Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. It can cause a wide range of symptoms, including back pain. Back pain is a common symptom of MS, experienced by around half of people with the condition. The location of MS back pain can help identify whether it is related to MS lesions in the spinal cord or nerve roots versus general back pain unrelated to MS.
What Causes MS Back Pain?
MS back pain is often caused by damage and inflammation in the central nervous system. MS causes damage to myelin, the protective coating around nerve fibers. This damage interferes with signals traveling between the brain and spinal cord, resulting in symptoms like pain, numbness, and fatigue.
There are a few ways MS can directly cause back pain:
- Lesions in the spinal cord: Damaged areas, called lesions or plaques, can form anywhere in the central nervous system. Lesions in the spinal cord can irritate nerves and cause neuropathic pain.
- Nerve root irritation: Nerve roots exit the spinal cord and branch out to other parts of the body. Inflammation and damage to these nerve roots as they exit the spine can cause radiating pain, numbness, and tingling.
- Muscle spasms: MS can cause stiff, painful muscle spasms in the back.
- Posture changes: Weakness, balance issues, and muscle tightness from MS can alter posture, putting strain on the back.
MS back pain may also be caused or aggravated by factors unrelated to MS lesions, such as poor posture, overuse, arthritis, or disk problems. Distinguishing between MS-related back pain and other causes can help guide treatment.
Where Does MS Back Pain Occur?
MS back pain can occur in several locations, depending on its underlying cause:
Middle Back Pain
Middle back pain can indicate a lesion in the thoracic or upper lumbar region of the spinal cord. This can cause band-like pain across the mid back.
Lower Back Pain
Lower back pain is common in MS, often due to lesions in the lumbosacral spinal cord affecting the lumbar nerve roots. This can radiate into the buttocks, legs and feet. Disk problems, posture changes and muscle spasms can also cause lower back pain.
Upper Back Pain
Lesions in the cervical spinal cord are less common but can cause pain in the neck or upper back, along with nerve-related pain into the shoulders and arms. Poor posture and muscle tension can also contribute to upper back pain.
Localized Back Pain
Some people with MS experience pain in very specific areas, such as one side of the lower back. This can indicate irritation of a single nerve root where it exits the spinal column.
Widespread Back Pain
Diffuse, widespread back pain that moves around is another characteristic of MS-related back pain. This is often due to muscle spasms or overall inflammation rather than a single lesion.
Other Symptoms Associated with MS Back Pain
Since MS affects the central nervous system, back pain may occur alongside other neurological symptoms, including:
- Numbness, tingling or burning sensations in the back, legs, arms or torso
- Weakness or heaviness in the legs
- Problems with coordination, walking or balance
- Stiffness or tightness in muscles
- Bowel or bladder dysfunction
- Fatigue
- Cognitive changes
- Mood disorders like depression or anxiety
The location and severity of symptoms varies greatly among individuals with MS depending on where lesions develop.
Is My Back Pain Caused by MS?
There are a few factors that can help distinguish MS-related back pain from other causes:
- Pain with no clear mechanical cause: MS back pain may come and go or move around with no obvious source like injury, disk problems or muscle strain.
- Neuropathic features: Radiating pain, burning, tingling or numbness may signal MS lesion involvement.
- Associated MS symptoms: Back pain that occurs alongside fatigue, bladder changes, cognitive issues, or other known MS symptoms may indicate an MS exacerbation.
- Lesion on MRI: Imaging like an MRI can identify areas of demyelination and inflammation that may be causing pain.
However, it is important to keep in mind that back pain can have causes unrelated to MS, like arthritis, poor posture, or general wear-and-tear. A comprehensive evaluation by your MS doctor can help determine whether your back pain is directly associated with MS inflammation versus other factors.
How is MS Back Pain Treated?
Treatments for MS back pain focus on relieving symptoms while also addressing any underlying MS disease activity:
- Medications: Over-the-counter pain relievers, prescription neuropathic pain drugs, muscle relaxers, or steroids may help alleviate pain and inflammation related to MS lesions.
- Physical therapy: Stretching, strengthening exercises, hot/cold therapy, and massage can help reduce spasms, improve mobility, and manage symptoms.
- Posture correction: Braces, occupational therapy, or chiropractic care can address posture issues contributing to back pain.
- Disease-modifying therapy: Medications that slow MS progression and reduce flare-ups may prevent future lesion development.
- Alternative therapies: Some people find relief through acupuncture, yoga, meditation, or massage therapy.
A multidisciplinary approach including both conventional symptom management and MS disease therapy provides the best chance of long-term relief.
When to See a Doctor
It is important to discuss any recurring, worsening or severe back pain with your doctor to identify its underlying cause. Seek prompt medical attention if back pain occurs alongside:
- Loss of bowel or bladder control
- Sudden weakness or numbness in the legs
- Severe pain following injury
For those with MS, worsening back pain can signal a disease flare-up or new spinal lesion that may require steroids or other treatment. Ongoing management of back pain is key to preserving function and quality of life.
Conclusion
Back pain is a common symptom in multiple sclerosis that stems from spinal cord lesions, nerve inflammation, muscle spasms, and posture changes. It can occur in the upper, middle or lower back, and may radiate to other areas. Distinguishing MS-related back pain from other causes helps guide appropriate treatment, which may include medications, physical therapy, and disease-modifying MS therapy. Addressing back pain is an important part of managing MS symptoms and limitations.