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What are uncommon causes of low back pain?
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
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 (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.