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Back Pain

Updated 13 May 2019

Chronic disease and lower back pain: how the two may be connected

Back pain can be painful and debilitating, and not knowing the exact cause is frustrating.

Low back pain remains a common health problem and stems from a range of underlying causes such as injury, activity and chronic disease. According to Professor Quinette Louw of the Division of Physiotherapy at Stellenbosch University and co-author of a 2018 review in The Lancet, back pain is a major reason for work absenteeism in South Africa and causes more disability than lung‚ bowel and breast cancer combined. 

Dr Yair Edinburg and Dr Dean Sevel of Ubuntu Family Health Centre reveal how three common chronic diseases can cause low back pain, and what you can do to manage it.

Osteoarthritis

Osteoarthritis or degenerative joint disease is a condition caused by the deterioration of the cartilage and bone that make up the affected joints. According to this Health24 article, it is the fourth most frequent cause of health problems in women worldwide and the eighth in men. This disease commonly affects joints in your hands, knees, hips and spine.

The main presenting features of osteoarthritis, with a focus on the back and spine, include pain and stiffness in the back, but can also present as muscle weakness or numbness owing to bony outgrowths pressing on spinal nerve roots.

"The pain is caused by degeneration of the cartilage that normally exists between two bony surfaces and prevents them from rubbing or articulating on each other," explains Edinburg. When this cartilage breaks down, the bones then come in contact with each other, which causes pain and inflammation.

The chronic friction between the bone edges causes bony outgrowth formations, known as osteophytes. These may, in turn, press on nerves exiting the spinal cord and cause neurological symptoms like pain, paresthesia (pins and needles), numbness or muscle weakness in the back of the limbs.

Edinburg says this condition can be diagnosed through X-ray or MRI. Pain is usually relieved when at rest or when lying down flat, and management of the pain involves maintaining a healthy lifestyle with the emphasis on a good diet, weight loss and exercise. For medical management, pain relief with anti-inflammatories usually works. The good news is that surgery is usually not required, but Edinburg explains that it may be useful in cases of nerve impingement or neurological fallout.  

Cancer

"One has to realise that back pain can be due to primary bone cancer which may be present in the vertebrae or spinal bones," says Sevel. As a result, this type of cancer can cause pressure on other tissues in the area, including nerve roots.

Bone cancer may also cause weakening of bony tissues which can lead to pathological fractures and a collapse of the bones, ultimately causing pain. Sevel adds that cancer from primary sites like prostate, lung, breast and colon cancer, among others, can spread or metastasize to the bones in the back causing back pain.

Cancer treatment such as radiation therapy and certain forms of chemotherapy, as well as Herceptin hormone therapy, could also be a contributing factor to your back pain. Sevel advises that you visit your doctor if you suffer from cancer and experience back pain, so that deterioration of the condition and worsening of the pain can be prevented. 

Treatment of this type of back pain depends mainly on its cause, says Sevel, adding that physical therapy, palliative care, analgesic medication (pain killers) and surgery are options to help relieve the pain.

Diabetes

A study conducted by researchers at the University of Sydney this year revealed that diabetics have a 35% higher risk of experiencing low back pain than non-sufferers. 

According to the National Institute of Diabetes and Digestive and Kidney Diseases, about 60–70% of type 1 and 2 diabetics experience neuropathy, a side effect of diabetes. Diabetic neuropathy is a common complication of diabetes and a type of nerve damage brought on by uncontrolled glucose (also called blood sugar) levels.

“There are four main types of neuropathy, and symptoms ranging from discomfort to numbness and severe pain, such as back pain, can affect individuals differently,” says Sevel. With mononeuropathy (or focal neuropathy) you typically have damage to single nerves or a nerve trunk. This can cause the chronic low back pain commonly experienced by diabetics.

While it is usually not as progressive as other types of neuropathies, it often has a rapid onset with severe symptoms. High blood sugar levels can cause damage to the nerve fibres throughout the body and small blood vessel damage, caused by diabetes, leads to blood restriction to the nerve fibres. The resultant damage then brings on the severe low back pain.

Many risk factors for neuropathy exist, including long-term poorly controlled diabetes, obesity and smoking. In this disease, prevention is key, cautions Sevel. Critical risk factors must be addressed in order to ensure that diabetic neuropathy doesn’t occur or progress, as it can lead to severe loss of physical capacity in the affected person.

By taking care of yourself, your bouts of low back pain can be managed and decreased. Sevel advises patients do the following:

  • Work with your healthcare provider to control your glycaemic (blood sugar) level with medical therapy, such as insulin.
  • Lifestyle modification that includes quitting smoking, reducing alcohol intake and exercising regularly can also help you control your blood sugar levels.
  • Undergo follow-ups and HbA1C tests at least twice a year, and more often if medication is changed.

If you’re diabetic and suffer from low back pain, diagnosis of neuropathy can be done via a physical examination as well as further special tests. 

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