Inflammatory Back Pain [The Ultimate Guide 2021]

Back pain can be a frustrating and sometimes scary thing to experience.

Often back pain is caused by pulled or injured muscles, sometimes it can be caused by a degenerated disc that’s putting pressure on a nerve and, in other cases, back pain is caused by inflammation.

If you’re worried about your own back pain, determining its cause can seem like a daunting task. Fortunately, there are many resources available to help transform pain and suffering into knowledge and action. If you want to know whether your pain is simply mechanical or the cause of inflammation, you’ve come to the right place.

In this blog post, we’ll discuss everything you need to know about back pain that’s caused due to inflammation as well as how you can start to combat it.

What is inflammatory back pain?

Inflammatory back pain (IBP) is a chronic condition that occurs when inflammation or swelling starts to occur in the spine. It is often attributed to arthritis.

IBP often occurs around the lumbar spine, or the lower back, but can really appear anywhere in the spine that contains a large joint. Because spinal inflammation is often a form of arthritis it usually includes the swelling and tenderness of one or more of your joints.

Inflammatory back pain affects 3% of adults and it can occur for a number of reasons.

A number of symptoms indicate IBP:

  • The pain starts before age 40.
  • The pain lasts more than three months
  • The pain is bad enough to wake you up from a sound sleep.
  • The pain is worse in the later part of the night or early morning.
  • You feel stiff when you wake up.
  • The pain lessens with exercise and movement.
  • The pain is helped by nonsteroidal inflammatory drugs (NSAIDs) like ibuprofen.

Another possible symptom of inflammatory back pain is pain or tenderness where your lower spine meets your pelvis (the sacroiliac joint). You may experience this pain alternating between the buttocks. If pain spreads from there to other points of the body, that may also be a sign of inflammatory back pain.

It is not caused by any physical trauma. For most people who suffer from inflammatory back pain, it starts before age 35 and lasts for longer than three months. It's not known why some people get this condition and others don’t, but researchers believe there may be a link with a particular gene known as HLA-B27.

IBP can make a huge negative impact on a sufferer’s life. It can be the difference between high and low quality of life. Everyday actions, from sitting to lifting things, can be made difficult by inflammatory back pain. Chronic pain can make the unconscious actions you take on a normal basis into excruciating challenges.

Why, then, is inflammatory back pain something that creates problems for sufferers?

Why does inflammation cause back pain?

Inflammation causes back pain when swollen nerve tissue presses into the sensitive nerve endings in the back.

Inflammation generally occurs when your body is reacting to some kind of foreign irritant. It is your body’s signal that something is wrong and an indication that your body is fighting off an invader.

With inflammatory back pain, however, this isn’t the case. With IBP – a chronic and common condition – your body’s immune system accidentally thinks your spinal joints are a threat. As a result, your body feels pain from your immune system’s mistaken belief that your body is the intruder. In some cases, the brain can adapt to the pain signals, and you may not notice the pain any longer.

The swelling experienced during inflammatory back pain is the result of the body’s white blood cells spending too much time at the inflamed site. While this is usually a healthy, normal process, inflammatory back pain represents a case where the white blood cells are at the site beyond, or more than, the normal amount needed for health.

This isn’t the case, however, for mechanical back pain. The difference between it and IBP are the difference between the parts of the back not working together, and the body erroneously attacking the back.

What is the difference between mechanical back pain and inflammatory back pain?

Mechanical back pain has purely physical causes, but inflammatory back pain is caused by your immune system attacking your body.

A 2014 article in the journal BMC Musculoskeletal Disorders introduced a diagnostic tool for determining the difference between inflammatory and mechanical back pain, called the mechanical and inflammatory low back pain index (MIL Index)[5]. The index’s designers reduced the number of symptoms of both types of pain to seven factors.

The characteristics of inflammatory lower back pain were:

  • Feeling pain when waking and getting up,
  • Feeling pain after repetitive bending,
  • Intermittent pain during the day, and
  • Post-rest stiffness.

Mechanical back pain was characterized primarily by:

  • Pain at trunk flexion,
  • Pain when lateral bending, and
  • Pain at palpation of the vertebra.

There are other differences between mechanical back pain and inflammatory back pain. IBP is generally insidious onset, meaning it develops slowly, and symptoms show up over a period of months, or even years. This is not the case for mechanical back pain. Contrarily, mechanical back pain is acute onset, meaning it happens suddenly, as a result of a surgery or accident, and gets better as you heal.

Rest generally doesn’t help treat IBP, though it does help with mechanical back pain. Also, inflammatory back pain is less common than mechanical back pain.

One of the first symptoms isolated for inflammatory back pain was actually the stiffness and pain felt after periods of immobility. In 1949, the British doctor F. Dudley Hart provided one of the first comprehensive descriptions of IBP. An important part of that description was the fact that immobility was inevitably a source of discomfort for those with inflammatory back pain.

