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CAUSES OF CHRONIC BACK PAIN: ARTHRITIS
Arthritis is a common cause of chronic back pain. The type of arthritis most often related to back pain in general is osteoarthritis-often referred to as “wear-and-tear” arthritis, because it is more common as people get older or sustain injuries, Over years or after an injury, the cartilage between the joints of the lower back, spine, and hips wears away.
Osteoarthritis is a very common cause of chronic back pain, Osteoarthritis in the lower back can cause people pain and stiffness that worsen when they are standing and walking. You may have stiffness when you wake up in the morning and when you sit in one position for more than a few minutes. The pain does not usually travel down the legs. This form of arthritis may come on gradually and worsen over years. It may also worsen after injuries to the back.
Other types of arthritis can also cause chronic back pain. For example, one form of arthritis in the lower back, ankylosing spondylitis, especially affects young men.
A 25-year-old man recently came to see us because he had had pain and stiffness in the lower back for over eight years, and it was gradually worsening. On awakening in the morning, his back was stiff for about two hours; as he became more active, the stiffness decreased. He complained of milder aching in the shoulders and hips and noticed more pain when he sat at h{S office desk for prolonged periods of time.
The young man was found to have ankylosing spondylitis after x-rays showed typical changes in the lower back and cr0iliac joints. He began The 2-Week Plan for Relief and over a few months noticed less pain and stiffness. He also found that his energy level increased. He now continues with a regular exercise program and a non-cortisone anti-inflammatory drug (NSAID) for treatment of the arthritis.
Ankylosing spondylitis comes on gradually. By the time help is found, the condition has usually been present for months or years.
In this type of arthritis, the joints of the lower back-the sacroiliac joints and joints of the lumbar spine-become inflamed. Inflammation most commonly begins during the teen years and up to age 30. The pain may come and go at first and is often thought to be due to a strain or an injury. After a while, the pain stays and gradually worsens.
On arising in the morning, there is usually stiffness in the back that lasts a few minutes to several hours; there may be fatigue as well. Prolonged inactivity usually causes more pain and stiffness in the back. This type of arthritis is different from most back injuries, for which inactivity usually helps the pain.
With ankylosing spondylitis, there may be pain and stiffness in other areas, such as the shoulders, hips, or other joints. After a few years, there may be pain in the middle or upper part of the back. There may be a gradual stiffening of the spine and, eventually, of the neck.
Diagnosis of ankylosing spondylitis is usually made after discussion, examination, and evaluation of x-rays of the back. Other tests can be helpful. Proper treatment is especially important (and very effective) in prevention of deformity of the spine.
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