Back pain is a complicated subject. There are so many potential issues at stake, it’s really not one entity at all. Here is an example of a potentially confusing back pain story that responded great to treatment after a correct diagnosis was made. Ms P is a 52 year old woman with a prior history of Crohns disease who presented with severe lower back pain. She had previously been told that she has arthritis in her spine. She tried physical therapy and had been using handfuls of ibuprofen per day. Her exam showed that her pain actually was more focused to her sacroiliac joints, the joints that connect your pelvis to the spine, rather than the spine itself. X-rays confirmed an arthritic process in her sacroiliac joints. Incidentally she mentioned that her Crohns disease had been mildly active recently, with abdominal cramping and occasional diarrhea.
Crohns disease is an autoimmune condition that primarily causes inflammation in the intestines. So what treatment did she receive that has almost completely controlled her pain? She was instructed to see her gastroenterologist for her Crohns disease and have that treated. How does that make any sense; she asked for treatment for her back pain and was recommended to treat her gut first. Well Crohns disease can also cause inflammation in other areas of the body, including in the joints. In Ms P’s case she had sacroilitis related to her Crohns disease. Rather than treat the joint pains in isolation, treating her underlying problem resulted in almost complete relief of her sacroiliac pain. As her gut inflammation subsided with specific medication for her Crohns, her joint inflammation subsided as well.