Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Uncommon causes of low back pain include Paget's disease of bone, bleeding or infection in the pelvis, infection of the cartilage and/or bone of the spine, aneurysm of the aorta, and shingles.
Paget's disease of bone
Paget's disease of the bone is a condition of unknown
cause in which the bone formation is out of synchrony with normal bone
remodeling. This condition results in abnormally weakened bone and deformity
and can cause localized bone pain, though it often causes no symptoms. Paget's disease is more common in people over
the age of 50. Heredity (genetic background) and certain unusual virus
infections have been suggested as
causes. Thickening of involved bony areas of the lumbar spine can cause the
radiating lower extremity pain of sciatica.
Paget's disease can be diagnosed on plain X-rays.
However, a bone biopsy is
occasionally necessary to ensure the accuracy of the diagnosis. Bone scanning is
helpful to determine the extent of the disease, which can involve more than one
bone area. A blood test, alkaline phosphatase, is useful for diagnosis and
monitoring response to therapy. Treatment options include
aspirin, other
anti-inflammatory medicines, pain medications, and medications that slow the
rate of bone turnover, such as calcitonin (Calcimar, Miacalcin), etidronate (Didronel),
alendronate (Fosamax), risedronate (Actonel), and pamidronate (Aredia).
Bleeding or infection in the pelvis
Bleeding in the pelvis is rare without significant
trauma and is usually seen in patients who are taking blood-thinning
medications, such as warfarin (Coumadin). In these patients, a rapid-onset sciatica pain
can be a sign of bleeding in the
back of the pelvis and abdomen that is compressing the spinal nerves as they
exit to the lower extremities. Infection of the pelvis is infrequent but can be
a complication of conditions such as diverticulosis, Crohn's disease,
ulcerative colitis, pelvic inflammatory disease with infection of the
Fallopian tubes or uterus, and even appendicitis.
Pelvic infection is a serious
complication of these conditions and is often associated with fever,
lowering of blood pressure, and a life-threatening state.
Infection of the cartilage and/or bone of the spine
Infection of the discs (septic discitis) and bone (osteomyelitis) is extremely rare.
These conditions lead to localized pain associated with fever. The bacteria
found when these tissues are tested with laboratory cultures include Staphylococcus aureus
and Mycobacterium tuberculosis (TB bacteria). TB infection in the spine is
called Pott's disease. These are each very serious conditions requiring long
courses of antibiotics. The sacroiliac joints rarely become infected with
bacteria. Brucellosis is a bacterial infection that can involve the sacroiliac
joints and is usually transmitted in goat's milk.
Aneurysm of the aorta
In the elderly, atherosclerosis can cause
weakening of the wall of the large arterial blood vessel (aorta) in the abdomen.
This weakening can lead to a bulging (aneurysm) of the aorta wall. While most
aneurysms cause no symptoms, some cause a pulsating low back pain. Aneurysms of
certain size, especially when enlarging over time, can require surgical repair
with a grafting procedure to repair the abnormal portion of the artery.
Shingles
Shingles (herpes zoster) is an acute infection of the nerves
that supply sensation to the skin, generally at one or several spinal levels and
on one side of the body (right or left). Patients with shingles usually have had
chickenpox earlier in life. The
herpes virus that causes chickenpox is believed to exist in a dormant state within the spinal nerve roots long after the
chickenpox resolves. In people with shingles, this virus reactivates to cause
infection along the sensory nerve, leading to nerve pain and usually an outbreak
of shingles (tiny blisters on the same side of the body and at the same nerve
level). The back pain in patients with shingles of the lumbar area can precede
the skin rash by days. Successive crops of tiny blisters can appear for several
days and clear with crusty inflammation in one to two weeks. Patients occasionally are left with a more
chronic nerve pain (postherpetic neuralgia). Treatment can involve symptomatic
relief with lotions, such as calamine, or medications, such as acyclovir (Zovirax) for the infection and pregabalin (Lyrica) or lidocaine (Lidoderm) patches for the pain.
One in every 20 people develop a kidney stone at some point in their life. A kidney stone is a hard mineral and crystalline material formed within the kidney or urinary tract. Kidney stones symptoms and signs are, blood in the urine and pain in the abdomen, flank (lower back), or groin. A number of different conditions can lead to kidney stones including: gout, hypercalciuria, people with inflammatory bowel disease, kidney disease, and hypoparathyroidism. Some medications also increase the risk of kidney stones.
