Lower Back Pain: When to Consult a Neurologist

Lower back pain

Dear Doctor,
I have been experiencing lower back pain for the past two weeks and am unsure which specialty to consult.
I noticed that the neurology department addresses back pain, so I am seeking your advice.
Here are my recent symptoms:
1.
About a month ago, I had diarrhea and experienced a sense of urgency with bowel movements, along with lower abdominal discomfort and sharp pain in the lower right abdomen.
I consulted a gastroenterologist and underwent a short colonoscopy.
The doctor diagnosed me with irritable bowel syndrome (IBS) and indicated that there were no significant issues.
2.
After one to two weeks of dietary adjustments, my bowel movements returned to normal, but the abdominal pain has been intermittent.
However, I gradually began to experience soreness in my right lower back (approximately below the kidney area).
3.
Recently, the soreness in my right lower back has worsened, and I have also started to feel soreness in my left lower back.
The pain in my lower right abdomen has become less noticeable, but it is most pronounced when standing.
During severe episodes, I can feel discomfort when sitting, but lying flat alleviates the pain.
While lying down, I do not feel back pain, but pressing on the right side of my abdomen near the navel often causes a sharp pain that gradually subsides after a while (similar to the sensation of needing to pass gas or have a bowel movement).
4.
Throughout the day, my back pain is most intense in the evening.
Once, I had a five-hour meeting with my teacher, and the stress exacerbated my back pain.
The pain feels achy, and it is most severe when I lean backward or bend over.
In severe cases, I also experience soreness in my right thigh.
Doctor, I have a few questions for you:
1.
Which specialty should I consult first?
2.
Can irritable bowel syndrome cause lower back pain?
3.
I have a history of autonomic nervous system dysfunction, experiencing symptoms ranging from headaches to chest tightness and stomach pain.
Could this autonomic dysfunction also be a cause of my back pain?

Xiao Yin, 20~29 year old female. Ask Date: 2012/12/17

Dr. Gao Chunde reply Neurology

You can first consult a neurologist to assess whether there is an issue with the lumbar nerve roots, especially since you experience pain in the right thigh when leaning backward.
Irritable bowel syndrome typically does not cause lower back pain; it is partially attributed to what is commonly referred to as autonomic nervous system dysregulation.
However, the pain associated with autonomic nervous system dysregulation differs somewhat from the symptoms of your current lower back pain.

Reply Date: 2012/12/17

More Info

When dealing with lower back pain, especially when it has persisted for two weeks, it is essential to approach the situation methodically to determine the underlying cause and appropriate treatment. Based on your symptoms and medical history, here are some insights and recommendations.

1. Which Specialist to Consult: Given your symptoms, it would be prudent to start with a visit to a primary care physician or a neurologist. A primary care physician can conduct an initial assessment and refer you to a specialist if necessary. A neurologist is particularly suited for evaluating nerve-related issues, which may be contributing to your pain. If your symptoms are more musculoskeletal in nature, an orthopedic specialist or a physical therapist may also be appropriate.

2. Connection Between Irritable Bowel Syndrome (IBS) and Back Pain: While IBS primarily affects the gastrointestinal tract, it can lead to referred pain in the lower back. The discomfort from IBS can cause muscle tension and spasms in the abdominal area, which may radiate to the lower back. However, it is essential to differentiate whether the back pain is a direct result of IBS or if there is another underlying condition, such as a musculoskeletal issue or a kidney-related problem, especially since you mentioned pain near the kidney area.

3. Autonomic Nervous System Dysfunction: Your history of autonomic nervous system dysfunction could potentially contribute to your symptoms. The autonomic nervous system regulates involuntary bodily functions, including pain perception. Stress and anxiety can exacerbate pain symptoms, leading to muscle tension and discomfort in various areas, including the back. It is not uncommon for individuals with autonomic dysfunction to experience a wide range of symptoms, including pain in different body parts.

Additional Considerations
- Pain Characteristics: You mentioned that your pain is most severe when standing and during certain activities, such as sitting for extended periods. This pattern could indicate a mechanical issue, such as muscle strain or spinal alignment problems. The fact that lying down alleviates the pain suggests that the pain may be related to pressure on the spine or surrounding muscles.

- Diagnostic Tests: If your symptoms persist, your doctor may recommend imaging studies, such as X-rays or an MRI, to evaluate the condition of your spine and surrounding structures. These tests can help identify any abnormalities, such as herniated discs, spinal stenosis, or other issues that may be contributing to your pain.

- Management Strategies: In the meantime, consider implementing some self-care strategies. Gentle stretching, heat therapy, and over-the-counter pain relievers may provide temporary relief. Additionally, practicing good posture and avoiding prolonged periods of sitting or standing can help manage your symptoms.

- Follow-Up: Keep a symptom diary to track your pain levels, triggers, and any associated symptoms. This information can be invaluable for your healthcare provider in diagnosing and treating your condition effectively.

In conclusion, while your symptoms may be multifactorial, starting with a consultation with a primary care physician or neurologist is the best course of action. They can help you navigate your symptoms and determine the most appropriate treatment plan. Remember, early intervention is key to managing pain effectively and improving your quality of life.

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