What are causes of my lower back pain?

What is chronic lower back pain?

Chronic low back pain is defined as lower back pain that persists for 12 weeks or more and does not resolve even when the presumed underlying cause is treated. About 20% of cases of lower back pain develop into chronic conditions, according to the National Institute of Neurologic Disorders and Stroke.

Chronic lower back pain is very common. About one in 10 American adults over the age of 21 experiences low back pain lasting more than three months that limits activities of daily living, according to a study in the Archives of Internal Medicine. Chronic low back pain is the second most common cause of disability, according to the Centers for Disease Control and Prevention. 

What causes low back pain?

The most common cause of low back pain is a pulled or torn muscle or ligament. This can happen simply by lifting something heavy, doing yardwork, or playing a sport. This type of back pain generally gets better in a few weeks and does not cause chronic low back pain.

Chronic low back pain, which lasts more than 12 weeks, can be caused by a variety of conditions, including stenosis, spondylolisthesis, or facet arthropathy. The most commonly diagnosed cause of long-term low back pain are conditions related to the discs, which are doughnut-shaped cushions that sit between the vertebrae, such as a herniated disc.

Research has turned up a new cause of chronic low back pain called vertebrogenic low back pain. It’s believed that many cases of chronic low back pain diagnosed as discogenic pain (caused by a disc problem) are actually vetebrogenic pain syndrome.

What is vertebrogenic lower back pain?

Vertebrogenic chronic low back pain is a general term describing pain that originates in the bones of the spine. Degeneration, or the “breakdown,” of the bone can cause lower back pain. But vertebrogenic chronic low back pain is largely attributable to vertebral endplate nerve dysfunction.

The vertebral endplate is a layer of cartilage that separates the bone of the vertebrae and the disc. It’s small—between 0.1 and 2 millimeters thick—yet it’s packed with nerves. Vertebral endplate nerve dysfunction is when the endplate and those nerves become compressed, causing a great deal of pain. The compression is a natural side effect of wear and tear, and becomes more common as we age.

How is the cause of my lower back pain diagnosed?

To determine the exact origins of your low back pain, a spine specialist provider at Neurosurgery One will take your medical history, ask you about the location, frequency, and duration of your pain, and perform a specialized physical exam. Depending on your symptoms, we may recommend an imaging test or scan, such as:

• Spine X-ray is used to identify degenerative disease, fractures, and tumors.
• CT scans of the spineproduce detailed, cross-sectional images of the spine, which can help detect subtle changes in bones.
• Spine MRI shows both tissue and bone and is useful in diagnosing a bulging, protruding, or herniated disc, or pinching of the nerves or spinal cord.
• Bone scans identify abnormalities of the bone, such as tumors or inflammation.

How is vertebrogenic lower back pain diagnosed?

Research has found that chronic low back pain caused by vertebrogenic pain syndrome is often overlooked or misdiagnosed. And because vertebrogenic back pain can exist alongside a disc problem, the disc issue is often the condition that is first recognized and treated.

When you’ve had chronic lower back pain for longer than six months that has not gotten better with physical therapy or other treatments, vertebrogenic changes may be the cause.

A spine MRI is used to diagnose vertebral endplate nerve dysfunction causing vertebrogenic pain syndrome. But because the condition isn’t widely recognized, many physicians may fail to look for the signs on the imaging. The tell-tale sign of vertebral endplate nerve dysfunction seen on an MRI is called Modic changes, which are bone marrow lesions within the vertebrae. Your Neurosurgery One provider also may order an X-ray to rule out other causes.

If you have had chronic low back pain for more than six months that has not gotten better with treatment, our spine specialists can review your MRI even if you have had it done elsewhere. If you’ve had low back pain for longer than 12 weeks and haven’t seen a medical provider, we also can see you for your initial appointment to order imaging and give you an accurate diagnosis.

When should I see a doctor for my lower back pain?

Many instances of low back pain are caused by pulling a muscle or tendon. In those cases, using home treatments such as ice or heat and a nonprescription pain reliever (look for an anti-inflammatory such as aspirin, ibuprofen, or naproxen, not acetaminophen) should relieve your pain within a few days to a few weeks. If you have had pain for more than 12 weeks, we recommend seeing a medical provider. At Neurosurgery One, we see patients with back pain or neck pain who need care at any stage from the initial consultation and diagnosis through all forms of treatment, including spinal injections, various interventional pain management procedures, and spine surgery.

What can help my chronic lower back pain?

Every patient with low back pain that has lasted more than 12 weeks, called chronic low back pain, will need treatment that addresses the immediate pain as well as the underlying cause of the pain. Unless a patient is experiencing symptoms of a condition that requires emergency surgery –such as loss of bladder control or loss of sensation in the groin, anal area, buttocks, or inner thighs – almost all patients with low back pain will be started on physical therapy.

Physical therapy is the starting point because substantial research has shown that most low back pain will respond to this nonsurgical treatment. In physical therapy, you will be taught specific exercises to relieve low back pain. Your low back pain physical therapist also may treat you with techniques such as electrical stimulation. Neurosurgery One’s physical therapy services are available either next door to our clinics or within the same medical complex.

If your lower back pain does not improve with physical therapy and other conservative treatments, such as massage, heat/ice, and over-the-counter pain relief medication, we may recommend pain relief procedures. These procedures include epidural steroid injections, other types of spinal injections, and other procedures such as nerve blocks, neuromodulation, spinal cord stimulators, and radiofrequency ablations.

If your chronic lower back pain is due to vertebral endpoint nerve dysfunction, we may recommend a new minimally invasive procedure called basivertebral nerve ablation.

Neurosurgery One has board-certified physiatrists on staff who specialize in interventional procedures that help reduce or eliminate pain caused by spine problems. Some of our spine neurosurgeons also perform procedures to manage pain.

Spine surgery also may be recommended, depending on the underlying condition that is causing your pain. In particular, spine surgery has been proven to help in the case of herniated lumbar discs and spinal stenosis (narrowing of the spine); however, there are other conditions that benefit as well from spine surgery.

How is vertebrogenic lower back pain treated?

In the case of vertebrogenic chronic low back pain, a procedure called Intracept that stops the basivertebral nerve from sending pain signals to the brain is the most effective treatment. Neurosurgery One patients with low back pain are screened for vertebrogenic changes to ensure that the proper treatment is recommended. In general, you should be screened for vertebrogenic lower back pain if you meet these conditions:

• You have experienced lower back pain for six months or longer.
• Your lower back pain has not improved with physical therapy.