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Do You Suffer From Lower Back Pain?

March 15, 2011

Rheumatologist Will Discuss the Role of Inflammation at Upcoming Seminar

If you suffer from lower back pain, you are not alone. Lower back pain is second only to the cold as the most common ailment among adults, according to the American College of Rheumatology. In addition, lower back pain disables 5.4 million people in this country and costs about $90 billion in medical care and lost productivity each year.

"It’s important to know the cause of your back pain," said Dr. Barry Shibuya, a rheumatologist and member of the Washington Hospital medical staff. "Ninety percent of cases are associated with overuse of the back or spine, what we call mechanical causes. But the other 10 percent are non-mechanical, caused by a systemic problem."

Shibuya will be the featured speaker at a Washington Hospital seminar titled: "Oh My Aching Lower Back" on Tuesday, March 22, from 1 to 2:30 p.m. The free seminar will be held at the Conrad E. Anderson, M.D. Auditoriums, located at 2500 Mowry Avenue (Washington West) in Fremont. You can register online at www.whhs.com or call (800) 963-7070.

He will talk about the non-mechanical systemic causes of back pain, which could include osteoporotic conditions, cancers or infection of the spine, and spondylitis. Spondylitis is the term for a group of chronic diseases that result from inflammation of the spine. He said ankylosing spondylitis is the most common type.

Shibuya said it’s important for people to understand how to categorize their back pain. He said one of the first indications that back pain is not mechanical is that it doesn’t go away in a few weeks or months. Mechanical back pain should resolve itself in six to eight weeks, he added.

"When back pain and stiffness are worse after periods of inactivity, that indicates inflammation is at work," he said. "The pain tends to improve with stretching and warm showers. Sometimes, back pain from inflammation can actually wake people up in the middle of the night because of the inactivity."

According to Shibuya, symptoms of spondylitis generally start before age 40. Like other inflammatory diseases, the disease process is the result of an overactive immune system.

Medical History Needed for Accurate Diagnosis

"It’s important for doctors to know your complete medical history because this disease process drives a number of related illnesses that can present themselves differently," Shibuya said. "When I see patients with chronic lower back pain, I ask them if they have a number of other problems they might not know are related. Sometimes they wonder why I’m asking about their skin or eyes, but it’s necessary for an accurate diagnosis."

For example, psoriatic arthritis affects some people who have psoriasis, a skin condition that features red patches of skin topped with silvery scales. Some people can develop spondylitis as a result of psoriatic arthritis, he said.

Inflammatory bowel disease (IBD) can also be related to arthritis, according to Shibuya. IBD is a general term that includes ulcerative colitis and Crohn’s disease.

"Patients often think they need to have severe abdominal pain to have IBD, but that’s not always true, especially for people who have related arthritis," he said.

Iritis and uveitis are inflammatory eye diseases that can also be related to spondylitis, Shibuya said. Symptoms include slightly red or pink eye and watery or teary eyes.

He will also talk about reactive arthritis, which is usually caused by an infection in the gut or urinary tract. In some cases, the immune system overreacts to the infection, causing inflammatory arthritis. According to Shibuya, about 80 percent of reactive arthritis cases resolve themselves within six to nine months, but about 20 percent can go on to be chronic."

"It’s so important to have your back pain properly diagnosed because chronic inflammation can manifest in so many ways," he said. "Chronic inflammation in the blood can also increase your risk for heart attack and stroke."

Shibuya will also talk about treatments that are available for spondylitis and chronic inflammation. Some anti-inflammatory medications that are available only work on peripheral joints like the hands, feet, and ankles, he explained. But there are newer anti-inflammatory drugs available now that are more effective for the back, hip and shoulder.