Have You Been Diagnosed With
Back Arthritis?

Arthritis pain can come in many forms and back arthritis is one of them. If you’ve been diagnosed with arthritis of the back, you’ll want to arm yourself with information. What exactly is back arthritis? What are the best treatment options? Will surgery be necessary?



What is Back Arthritis?

spinal anatomy

The spine is comprised of a variety of structures. The vertebrae provide the bony structure of the spine while the discs separate the vertebrae and help to provide cushioning and allow for normal movement.

Arthritis in general means inflammation of the joint. In the spine, this arthritis can come in a number of forms. Each vertebra is connected to the one above and below via facet joints. These joints, like other joints of the body can become arthritic leading to facet joint pain. The diagnosis of back arthritis can implicate these joints.

Another condition associated with arthritis in the back is degenerative disc disease. The intervetebral discs that separate each vertebra are hydrated or filled with fluid. As we get older, or if we have sustained a herniated disc, the fluid in these discs can diminish, resulting in a flattened disc. A severe form of this disc thinning is degenerative disc disease.

In addition, without the height of the disc, the space in which the nerves exit the spine can become more narrowed. This narrowing can result in the nerve root becoming pinched. This condition associated with the narrowing of the nerve space is called spinal stenosis.

This combination of the lack of disc cushioning, the vertebra and facet joints become compressed and inflamed, and the nerve space becoming more narrowed can all be associated with and diagnosed as arthritis in the back.


Typical Signs and Symptoms

Most commonly those with degenerative changes in the spine will experience back and or leg pain. Frequently the symptoms will be aggravated with standing, walking, and moving from sitting to standing. Symptoms are generally relieved with bending or sitting.

It is not uncommon for symptoms to be worse upon first waking up in the morning. Inflammation in a way is like honey; when honey sits on the shelf it becomes rigid but once stirred becomes more flexible. Inflammation is similar in that when we are at rest for a prolonged period of time (such as overnight when sleeping) the inflammation becomes rigid making the joint stiff. With repetitive movement the natural lubricant of joints called synovial fluid helps the inflammation to become more flexible and the joint less stiff and painful. Thus, for the first 30 minutes after waking up in the morning the joints feel stiff and painful but after moving around these symptoms improve.


Typical Treatment

low back pain

Of course there is not a cure for arthritis but there are treatments that are effective in minimizing symptoms. Typical treatment options include medication, injections, and physical therapy.

Anti-inflammatory medication is the most commonly prescribed medication for back arthritis. Types can include NSAIDS such as ibuprofen. One of the complications with this type of medication is stomach upset. Another type of anti-inflammatory is a class of medication called cox-2 inhibitors. These medications work to relieve inflammation but have less irritation on the stomach. The most common medication in this class is Celebrex.

In addition to medication, arthritis supplements may be helpful in reducing back pain related to arthritis. Research indicates that taking 1200 mg of Omega-3 (fish oil) is an effective alternative to NSAIDS in the treatment of back pain. Being that fish oil does not have the side effects associated with NSAIDS (namely stomach upset), fish oil may be more appropriate choice for many.

If oral medication is not helpful, cortisone injections, called epidurals, are generally the next step. For those experiencing significant pain and or nerve involvement, this treatment option can be very effective.

As part of an overall treatment plan, physical therapy is a must. Numerous research studies have found that exercise is extremely valuable in reducing chronic back pain. Yoga, Pilates, and general exercise programs are all supported by research. A physical therapist can help determine the most effective exercise plan for your low back condition.

For those who have gone through a long course of conservative treatment and continue to have significant symptoms, surgery can be an option. The typical procedure for degenerative disc disease or spinal stenosis is a spinal fusion. Undergoing surgery should always be a last option and come after seeking a number of opinions.


Summary

• Back arthritis is often associated with degenerative disc disease, spinal stenosis, and facet arthritis.

• Symptoms are generally aggravated with standing, walking, and transition movements with pain being worse in the morning.

• Treatments include medication, supplements, exercise, injections, and at worst surgery.

Back arthritis does not have to be debilitating. Seek help from a qualified orthopedic or neurosurgeon that specializes in the spine to get a specific diagnosis. Working with the health care professionals by developing and following through with the recommended treatment plan will give you the best opportunity to get you out of pain and back to the activities you enjoy.


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References

AAOHN J. 2011 Aug;59(8):355-61; quiz 362. doi: 10.3928/08910162-20110718-01. Epub 2011 Jul 25.Yoga to treat nonspecific low back pain.Carter C, Stratton C, Mallory D.

J Orthop Sports Phys Ther. 2011 Feb;41(2):70-80. Epub 2010 Oct 22.Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis.Lim EC, Poh RL, Low AY, Wong WP.

Best Pract Res Clin Rheumatol. 2010 Apr;24(2):193-204.Exercise therapy for chronic nonspecific low-back pain.van Middelkoop M, Rubinstein SM, Verhagen AP, Ostelo RW, Koes BW, van Tulder MW.

Spine J. 2008 Jan-Feb;8(1):70-9.Evidence-informed management of chronic low back pain with herbal, vitamin, mineral, and homeopathic supplements.Gagnier JJ

Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.Maroon JC, Bost JW.


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