One way to better understand the difference between inflammatory and mechanical back pain is to look at two cases that help clearly illustrate the differences.

In Don L. Goldenberg’s consideration of two such cases, he notes that one major difference is that the sufferer with inflammatory back pain improves with movement. Contrarily, the patient he considers with mechanical back pain is unaffected by movement or exercise.

Another difference noted by Goldenberg is that the patient with inflammatory back pain also had pain in the buttocks. This is a common problem for sufferers. The buttocks aren’t the only related area to suffer pain, however. Patients with IBP often also note pain in the chest wall, and lumbar and cervical spine.

Contrarily, the patient with mechanical back pain didn’t notice pain in the buttocks. Instead, the pain was more localized around that part of the back.

The type of pain involved can also help doctors determine if the pain is inflammatory or mechanical. Inflammatory back pain is often described as “deep,” “throbbing,” or “gnawing.” Another distinguishing feature of IBP, is when the pain extends to the buttocks.

What helps decrease or relieve inflammation in the spine?

Often, inflammatory back pain is chronic, but by incorporating some simple, pain-relieving practices into your daily lifestyle, you can help reduce the amount of pain that is felt.

Many people take medications at the start of the day to cope with their inflammatory back pain, and following a regular schedule of medications is a good way to start a day of combatting inflammatory pain.

If your doctor prescribes medications, be sure to take those medications, and stick to the doctor’s recommended dosage and frequency. If you’re a smoker, be aware that tobacco can contribute to back pain. If you’ve ever thought of quitting, an extra motivation to do so is the lessening pain you’ll get when you kick the habit.

Watching your diet throughout the day is also a way to decrease your back pain. Particularly, try to avoid cooking foods at high heat. There are also spices you can use to help decrease inflammation. Seasonings like cinnamon, ginger, garlic, cayenne pepper, and turmeric have all been linked to decreased inflammation. The properties of these spices are behind their anti-inflammatory function. Ginger, for instance, has compounds that function in the same way as COX-2 inhibitors, which have been used to treat inflammation. In one study, ginger had an anti-inflammatory effect as strong as ibuprofen.

The types of foods you eat can have an impact, too. Red meat can lead to further inflammation, so it’s a good idea to limit that. Sunflower seeds, olive oil, and nuts are rich in omega-3s, which help fight inflammation. Sunflower seeds, for instance, are rich in vitamin E, which combats inflammation. Olive oil is an excellent fighter against inflammatory back pain because of the anti-inflammatory compound called oleocanthol.

After work, find activities that will relieve spinal inflammation. Doing core and back exercises are one method. Yoga, an activity you may already participate in, is another. One 2015 study found that a twelve-week Yoga program helped back pain sufferers lessen their pain, and cope with stress.

If your pain is serious enough, physical therapy may help. Massage is another option that helps some sufferers relieve pain. Massage is effective because it reduces the number of inflammatory cytokines, proteins that are inflammation’s source.

Get to sleep at a reasonable time, as sleep is another thing that helps combat inflammatory back pain. If back pain prevents you from sleeping, try sleeping on your side, with a pillow between your legs. As a heads-up, however, too much rest can be bad for inflammatory back pain.

Do any autoimmune diseases cause inflammation in the back?

In short, yes, some autoimmune diseases, conditions where the immune system attacks the body, can cause spinal inflammation.

Several autoimmune diseases are also linked to spinal inflammation. Some examples of these diseases are psoriasis and rheumatoid arthritis. One common autoimmune condition often linked to inflammatory back pain is called ankylosing spondylitis. Ankylosing spondylitis affects the lower spine, and sacroiliac joints.

There isn’t a causal connection between IBP and ankylosing spondylitis, but the two often occur together.

An early comprehensive description of the condition was provided in 1977 by a team of doctors studying ankylosing spondylitis patients. The original five-item description of IBP demonstrates how much of an overlap there is between IBP and ankylosing spondylitis. The five characteristics were insidious onset, an age of less than 40 at onset, pain lasting longer than three months, attendant morning stiffness, and pain lessening with exercise.

There’s been no definite connection between the two established, but the five similarities demonstrate the possibility that there’s some sort of connection between the two.

Conclusion

If you suspect you have inflammatory back pain or your doctor has diagnosed you with inflammatory back pain, you may worry that the pain will never go away. But inflammatory back pain can be treated.

If you have further questions about back pain, and whether yours is inflammatory, one of the best things you can do is consult your doctor. The human body is a complex organism. It’s even more complex in that every individual body differs from every other one, often in minute ways. These minute ways can make a big difference in the diagnosis and treatment you need.

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Atlantic Brain and Spine A graduate of both Yale and Stanford, Dr. Jae Lim is a board-certified spine surgeon who specializes in minimally invasive spine surgery and robotic spine surgery, significantly reducing surgical impact and recovery times. (703) 876-4270
8501 Arlington Blvd. Suite 330
Fairfax
Virgina
22031
United States
Jae Y. Lim Ben L. Nguyen