When Back Pain Means More Than a Back Problem

Medical conditions may masquerade as spine pain

Woman with back pain

Pain in your lower back. Cramps shooting down your leg. That “pins and needles” feeling. When you have these symptoms, you may assume you have a problem with your spine.

“The problem with assuming is that we often see people who have medical issues that are mistaken as only a spine issue, when it could be a medical issue on its own — or a combination of the two,” says physical medicine/rehab specialist Tagreed Khalaf, MD.

For example, lumbar spinal stenosis is a nerve problem and peripheral arterial disease is related to blood flow, but the two have many symptoms in common. So do spinal stenosis and diabetic neuropathy, or nerve damage in the legs and feet. And disc issues can feel a lot like inflammatory arthritis.

When the back is the usual suspect

Spinal stenosis is one of the most common causes of spinal pain not related to injury. This narrowing of the space around the spinal cord puts pressure on the nerves. If you have the following symptoms, spinal stenosis may be to blame:

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  • Pain in the lower back
  • Cramping in the legs
  • A heavy feeling in the legs, which may lead to trouble walking
  • Increased pain going downhill
  • Symptoms that get worse with activity
  • Relief from the “grocery cart” position — bending forward like you’re leaning on a shopping cart

However, Dr. Khalaf notes how common “false positives” are. “Around 21 percent of asymptomatic people over age 60 will show signs of spinal stenosis on an MRI,” she says. “And sometimes spinal stenosis and peripheral arterial disease co-exist. That’s why you need a physical exam, and possibly other tests, to get a clear diagnosis.”

When a medical problem is the likely culprit

There are a few ways to tell the difference between spinal stenosis and something more serious:

  • Pain that gets worse when going uphill is more common with peripheral arterial disease, a buildup of plaque in the blood vessels leading to the your limbs.
  • Arterial disease patients don’t get relief from the “grocery cart” position.
  • If your symptoms are worse at night but better with exercise, neuropathy may be to blame.
  • In younger people, morning stiffness that lasts longer than 30 minutes and gets worse with stillness may be a sign of inflammatory arthritis, such as ankylosing spondylitis.
  • Other unexplained symptoms such as weight loss and fatigue may be signs of malignancies — very rare, but absolutely worth looking into.

“Serious issues such as malignancies or abdominal aortic aneurysms rarely present spine symptoms,” Dr. Khalaf says, “but sometimes they do. They’re serious enough that ruling them out is important.”

What to do for spinal stenosis    

If you do have spinal stenosis, there are ways to find relief:

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  1. Try physical therapy. Stretching and strengthening can help support your back, improve your balance and ease the pressure on your nerves.
  2. Ask your doctor about medications. Nonsteroidal anti-inflammatories and muscle relaxers may help. Some patients also find success with anti-seizure drugs such as Neurontin — also used for neuropathy.
  3. Consider steroid injections. Corticosteroids can reduce the inflammation and irritation that cause symptoms. They’re usually not a first resort because they can weaken bones and tissue over time.
  4. Know that surgery is an option. When more conservative treatments do not work, certain procedures can reduce symptoms.

What to do if you expect something else

There’s only one major tip here: See a doctor, whether it is your primary care physician or a specialist. Each condition that mimics spinal problems comes with its own treatments, but the first step is an accurate diagnosis. For example, a nerve test such as electromyography (EMG) can help a doctor spot neuropathy, and a blood-flow test such as the ankle-brachial index (ABI) can distinguish between spinal stenosis and peripheral arterial disease.

“It’s so important to look at all of your symptoms and history and do a thorough examination,” Dr. Khalaf says. “It’s how we can tell the difference between a back issue and a medical condition.”

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  • Larner james

    Better to consult a doctor to clear your problems, Ask him the suggestion which process is better to cure your back pain problem.

  • Christine Patterson

    I would recommend calling http://slcchiro.com/. They handle so many cases of back pains and back problems. This is who I used when I have any back issues.

  • judy Minwer

    Left shoulder pain, causing my arm to go numb, was a heart blockage requiring two stents.

  • Springoak

    Ankylosing spondylitis–an autoimmune disease that attacks the spine and eventually end up freezing it in whatever place it is in has long been misdiagnosed in this country.

  • facebook

    My back hurts all the time had a mri i have a dics problem i dont take nothing

    • Karen Zamora

      see a neurosurgeon, not

      a bone Dr.

  • http://www.facebook.com/noldaker Nikki Oldaker

    Wish this were the case for my back pain…You left out severe nerve damage from spinal fusion.

    • James Katkus

      The same happened to me, Nikki. I had a L5/S1 fusion in 2008 and my left leg went numb from my knee to the end of my big toe. The neuropathy is quite painful and not controlled with all of the meds I’m on. Three weeks ago my back locked up and a MRI revealed L4 is now badly damaged.

      • George Geller

        I have had back pain since 2007, after falling down 17 steps. In 2008 I had L5-S1 fused, 2011 had a spinal stimulator implanted and in 2012 L4-L5-S1. I still have back pain with being on 5 pain meds and I’m told they don’t know why i’m in pain.

