Back Inflammation: What You Need to Know

Spine inflammation is more common than you think, and it can bring about a variety of painful back conditions

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You’ve likely heard the term “inflammation.” Beyond knowing that “anti-inflammatory” drugs like Advil treat it, you may not know much about this condition. As it turns out, it can be a substantial factor in causing back pain, and if you treat back inflammation properly, you may feel better before you know it.

Back inflammationBack inflammation can feel like this.

What Is Inflammation?

According to a 2020 report, the number of diseases tied to chronic inflammation will increase exponentially over the next three decades in the United States. It says that in 2014, an estimated 60% of Americans were dealing with at least one chronic condition caused wholly or in part by inflammation.

But what is inflammation exactly?

“Inflammation in the body typically means there’s an immune response to something in your body,” explains Ai Mukai MD, physiatrist at Texas Orthopedics, Sports and Rehabilitation Associates in Austin, Texas. “Typically, acutely, there’s swelling, redness, and warmth to signal an inflammatory response in the context of an injury or infection.”

Chronic inflammation—long-term—can show up through a series of symptoms, including generalized fatigue, diffuse multi-area pain, and, as Dr. Mukai puts it, “just feeling off” and “not as sharp.” Inflammatory conditions can include skin changes like rash, joint swelling, and lymph node swelling, along with endocrine, heart, lung, and neurological issues.

And of course, inflammation can pose as inflammatory back pain as well. But why does this happen?

Dr. Mukai walks us through the biology: “The immune system is there to protect your body from an ‘attack’ from the outside. The cells and chemicals are there to fight the attack and try to ultimately heal the injury. Sometimes, there is no attack, and the immune system becomes hyper-reactive, attacking itself in the case of autoimmune disease, or becomes chronically inflamed. Chronic inflammation, which is typically longer than 3 months, can lead to diseases such as diabetes and heart disease whereas autoimmune inflammation can manifest in rheumatological disorders such as rheumatoid arthritis.”  

Inflammation vs. Inflammatory Conditions

As Dr. Mukai touched upon, autoimmune inflammation that presents as ankylosing spondylitis and rheumatoid arthritis is in a different category.

“It’s when the body starts attacking itself,” she says. “Sometimes, this is triggered by an outside event, like a viral infection, which stimulates the immune system. This can cause joint destruction, ligament pain, and soft tissue swelling. Some of these conditions are hereditary while others just seem to happen.”

Types of Inflammatory Spinal Conditions

Inflammation can make its way into the body’s spinal and neurological systems, resulting in painful conditions that can disrupt daily life.

  • Ankylosing Spondylitis: Ankylosing spondylitis, or AS, “classically affects the spine,” Dr. Mukai says. She details that it typically starts in the lower back and can spread upward. It’s a form of arthritis that often causes vertebrae to fuse together.  AS can also cause inflammation in the urological and ophthalmological systems. “It is thought to be at least somewhat genetically mediated,” she says. “There is a genetic marker called HLA B27 that is usually positive in patients. It is more common in young males.”
  • Rheumatoid Arthritis: Rheumatoid arthritis, or RA, causes inflammation in joints’ synovium, which produces a lubricating fluid that helps lubricate and nourish joints.  RA is found “most commonly the hands, wrists, and knees,” Dr. Mukai says, but can also take hold in the spine’s facet joints that connect vertebrae to each other. “It has some genetic predisposition, but also some correlation with smoking and obesity,” Dr. Mukai says. “It’s typically diagnosed with lab work, like inflammatory markers, rheumatoid factor, and anti-CCP, and physical examination by a rheumatologist.” RA pain is commonly found in the cervical spine, aka the neck. Rheumatoid arthritis in lower back is considered to be rare.
  • Transverse Myelitis and Multiple Sclerosis: These closely tied conditions are caused by inflammation in the central nervous system (CNS). The immune system attacks and strips nerve cells of myelin, a fatty substance that insulates nerves and helps them efficiently conduct impulses to and from CNS. “This can cause pain, weakness, numbness, and bowel and bladder issues,” Dr. Mukai says. Transverse myelitis affects the spinal cord whereas MS can affect the brain and the spinal cord. “Transverse myelitis is usually acute, whereas MS is thought to be more long-term and can have a waxing and waning course or progressive symptoms. Transverse myelitis can be a symptom of MS,” says Dr. Mukai.

Other than chronic conditions, some lifestyle choices can cause or exacerbate inflammation. “Obesity, smoking, and nutritional status can all impact chronic inflammation,” Dr. Mukai says.

What Spinal Structures Can Be Affected by Inflammation?

Every part of the spine can be affected by inflammation, from lower back inflammation to inflammation of the vertebrae. Acute injuries to the spine, including the bones, discs, ligaments, and joints, can cause swelling and fluid build-up that can be spotted on an MRI, which Dr. Mukai adds “is typically the best way to look for inflammation visually.”

She goes on to say that the term “-itis” usually signifies some sort of inflammation.

She says, “For example, neuritis means inflammation of the nerve. This can be seen with nerve compression where the nerve looks swollen on an MRI.”

Treating Spinal Inflammation

The causes of inflammation can be rooted in lifestyle choices, but they also can be alleviated through good lifestyle habits.

  • Nutrition: “In general, I usually recommend avoiding or decreasing processed foods, trans fats, and sugar,” Dr. Mukai says. “Some people are sensitive to certain foods such as nightshades, dairy, and gluten. I also recommend considering supplementing vitamin D, magnesium, and omega 3.”
  • Quitting Smoking: Dr. Mukai notes, “Smoking cessation can help by improving circulation and decreasing vascular inflammation.”
  • Exercise: Inflammation can be decreased through aerobic exercises that improve cardiac function and circulation as well as specific exercises that support the spine in an ergonomic way. “We usually discuss core and pelvic stabilization for lower back pain,” Dr. Mukai says. “Doing things like planks and squats can help.”
  • Medication: For acute inflammation caused by injuries, Dr. Mukai turns to oral steroids and NSAIDs for her patients. She also recommends injected steroids to help with severe pain and inflammation.

You might be wondering if surgery can help bring down inflammation.

“For the spine, we typically don’t recommend surgery as a first line treatment unless there is impending permanent neurological damage,” Dr. Mukai says. “If medication, physical therapy, injections, supplements, lifestyle changes, and/or complementary treatments such as acupuncture are not helpful and there is significant impact on quality of life and function, elective surgery can be considered.”

Updated on: 01/21/21
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