Sciatica pain, caused by irritation of the sciatic nerve, typically radiates from the low back to behind the thigh to below the knee. Disc herniation is usually the cause of sciatica. Medication to alleviate pain, physical therapy, and bed rest are treatments for sciatica.
A pinched nerve can be caused of a variety of conditions, for example, carpal tunnel syndrome, herniated disc, sciatica, arthritis, spinal stenosis, trauma, and more. Common symptoms of a pinched nerve include pain, numbness, tingling, and weakness. Treatment of a pinched nerve depends on the cause of the pinched nerve.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
In the U.S., more than 2,000 people are diagnosed with bone cancer every year. There are many types of bone cancer. The most common forms of bone cancer are osteosarcoma, Ewing's sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, and chordoma. Pain is the most common symptom. Treatment usually involves surgery, chemotherapy, and radiation therapy.
Endometriosis is the growth of cells similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder. Treatment of endometriosis can be with medication or surgery.
Sacroiliac joint (SI) dysfunction is a general term to reflect pain in the SI joints. Causes of SI joint pain include osteoarthritis, abnormal walking pattern, and disorders that can cause SI joint inflammation including gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. Treatment includes oral medications, cortisone injections, and surgery.
Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is
"hardening of the arteries" called arteriosclerosis.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Scoliosis causes an abnormal curvature of the spine. When the cause of scoliosis is unknown the disorder is described based on the age when the scoliosis develops (infantile, juvenile, or adolescent idiopathic scoliosis). In functional scoliosis, curvature develops due to a problem somewhere else in the body. With neuromuscular scoliosis, there is a problem when the bones of the spine are formed. Treatment typically involves observation, bracing, and surgery and is dependent upon the severity of the curvature.
A herniated disc may be caused by injury or degeneration from age. Symptoms depend on the location of the herniation and whether nerve tissue is being irritated. An MRI or CT scan is performed to diagnose a herniated disc. Treatment may involve physical therapy, cortisone injection, pain medications, antiinflammatory medications, muscle relaxants, and surgery.
Vancomycin-resistant enterococci (VRE) infection is the most common type of infection acquired by patients while hospitalized. Patients at risk for VRE are those who are already ill, and hospitalized, including individuals with diabetes, elderly, ICU patients, kidney failure patients, or patients requiring catheters. Enterococci can survive for months in the digestive tract and female genital tract. Other risk factors for acquiring VRE include those how have been previously treated with vancomycin and combinations of other antibiotics. Treatment of VRE is generally with other antibiotics other than vancomycin. Prevention of VRE can be achieved by proper hand hygiene.
Coccydynia is an inflammation of the bony area (tailbone or coccyx) located between the buttocks. Coccydynia is associated with pain and tenderness at the tip of the tailbone between the buttocks. Pain is often worsened by sitting. There are many causes of tailbone pain that can mimic coccydynia including: fracture, pilonidal cysts, infection, and sciatica. Treatment methods include medication and rest.
Osteomyelitis is an infection of the bone. Potential causes include injections around the bone, fractures that puncture the skin, recent surgeries, and bacterial infections that travel from other areas of the body, spreading through the blood to the bone. Symptoms include pain, fever, chills, stiffness, and nausea. Treatment involves antibiotics and pain medications. Surgery is sometimes necessary.
Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
The five types of spondylolisthesis include 1) dysplastic, 2) isthmic, 3) degenerative, 4) traumatic, and 5) pathologic. The most common symptom of spondylolisthesis is lower back pain. Treatment depends on the type and severity of spondylolisthesis. Surgery is required in some cases of spondylolisthesis.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Diffuse idiopathic skeletal hyperostosis (DISH or Forestier's disease) is a form of degenerative arthritis. It is characterized by calcification along the sides of the vertebrae of the spine. Symptoms include stiffness and pain in the upper and lower back. Anti-inflammatory medications are used to treat DISH.
Cauda equina syndrome is a medical emergency condition that is caused by the uncommon compression of the nerves at the end of the spinal cord. Symptoms of cauda equina syndrome include lower back pain, tingling and/or numbness in the buttocks and lower extremities, bowel or bladder incontinence, and weakness in the legs. Causes of cauda equina syndrome include herniated discs, hematomas, or infection. Treatment is generally prompt surgery.
Typhus is a disease caused by Rickettsia bacteria. Symptoms and signs include fever, headache, nausea, vomiting, diarrhea, and rash. Antibiotics are recommended as the treatment for endemic and epidemic typhus infections.
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