a ruptured abdominal aortic aneurysm may also cause acute back pain in the first instance.