        • James Katkus

          Sorry to hear that George. I am on a Fenatyl patch, Oxycodone and Gabapentin. Combined they take my pain level down to a 3, but I am still in pain always. I long for a day that my back doesn’t hurt…just to remember what pain-free feels like!

          • Emily Watson

            I so understand

          • Rita

            I’d love my pain to be down to a 3.

          • James Katkus

            Rita – Did you notice the amount of drugs I am on to get the pain to a 3? I could take more (as prescribed) but I don’t know if it would mean living life as a zombie and not caring about the pain, or that I would actually get more relief.

          • Rita

            I understand what you mean…those of us in chronic pain, or with acute flares do so many things to achieve comfortable levels that allow us to function. That gets tiresome when pain rears it’s ugly head beyond what is tolerated. I had fallen at the end of December an I am still having times when the pain is effecting the quality of work I am able to deliver.

  • Ramon

    I have an Spinal fusion on my L3,L4,L5,S1 AND 5 SCREWS IMPLANTED ON THEM. I have tried nerve blocks, patches, neurontin, liryca,oxycondone,lortab (Vycodine), Lodine, or Etodolac, Baclofen, Relafen, Cymbalta ans so on, I also have an Neuroestimulator implanted of the Boston Scientific and NONE of this options have helped me out at all. I have given up on Science and every Doctors and hospitals that they said they have an solution for my back chronic pain. My only optio have being talking to my body and to GOD ans asked them to satart the healing process on myself, and I have have good resoltsabout it. I CAN’T TRUST THE SCIENCE ANY LONGER.

    • ronda

      Same here.been living in pain for 27 yrs..have been on every kind of narcotic and no prevail. The only that has happen to me..is I became addicted to them..my back has ruined my life and not one Doctor can help me.Im now off of ALL narcotics and its a fight every day just to walk across the floor. .any answers?

      • Phyllis Anne

        You first say the narcotics didn’t help. Then you said you’re off all narcotics and it’s a fight just to walk across the floor. There’s your answer right there. You need the narcotics to be able to do anything towards a reasonable quality of life.

        • Suzanne

          I have had 5 back surgeries, 4 fusions still have a lot of pain. I think another nerve is pinched. The pain pills only made me sick, a friend had a marijuana Tenture that I tried. It helped not pain free but so much better. I now have my marajuana medical card. I DON’T smoke it. Only Tentures and brownies. No side effects. I can do a lot of things I use to do. Just another option.

          • Annie

            Are you the OP? ronda? If so. That’s good news for you! I just wanted to ask, not out of malice, but only being thoughtful. Unfortunately, all pills make me feel sick. I am considering MMJ. But regular MJ makes me feel ill too. I was wondering about the MMJ, maybe better and better dose control? Sorry about taking so long to reply, as I haven’t had the time to figure Discus out yet to get back here again.

    • Emily Watson

      I have had three fusions, Herrington rods fused now from T1 to L4. I have done facet joint inj, epidurals, radio frequency burn of the nerves, too many meds and now they want to fusel4 to s1 with screws in the hips. I have a young son and scared to run outta options. I just want to care for him that’s all.

    • Polly Newsome Searls

      Watch your blood pressure after eleven years plus of chronic back pain contributed to my husbands high blood pressure causing cerebral anyerizm which burst and left him in a comma he died six weeks later

      • Bill Ipain

        I now have spinal stenosis and perefereal artery disease and I’m only 58,what a BEAR ,oh yeah I’m a diabetic for 30 yrs,luckily Nurotin helps
        God also helps a lot .any other ideas that might help??!!

    • Linda Jean Limes Ellis

      Personally, I feel needles in the spine are a bad idea. I belong to several Tarlov Cyst Facebook groups and am learning that needles in the spine just make the situation worse for pain and progression.

  • Summergal

    I have ruptured discs L3/4, L4/5,L5/S1 as a result of childbirth in 2012…I have had physical therapy, taken pain meds, and had a series of pain blocks. I had moderate relief with pain blocks but now they have worn off. Unsure what my next step will be.

    • Rosemary Morsani

      Has anyone tried acupuncture for the pain?

  • dana meeker

    I have lived with chronic pain for too many years ,,,,,,what few meds I get don’t help much my life has became my recliner ,,sadly

    • David Garcia

      Try ( OPANA ER ) 40mg. It’s a slow release pill it last 12 hour. So far it’s working. Fingers crossed!!!

  • Nancy Morsillo

    After having back pain for over 25 years, I had a spinal fusion at UPMC with a major surgeon. (Rods, screws and all) Although the surgery was successful, I still had back pain of another kind, with the explanation from the surgeon that the areas above and below the fusion would continue to possibly cause pain as the fusion area was stationary, but the entire spine was not. I suffered for another 10 years and researched options and came across Cleveland Clinic Pain Center. I called the 800 number, spoke with a knowledgeable person that arranged an appointment with Dr. Nagy Mikael. Believe me….I can truly say that was the best decision I have ever made. I am 75 years old and have had less pain these past three years after treatment at the pain center, than when my spinal problems began at age 40. Thank you Cleveland Clinic and Dr. Mikael.