RPS Greenwich PAIN 101

While most cases of low back pain are caused by benign mechanical issues and soft-tissue injury, there are a few rare spine conditions (discussed below) that may be causing the symptoms.

Although back pain is common, the evaluation shouldn’t assume that it’s always caused by common conditions.  At Restorative Pain Solutions, all patients receive a 360-degree evaluation that includes not only an evaluation of the presenting problem but the medical conditions and lifestyle factors that may be contributing as well.

Arachnoiditis

What is Arachnoiditis?

Arachnoiditis is a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the spinal cord. Severe stinging, a “burning” pain, and neurological problems characterize the condition.  Inflammation of the arachnoid can lead to the formation of scar tissue and can cause the spinal nerves to stick together and malfunction.

What causes Arachnoiditis?

The arachnoid can become inflamed due to irritation from one of the following sources:

• Direct injury to the spine
• Chemicals: Dye used in myelograms (diagnostic tests in which a dye called radiographic contrast media is injected into the area surrounding the spinal cord and nerves) have been blamed for some cases of arachnoiditis. The radiographic contrast media responsible for this is no longer used, however. Also, there is concern that the preservatives found in some of the steroids used for epidural steroid injections may cause arachnoiditis.
• Infection from bacteria or viruses: Infections such as viral and fungal meningitis or tuberculosis can affect the spine.
• Chronic compression of spinal nerves: Causes for this compression include chronic degenerative disc disease or advanced spinal stenosis (narrowing of spinal column).
  Complications from spinal surgery or other invasive spinal procedures: Similar causes include multiple lumbar (lower back) punctures.

What are the symptoms of Arachnoiditis?

Arachnoiditis has no consistent pattern of symptoms, but in many people, it affects the nerves connecting to the lower back and legs and its most common symptom is pain.

Arachnoiditis can cause many symptoms including the following:

• Tingling, numbness, or weakness in the legs
• Sensations that may feel like insects crawling on the skin or water trickling down the leg
• Severe shooting pain that can be similar to an electric shock sensation
• Muscle cramps, spasms, and uncontrollable twitching
• Bladder, bowel, and/or sexual dysfunction

Symptoms may become more severe or even permanent if the disease progresses. Many people with arachnoiditis are unable to work and have a significant disability because of constant pain.

Ankylosing Spondylitis

What is Ankylosing Spondylitis?

Ankylosing Spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae in your spine to fuse.  This fusing makes the spine less flexible and can result in a hunched-forward posture.  If ribs are affected, it can be difficult to breathe deeply.
Ankylosing spondylitis affects men more often than women.  Signs and symptoms typically begin in early adulthood.  Inflammation also can occur in other parts of your body — most commonly, your eyes.

There is no cure for Ankylosing Spondylitis, but treatments can lessen your symptoms and possibly slow progression of the disease.

What causes Ankylosing Spondylitis?

Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved.  In particular, people who have a gene called HLA-B27 are at greatly increased risk of developing ankylosing spondylitis.  However, only some people with the gene develop the condition.

What are the risk factors for Ankylosing Spondylitis?

Your sex.  Men are more likely to develop ankylosing spondylitis than are women.
Your age.  Onset generally occurs in late adolescence or early adulthood.
Your heredity.  Most people who have ankylosing spondylitis have the HLA-B27 gene.  But many people who have this gene never develop ankylosing spondylitis.

What are the symptoms of Ankylosing Spondylitis?

Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in your lower back and hips, especially in the morning and after periods of inactivity.  Neck pain and fatigue also are common. Over time, symptoms might worsen, improve or stop at irregular intervals.
The areas most commonly affected are:

• The joint between the base of your spine and your pelvis (sacroiliac)
• The vertebrae in your lower back
• The places where your tendons and ligaments attach to bones (entheses), mainly in your spine, but sometimes along the back of your heel
• The cartilage between your breastbone and ribs
• Your hip and shoulder joints.

When to see a doctor:

Seek medical attention if you have low back or buttock pain that came on slowly, is worse in the morning or awakens you from your sleep in the second half of the night — particularly if this pain improves with exercise and worsens with rest.  See an eye specialist (ophthalmologist) immediately if you develop a painful red eye, severe light sensitivity or blurred vision.

What are the complications of Ankylosing Spondylitis?

In severe Ankylosing Spondylitis, new bone forms as part of the body’s attempt to heal. This new bone gradually bridges the gap between vertebrae and eventually fuses sections of vertebrae.  Those parts of your spine become stiff and inflexible. Fusion can also stiffen your rib cage, restricting your lung capacity and function.
Other complications might include:
Eye inflammation (uveitis). One of the most common complications of ankylosing spondylitis, uveitis can cause rapid-onset eye pain, sensitivity to light and blurred vision. See your doctor right away if you develop these symptoms.
Compression fractures. Some people’s bones thin during the early stages of ankylosing spondylitis. Weakened vertebrae can crumble, increasing the severity of your stooped posture. Vertebral fractures can put pressure on and possibly injure the spinal cord and the nerves that pass through the spine.
Heart problems. Ankylosing spondylitis can cause problems with your aorta, the largest artery in your body.  The inflamed aorta can enlarge to the point that it distorts the shape of the aortic valve in the heart, which impairs its function.

Transverse Myelitis

What is Transverse Myelitis?

Transverse Myelitis (TM) is a disorder caused by inflammation of the spinal cord. It is characterized by symptoms and signs of neurologic dysfunction in motor and sensory tracts on both sides of the spinal cord.  The involvement of motor and sensory control pathways frequently produce altered sensation, weakness and sometimes urinary or bowel dysfunction.

What are the symptoms of Transverse Myelitis?

There are four classic symptoms of transverse myelitis:

• Weakness in the arms/legs
• Sensory symptoms such as numbness or tingling
• Pain and discomfort
• Bladder dysfunction and/or bowel motility problems

The distribution of those symptoms may be symmetric or asymmetric affecting either legs, arms or both.

What causes Transverse Myelitis?

The cause of 60% of TM cases may remain unknown despite the presence of inflammatory mechanisms. However, the remaining 40% is associated with autoimmune disorders such as multiple sclerosis, neuromyelitis optica, systemic lupus erythematosus, Sjogren’s syndrome and sarcoidosis among others. The term idiopathic — meaning the cause is unknown- has been used in the past in situations in which the cause cannot be determined. However, the lack of demonstration of a causative disorder, mechanism or agent may be the result of the failure of an early diagnosis or the result of causative factors that disappears quickly such as in cases of viral infections or post-infectious disorders.

TM is an unbiased condition, striking all age groups — from young children to the elderly — regardless of family history, gender or race.  In younger patients, transverse myelitis may be the first indication of disorders such as multiple sclerosis or neuromyelitis optica. In some patients, a spinal cord stroke or vascular myelopathy may be confused with TM, a situation that may lead to erroneous treatment approaches.

We hope you find this information helpful!

Although these conditions are relatively rare, anyone who experiences pain, weakness, or abnormal sensations in the back or neck, or even in their arms or legs, should seek out care from a Board Certified Physician, such as Dr. Whitney at RPS Greenwich, who has been extensively trained in the diagnosis and management of back pain and the related disorders that may be causing the symptoms.