WHEN SHOULD BACK PAIN BE INVESTIGATED?

Are you experiencing back pain? If so, you’re not alone. According to Bone and Joint Canada, back pain affects up to 80% of adults at least once in their lifetime. It’s one of the most common reasons people see a doctor or miss days at work.

Back pain is most often experienced in the lower back and can present in a variety of ways from a dull, constant ache to a sudden, sharp or shooting pain. The causes for this pain can be numerous, but more than 90% of the time it’s not caused by a serious underlying injury or disease.

WHAT ARE THE TYPES OF BACK PAIN?

Most low-back pain is acute – it’s short term and lasts a few days to a few weeks. This type of pain tends to resolve on its own with self-care and without loss of function. Acute pain can be caused by an accident, lifting something heavy, or from getting too little exercise followed by a strenuous workout.

In comparison, chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low-back pain has been treated. This type of pain often requires many investigations into the underlying cause, which may not be easily identified or treated.

WHAT CAUSES BACK PAIN?

Many forms of arthritis and related conditions can cause pain, stiffness, and swelling in the back. Arthritis pain usually presents in the low back and doesn’t travel past the buttock. Pain due to nerve impingement is called radicular pain. It can present as back pain, but often includes symptoms down one or both legs.

THE MOST COMMON ARTHRITIS OF THE SPINE

Of the more than 100 different types of arthritis, most of them could affect the back. The most common form of spinal arthritis is osteoarthritis of the spine. It’s sometimes described as degenerative or “wear-and-tear” arthritis.

In normal joints, the cartilage (tough elastic material that covers the surface of the joints) acts as a cushion. Osteoarthritis (OA) causes the cartilage to break down, leading to pain, swelling, and problems moving the joint. As it worsens over time, the cartilage wears away and bone rubs against bone, causing joint degeneration and increased pain. In the spine, OA can affect the facet joints, where the vertebrae link together. The degeneration of the vertebrae can also form bony outgrowths called spurs and narrowing of the foramina (pathways where the nerves exit the spine), which can press on nerves and cause radicular or nerve pain.

WHAT IS SPONDYLOARTHRITIS?

Spondyloarthritis is a group of inflammatory diseases that affect both the joints and the locations where the ligaments and tendons attach to the bones. While there are several types of these diseases, some are more common in the spine than others:

• Ankylosing spondylitis may cause inflammation of the vertebrae and the sacroiliac joints at the base of the spine. In severe cases, several vertebrae may fuse together and cause a hunch in the back.
• Psoriatic arthritis is associated with psoriasis — an autoimmune disorder causing an itchy, scaly rash. The National Psoriasis Foundation estimates that about 30% of people with psoriasis also have psoriatic arthritis. It’s more common in smaller joints but may also affect the spine.
• Reactive arthritis is joint inflammation triggered by infection somewhere else in the body — often in the bowel or the genitals. Reactive arthritis in the spine usually occurs in the lower back and tends to go away on its own.
• Enteropathic arthritis is linked to inflammatory bowel disease (IBD). Not all people with IBD develop arthritis, and of those who do, not all get it in the spine.

HOW IS ARTHRITIS OF THE SPINE DIAGNOSED?

The first step in diagnosing the cause for low-back pain is to speak to your health care practitioner about your symptoms. Your doctor will discuss your medical history and perform a physical exam to see if you have pain, tenderness, loss of motion involving the neck or lower back, or if symptoms are suggestive of nerve involvement such as weakness, reflex changes, loss of sensation, or pain that includes numbness or burning sensations.

Your doctor may order blood tests and imaging exams, such as X-rays to look for bone degeneration, bone spurs, and loss of cartilage or magnetic resonance imaging (MRI) to show possible damage to discs or narrowing of areas where spinal nerves exit. Bone scans are also ordered to determine which facet levels have active inflammation and may be contributing to facetogenic pain.

At Mayfair Diagnostics, our experienced and sub-specialized radiologists, and clinical specialty colleagues, provide comprehensive musculoskeletal (MSK) and spine care. We offer a multidisciplinary service that ensures whether you have an MSK or spinal concern, we coordinate a clinical assessment by our specialty colleagues and appropriate imaging to direct the most appropriate pain management treatment plan.

A clinic assessment is often ordered to initiate a comprehensive investigation into the cause for your symptoms. Your health care practitioner would need to request an assessment when they complete the Mayfair pain management requisition.

WHAT ARE THE TREATMENTS FOR ARTHRITIS OF THE SPINE?

Osteoarthritis is a chronic (long-term) disease and, although there is no cure, treatment can help reduce your symptoms and make it possible for you to lead a full and active life. In most cases, you can manage mild to moderate arthritis symptoms for many years with a treatment plan that may include:

• Medication such as acetaminophen, non-steroidal anti-inflammatory drugs like ibuprofen or naproxen, or capsaicin cream for the skin.

• A positive outlook to help you cope with the stress and challenges of living with arthritis.
• Assistive devices and orthotics to help protect and take the stress off of your joints.
• Changing activities to reduce stress on the painful joint and allow you to move better.
• Exercise to help keep your muscles strong and your joints moving well.
• Hot and cold therapy, such as hot compresses, cold packs, ice massage, or paraffin wax.
• Medication such as acetaminophen, non-steroidal anti-inflammatory drugs like ibuprofen or naproxen, or capsaicin cream for the skin.
• Physiotherapy or occupational therapy.
• Weight loss, if you’re overweight, to reduce the stress on your joints.

If the pain and stiffness from arthritis doesn’t improve or worsens, your doctor may recommend pain management treatments, pain medication, or, if the pain is debilitating, surgery.

For more information on your treatment options, please speak to your health care practitioner.

REFERENCES

Arthritis Foundation (2022) “When Back Pain May Mean Arthritis.” www.arthritis.org. Accessed March 9, 2022.

Bone and Joint Canada (2014) “Low Back Pain.” www.boneandjointcanada.com. Accessed March 9, 2022.

Johns Hopkins Medicine (2022) “Spinal Arthritis (Arthritis in the Back or Neck).” www.hopkinsmedicine.org. Access March 9, 2022.

National Institute of Neurological Disorders and Stroke, National Institutes of Health (2020) “Back Pain Fact Sheet.” www.ninds.nih.gov. Accessed March 9, 2022.

National Psoriasis Foundation (2022) “About Psoriatic Arthritis.” www.psoriasis.org. Accessed March 9, 2022.