When Back or Neck Pain Might Be Osteoarthritis

By Anneke Smith

Maybe you overdid it cleaning the house or sprucing up your garden this weekend. Or you’re using a hot or cold pack on your lower back more often over the past few months. Does the pain come and go or seem to be getting worse? If the pain is getting worse or bouts become more frequent, it might be time ask your doctor if you have osteoarthritis (OA) in your spine (that runs from the neck to the lower back).

As you age, the cartilage lining the joints of your spine wears down, allowing the bones to rub together, causing back pain and stiffness. Other causes of spinal OA include injury, infection, obesity or repeated stress (due to some work or sport activities). You’re also more likely to develop back pain related to osteoarthritis if a close relative had it. OA can form in any part of your spine and is sometimes called spondylosis.

But how do you know the difference between run of the mill back pain and osteoarthritis?

Is It Osteoarthritis?

The pain from back OA is different from muscular or mechanical back pain, which is the type of back pain most people experience. Mechanical back pain can affect anyone at any age, while back OA generally affects adults older than 50 years. Mechanical pain is considered acute pain and is usually short-lived compared to inflammatory or degenerative back pain or OA, which is considered chronic (long-lasting).

“Ninety percent of acute back pain is reversible in the first six weeks and is usually related to musculoskeletal causes such as muscle spasms, bulging discs, pinched nerves and so on,” says Mondira Sengupta, MD, assistant professor of medicine at Rush Medical College and attending physician at Rush University Medical Center in Chicago.

Spinal OA can cause back or neck pain. It’s usually worse in the morning, after activity, or after sitting for a long time. It can come and go, and lying down often makes it feel better. Despite a reduction in pain, lengthy periods of inactivity can cause increased stiffness, tenderness and loss of movement.

Along with loss of cartilage, OA also causes formation of bone spurs called osteophytes. These osteophytes can pinch nerves as they leave the spinal column, causing pain, tingling, or numbness to radiate down your arms or legs (called sciatica). The pain and inflammation from these pinched nerves can cause sleep problems.

Osteophytes can lead to a more serious condition called spinal stenosis in which the spinal cord is pinched. Another spine condition related to OA is degenerative disc disease, in which the effects of aging reduce the space between the discs, leading to lower back pain.

Diagnosing Spinal OA

It’s sometimes hard for a doctor to figure out the cause of back pain because it can come from your muscles, bones, discs or nerves.

“It’s a general truth in rheumatology that changes on spinal X-rays do not necessarily correlate with a patient’s symptoms,” remarks Dr. Sengupta. “This can make it difficult to determine the cause of a patient’s back pain. A comprehensive physical exam and detailed medical history can often reveal the reason for a patient’s back pain.”

Your doctor may also order MRI or CT scans, which can reveal damage in soft tissues like cartilage, nerves, ligaments and discs.

Common OA Treatments Work for Back Pain, too

Treatment for back OA is similar to any treatment plan for osteoarthritis in other joints. The multi-tiered approach may include physical therapy and exercise, weight management, medications and complementary therapies, such as acupuncture, massage and hot and cold therapy. Joint surgery is a last resort.

Dr. Sengupta emphasizes the benefits of physical therapy in treating back pain and spinal OA. “It really helps alleviate pain when patients go to a physical therapist who is trained to evaluate body mechanics and then recommend targeted exercises tailored to the patient’s needs. Aerobic exercises are great for weight loss, which is beneficial, but I believe core strengthening is even more important,” notes Dr. Sengupta.