Coping With Low Back Pain in Multiple Sclerosis

Be sure to get your back pain checked out, as it may not always stem from MS

Man lying on bed with back pain
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Do you have lower back pain and question whether it's linked to your multiple sclerosis? If so, you are not alone, as approximately one out of five people with MS report back pain.

While your lower back pain may seem like another rock on your mountain of already burdensome MS symptoms, know that there are strategies to soothe your discomfort.

Let's take a closer look at the "why" behind your lower back pain in MS, and how you can best manage it.

Causes and Treatment of Low Back Pain in MS

There are a few potential MS-related culprits behind your low back pain and teasing out the root cause can take some time.

In the end, undergoing a proper evaluation is important, so you can move forward with an effective treatment plan.

Spasticity

Spasticity is a common symptom in MS and is mostly caused by demyelination, where nerve signals to muscles are slowed or interrupted. While spasticity technically refers to an increase in muscle tone and uncontrolled muscle contractions, people with spasticity often describe a variety of unique sensations like:

  • Stiffness
  • Tugging
  • Pulling
  • Aching
  • Squeezing
  • Tightening

Spasticity tends to vary from person to person, like other symptoms of MS. For instance, a person may notice a mild tightening of his or her legs that does not affect their daily functioning. On the flip side, a person may experience severe leg spasticity that causes painful cramping which interferes with movement.

 

How does spasticity relate to low back pain? While spasticity most commonly affects a person's calves, thighs, groin, and buttocks, it can also cause tightening and aching in and around the joints and lower back.

Treatment of spasticity that affects your lower back usually entails a combination of both medication and physical therapy.

These therapies may include:

  • Heat therapy
  • Massage
  • Physical therapy including stretching and range of motion exercises
  • Muscle relaxants like Zanaflex (tizanidine)
  • Anti-seizure medications like Neurontin (gabapentin)
  • A benzodiazepine
  • Oral cannabis

People whose spasticity does not respond to the above therapies may require one or more of the following invasive treatments:

Lastly, avoiding triggers is another way to prevent worsening of your spasticity in your lower back. Examples of triggers that may irritate your spasticity include heat exposure (called the Uthoff phenomenon), infection, sudden changes in position or movement, tight or irritating clothing, or a full bladder or bowel.

Lhermitte's Sign

One classic cause of back pain in multiple sclerosis is a phenomenon called Lhermitte's sign which refers to a shock-like sensation (sometimes called a wave of electricity) that moves rapidly from the back of a person's head down through their spine.

This sensation occurs when a person bends their neck forward (for example, when removing a necklace or tying your shoes). The sensation is short-lived and goes away once a person moves their head back up.

The cause of Lhermitte's sign is due to MS lesions in the cervical spine (the upper part of your spine that comprises your neck). The upside of this uncomfortable and rather unusual feeling is that certain medications and strategies can help prevent the pain from occurring in the first place. One example of a medication your doctor may prescribe is the anti-seizure drug called Neurontin (gabapentin).

You don't always have to take a medicine to treat Lhermitte's sign. In other words, a medicine like Neurontin is generally reserved for those who find Lhermitte's sign to be debilitating (in other words, affecting their quality of life and/or daily functioning).

Muscle and Mobility Problems

Another culprit for low back pain in MS is related to issues stemming from immobility. For instance, if a person with MS is using his or her cane or other mobility-assistive devices improperly, low back pain may develop.

In order to compensate for a MS-related issue like a numb or tingling leg or foot, a person may walk funny or distribute their weight unnaturally, and this can put a strain on their lower back. Sitting in a wheelchair all day can also put undue pressure on one's back.

Likewise, various MS symptoms can lead to abnormal posturing. Imagine if a person has spasticity in their legs. This can put stress on a person's ligaments and joints in their back causing pain—a vicious cycle, so to speak, of pain, creating more pain.

Strategies to prevent or combat these musculoskeletal causes of low back pain include:

  • Proper training on using your specific mobility-assistive device
  • Physical therapy
  • Heat therapy
  • Massage

Nonsteroidal anti-inflammatories (NSAIDs) can also be helpful in the short-term to relieve acute inflammation. That said, be sure to take to your doctor before taking one. NSAIDs are not safe or appropriate for everyone, even though some are available over-the-counter (for example, ibuprofen).

Low Back Pain That Is Not From MS

It's important to note that low back pain is common in the general population, meaning a lot of people experience it, regardless of whether or not they have MS. This is why it's essential to undergo a proper diagnosis for your low back pain, and not just assume it's from your MS.

Examples of common causes of low back pain in the general population include:

  • Sciatica or other lower spine nerve root compression
  • Spinal stenosis
  • Nonspecific musculoskeletal sprain/strain from trauma or injury

Of course, there are much less common, but more serious causes of lower back pain too including:

Even so, some people with MS may be more prone to a couple of these serious causes. For instance, taking corticosteroids increases a person's risk for infection, as well as for a compression fracture from osteoporosis.

Finally, sometimes a person thinks their pain stems from their lower back when it's actually simply referred there.

Example sources of referred pain include:

A Word From Verywell

On a final note, it's important to mention that while low back pain is one common MS-pain syndrome, people with multiple sclerosis may experience other types of pain as well like:

To complicate matters, some people experience low back pain that stems from more than one source (for example, MS and another health problem like a muscle strain from an injury or sciatica). Or they experience what doctors call "mixed pain," meaning more than one MS process is causing their discomfort.

Overall, be reassured that together you and your doctor(s) can find ways to help you feel better, both physically and mentally. It may take a little patience and some trial and error on your part, but a correct diagnosis and successful treatment plan can be made.

Sources:

Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012 Feb 15;85(4):343-50.

Foley et al. Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis. Pain. 2013 May;154(5):632-42.

Maloni H. (2016). National MS Society: Pain in Multiple Sclerosis.

Truini A, Barbant P, Pozzilli C, Cruccu G. A mechanism-based classification of pain in multiple sclerosis. J Neurol. 2013 Feb;260(2):351-67.

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