Pain in the lumbar spine does not have to originate from the spine itself. There are many referral structures that can cause low back pain and need to be ruled out as a source of pain (dangerous mimics of back pain). To understand why some of these structures would cause low back pain, we have to go back to embryology. The structures in the retroperitoneum (the area behind the intestines) are supplied by the same nerve endings as the back structures. Sometimes, the brain has difficulty differentiating where pain comes from in this area. These structures include the aorta, kidneys, pancreas, gall bladder, urinary bladder, ovaries and uterus. Any problem with one of these organs could refer pain to the back.
The most devastating one is an abdominal aortic aneurysm. The aorta is the main artery that brings blood to the lower body. It travels next to the spine in the abdomen and can create dangerous mimics of back pain. Occasionally in individuals older that 60 with high blood pressure or genetic diseases, the aorta can stretch out and pain from this can refer to the back. The danger is that this vessel can rupture and surgical repair can be lifesaving if done in time.
Kidney infections are famous for referring dangerous mimics of back pain to one side of the back, where the ribs meet the lower back. This is called costovertebral tenderness and is elicited by percussing at the lowest ribs along side the spine. Severe pain in this region can be an indicator of a kidney infection.
Gynecological problems can refer pain to the back. Endometriosis and ovarian cysts are two good examples. This pain will normally be cyclical with the patient's period. A pelvic infection from any number of causes can also cause pain. Ectopic pregnancy, a surgical emergency, can refer to the back. It is important to get a thorough history of the patient's cycles and activities to help rule this in or out.
Occasionally, diverticulitis can cause back pain. This occurs when small outpouchings of the intestinal wall become inflamed.
Gall bladder attacks can cause back pain. Normally, these would be worst after a fatty meal and are crescendo de- crescendo (get worse and then better in a matter of minutes) type of attacks. That is- the pain rises and falls as a crampy type of pain.
Cancer can obviously cause back pain. If a vertebra or pelvis fractures because the bone is weakened, the pain will be like typical fracture pain. X-rays and especially an MRI would differentiate this. Compression of a nerve or the cauda equina will give symptoms associated with these specific structures.
If you have additional questions regarding dangerous mimics of back pain, please contact Dr. Donald Corenman at 970-479-5895.
