Spinalogy Blogs

Back pain commonly happens due to conditions like degenerative disc disease, osteoarthritis, scoliosis, infections ,etc. It can also occur due to improper posture, prolonged sitting, heavy lifting or any kind of trauma. It can possibly happen due to muscle tension or strain because of uncomfortable strenuous activities.

The bones, ligaments, discs, and nerves make up our spine. It might be difficult to determine the precise cause and origin of pain because of all these factors. It's possible that the root of your back discomfort is not where you experience it. Anatomical structures such as the lower back muscles, vertebral joints and bones, intervertebral discs, spinal nerve roots, and/or abdominal organs might all have issues.

Generally, to rule out the exact cause of back pain, imaging techniques like X-rays, MRIs are prescribed. X-ray gives details about the bony structures, whereas MRI gives details about the anatomical structures of the spine. This helps physicians to rule out the exact cause of pain. But sometimes Imaging is normal, but the patient still experiences excruciating pain. Normal imaging doesn’t always mean No Pain. There could be various hidden causes of back pain that can’t be found out on imaging.

Neuropathic back pain can occur when your nerves send your brain incorrect pain signals. Back pain can be caused by psychological issues such as stress, worry, sadness, and fear. Both the beginning of pain and the development of chronic pain may be impacted by all these factors, which cannot be shown on imaging. Pain due to herniated disc, spinal canal stenosis, scoliosis, spondylosis, etc., can be ruled out with the help of imaging techniques. If imaging is normal but still pain persists, a physician might go for other options to rule it out. 

The following might be the reason for back pain that can’t be detected on imaging.

Fibromyalgia: Although physical trauma has been recognized as a potential trigger, the precise causes of many persistent discomforts like fibromyalgia are still unknown. Despite influencing the patient's everyday functioning, this "invisible" but crippling disorders frequently go undetected on diagnostic imaging because they lack a recognizable anatomical hallmark.

Chronic Pain Syndrome (CPS): It is a condition of persistent pain that lasts more than 3 months. It is a complex condition that involves psychological, biological, and social factors. Types of CPS are myofascial pain syndrome, complex regional pain syndrome, chronic fatigue syndrome, etc. It is challenging to diagnose chronic pain syndrome as the roots of CPS is difficult to find.  

Pregnancy-Related Pain:

• Hormonal Changes: Pregnancy hormones such as relaxin cause ligaments and joints, particularly in the pelvic region, to relax, which can cause pain and instability.
• Weight Gain: The spine and back muscles are strained by the additional weight of the developing foetus and uterus, which may lead to back pain.
• Changes in Gravity Centre: Your centre of gravity changes as your uterus expands, which can cause posture issues and back discomfort.
• Uterine enlargement: Back pain may result from muscle separation brought on by uterine enlargement. The uterus extends to the bottom of the rib cage from the pubic area, which can strain back muscles as well.
• Weakening of Abdominal Muscles: During pregnancy, the abdominal muscles weaken and stretch, which can lead to back pain and bad posture.

Piriformis syndrome: Referred back pain due to piriformis muscle occurs due to muscle tightness, overuse, trauma, or weakness of the muscle.  This pain may be felt in the low back or radiating pain in the lower limbs, but the real problem could be piriformis syndrome, which is causing discomfort. This can be missing on Imaging as it can’t be detected on MRI or X-ray.

Renal Calculi: Particularly when a kidney stone lodges in the ureter and obstructs urine flow, it can start with excruciating, acute pain and cramping in the flanks and back that may spread to the lower part of the abdomen and groin region. 

Hernia: Hernias are typically associated with pain in the bulging area (like the groin or abdomen); in some cases, they can cause or contribute to back pain.

• Large or strained inguinal hernia: It can cause lower back discomfort because it alters posture or gait, however, they are mostly linked to groin pain.
• Femoral Hernia: Femoral hernias can also have an indirect effect on the back because of their proximity to the thighs and lower abdominal region. This can result in changes in posture or gait that cause back pain.

Depression, PTSD, and Other Mental Health Conditions:

Accident-related emotional and psychological damage can be just as detrimental as physical injuries, despite not being visible on MRIs. Pain symptoms may be inwardly invisible in conditions like post-traumatic stress disorder (PTSD) and depression/anxiety brought on by an accident.

Cluneal Neuralgia:

Cluneal neuralgia involves irritation or entrapment of the superior, middle, or inferior cluneal nerves that supply sensation to the skin over the buttocks. Patients often complain of burning or stabbing pain over the lower back, buttock, mimicking low back pain. This condition is commonly missed due to normal MRI or X-ray findings. It may worsen with prolonged sitting, bending, or pressure over the gluteal region.

Meralgia Parasthetica:

Meralgia paresthetica results from compression of the lateral femoral cutaneous nerve, leading to numbness, tingling, or burning pain in the outer thigh. It is often linked to obesity, tight belts, pregnancy, or prolonged standing. Despite its superficial sensory nature, the discomfort can be distressing and misinterpreted as lumbar radiculopathy. Normal spine imaging further delays recognition.