Non Mechanical Syndromes
There are other cause of low back pain besides compression and wear and tear phenomena. These include nerve-mediated pain, referred pain, and pain due to internal medicine disorders.
Non-compressive damage to nerves arising from processes including blood vessel disease (vasculitis), diabetes, chronic inflammation after trauma, or autoimmune problems can result in chronic low back pain.
Internal organs—such as the abdominal organs, kidneys, prostate, etc.—have sensory nerves around them. When these organs are compromised, sometimes they send pain signals not only to the brain, but also to the soma (the musculoskeletal system), which may produce pain in the back or other areas.
Other internal medical/systemic disorders
Inflammatory arthropathy, metabolic bone conditions, and fibromyalgia are cited as the cause of chronic spine-related pain conditions.[17, 18] Those with very advanced artery hardening can have low blood-flow conditions at the spine or low back, producing pain.
Inflammatory, Seronegative or Spondylo-arthropathies; Ankylosing Spondylitis
This group of conditions—known as inflammatory or seronegative arthropathies, or spondyloarthropathy—shares some common features. Systemic inflammation due to an internal medical inflammatory or auto-immune condition may have associated spinal arthritis, other joint arthritis, or inflammation of the sacroiliac joint and other large joints, as with knee enthesitis (inflammation of tendon and ligament insertions onto bone). Eye, skin, and intestinal conditions commonly accompany these conditions.
However, those with ankylosing spondylitis have back pain only, and tend to test negative for autoimmune diseases (diseases in which the body’s immune system attacks itself) like rheumatoid arthritis or lupus.
These patients usually report low back morning stiffness, accompanied by problems with the Achilles tendon insertion and plantar fascia (foot and ankle complaints). XRay may show narrowing of SI joints, spondylitis (squaring of superior and anterior margins of vertebral bodies caused by enthesitis of the annulus fibrosus). Over time the ligaments of the spine, which should remain a soft tissue, ossify to become more like bone, and the facet joints begin to fuse, rendering the spine very rigid.
Very similar sacroiliac joint and spinal changes may accompany other inflammatory or auto-immune diseases; those with allergic conditions such as asthma (and the genes HLA B27), Chron disease and ulcerative colitis, or celiac disease may also complain of joint arthritis, eye problems (uveitis), heart inflammation (carditis), enthesitis (tendon and ligament chronic inflammations without trauma). The findings are similar to those of ankylosing spondylitis.
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