Unexplained Lumbar Pain: Causes and Treatment Options

Q: Unexplained Lumbar Pain: Causes and Treatment Options

Hello： 1. It is recommended to consult a neurosurgeon, especially one who specializes in spinal issues. 2. Best wishes to you. // Dr. Lai Chao-Kang, Director of the Spine Neurosurgery Department at Changhua Hospital.

Unexplained lumbar pain?

Hello, doctor.
Recently, my entire spine has been very stiff and painful, and I also experience a penetrating pain in both sides of my pelvis.
Sometimes, due to abdominal pain, when I bend over to walk, I feel a painful sensation of bone rubbing against bone at the connection between my pelvis and thighs.
The pain becomes more pronounced when I stand upright or sit still for a long time.
After midnight, the pain also intensifies.
About a year ago, I started experiencing pain in my lower back and around my pelvis, which even radiated down to my legs, causing temporary inability to stand.
After receiving acupuncture treatment from a traditional Chinese medicine practitioner, the leg pain has decreased significantly; however, the pain has now extended upwards to the mid-back (and I have also recently experienced mild discomfort in my cervical spine).
I previously consulted an orthopedic doctor and had an X-ray taken, which indicated that there were no significant issues with my spine.

1) I would like to ask which specialty clinic I should visit for further evaluation?
2) Additionally, since I have been troubled by back pain for the past year, I have noticed that my height has been gradually decreasing.
Could this be related?

Nana, 20~29 year old female. Ask Date: 2017/03/02

Dr. Lai Zhaokang reply Neurosurgery

Hello: 1.
It is recommended to consult a neurosurgeon, especially one who specializes in spinal issues.
2.
Best wishes to you.
// Dr.
Lai Chao-Kang, Director of the Spine Neurosurgery Department at Changhua Hospital.

Reply Date: 2017/03/02

More Info

Understanding unexplained lumbar pain can be quite complex, as it often involves multiple factors that contribute to discomfort and dysfunction. Based on your description, it seems you are experiencing a combination of symptoms that may be related to musculoskeletal issues, potential nerve involvement, and possibly even systemic factors.

1. Potential Causes of Your Symptoms
Your symptoms of stiffness and pain in the lumbar region, along with discomfort radiating to the pelvis and legs, could be attributed to several underlying conditions:
- Muscle Strain or Ligament Sprain: Overuse or improper posture can lead to muscle strains or ligament sprains, causing pain and stiffness.

- Degenerative Disc Disease: This condition occurs when the discs between the vertebrae lose hydration and elasticity, leading to pain and reduced height.

- Facet Joint Dysfunction: The facet joints in the spine can become inflamed or degenerated, leading to localized pain and stiffness.

- Sacroiliac Joint Dysfunction: This joint connects the spine to the pelvis and can become inflamed or misaligned, causing pain in the lower back and hips.

- Nerve Compression: Conditions such as herniated discs can compress nearby nerves, leading to pain that radiates down the legs.

- Inflammatory Conditions: Conditions like ankylosing spondylitis or other forms of inflammatory arthritis can cause chronic pain and stiffness in the spine and pelvis.

2. Recommended Specialists
Given the complexity of your symptoms, it would be advisable to consult with a few different specialists:
- Orthopedic Surgeon: They can evaluate your spine and pelvis for structural issues and may recommend imaging studies such as MRI if necessary.

- Physical Medicine and Rehabilitation (PM&R) Specialist: Also known as a physiatrist, this specialist focuses on non-surgical treatments for musculoskeletal issues and can help develop a rehabilitation plan.

- Rheumatologist: If there is suspicion of an inflammatory condition, a rheumatologist can conduct tests to rule out autoimmune diseases that may be contributing to your symptoms.

- Chiropractor or Osteopath: These practitioners can provide manual therapy and adjustments that may relieve some of your discomfort.

3. Height Loss and Its Relation to Back Pain
Your concern about height loss is significant. Height reduction can be associated with conditions such as:
- Degenerative Disc Disease: As mentioned earlier, the discs can lose height and hydration, leading to a decrease in overall height.

- Osteoporosis: This condition leads to weakened bones and can result in vertebral compression fractures, contributing to height loss.

- Postural Changes: Chronic pain and stiffness can lead to compensatory postures that may affect your height perception.

4. Treatment Options
Treatment for your symptoms may include:
- Physical Therapy: A tailored program can help strengthen the muscles supporting your spine, improve flexibility, and reduce pain.

- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. If your pain is severe, your doctor may consider other medications.

- Injections: Corticosteroid injections into the affected area may provide temporary relief from inflammation and pain.

- Lifestyle Modifications: Ergonomic adjustments at work, regular exercise, and maintaining a healthy weight can significantly impact your symptoms.

- Alternative Therapies: Acupuncture, chiropractic care, and massage therapy may provide additional relief.

Conclusion
In summary, your symptoms warrant a comprehensive evaluation by a multidisciplinary team of healthcare providers. It is essential to address both the immediate pain and any underlying conditions that may be contributing to your discomfort. Keep track of your symptoms, and don’t hesitate to seek further opinions if you feel your concerns are not being adequately addressed. Your health and well-being are paramount, and finding the right treatment plan can significantly improve your quality of life.

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