As I am sitting here on this toasty day, I am experiencing a stabbing pain in my lower mid-back that radiates around to the ribs on my right side. This pain has been my companion for the last three days. Like most pains it seems much stronger at night as there is nothing to distract me from the stabs and jabs of discomfort.
Years ago when I first encountered this pain I thought I must have collapsed a vertebra or blown a disc somewhere around the 8th or 9th thoracic vertebra. I ordered x-rays on myself, but nothing showed up. This was good news because I at least knew some nasty cancer was not eating its way through my spine, but it did not help me locate the cause of the pain. If I were a typical doctor I would chalk it up to some soft tissue damage or joint inflammation (arthritis) and prescribe pain relievers and rest.
The problem is I had done nothing to injure the area. Joint inflammation would have no reason to hit that area and not the adjacent areas around it. With the pain radiating around into the ribs it was obvious that the nerve root was inflamed. The next thing to do was to get the area in question adjusted to free up the nerve roots and mobilize the joints. This helped for a few hours, but the pain came right back by that night. I tried several more adjustments with the same results.
I figured that the inflamed muscles were spasming, and that that was yanking the vertebra out of place so I got a massage. Again the relief lasted a couple hours and then the pain came right back. I was running out of options and my lack of sleep was impairing my ability to function. Hot packs and cold packs had about the same effect. Stretching and lying on tennis balls sent the pain levels through the roof. I am not one of those “no pain, no gain” type people, so one try on the tennis balls was it for me. I was ready to try to get trigger point injections to unlock the pain.
Finally, I used some Biofreeze gel on the area to block the pain… and it did nothing. This was a big clue. The fact that it did nothing meant that the pain was not coming from where I was feeling the pain. Biofreeze gel uses a process called counter-irritant therapy which works because the brain will listen to the large A nerve fibers from the skin when they are signaling and block the messages from the smaller c nerve fibers that carry pain signals in the tissue right under the skin. This is how TENS therapy works. Since the therapy was not working it meant that the deeper tissues under the skin where I felt the pain was not where the pain was actually originating from.
I had a referred pain!
A referred pain is usually a pain signal coming from an internal organ. The pain signal travels to the spine where it jumps to the next nerve that travels up to the brain to tell my brain that something is wrong with that organ. Often the signal jump at the spine hits more than just the nerves going up to the brain. It often also hits the reflex nerves to the spinal joints and the tiny muscles between the vertebra and causes them to spasm and create lots of secondary joint capsule and nerve root pain. The Chiropractic adjustments and massage I was getting would help break up the spasm and relieve the pain for a couple hours, but the source of the pain in the internal organ was still firing its pain messages, so everything would tighten right back up in no time.
So now the simple question was what organ feeds into the spine at the level I was feeling the pain? Well that particular part of the spine is where the nerves from the small intestine enter the spine. I was not feeling any particular small intestine pain so I started palpating my intestines. Sure enough, once I started pressing on the intestines I found plenty of painful spots. My gut was having an acute inflammatory episode and I didn’t even know it. But my back sure knew it.
This did not come as a great shock since I knew I had gluten intolerance, because where there is gluten intolerance there is always a ton of other food intolerances. I must have been eating some foods that were triggering an inflammatory episode in my gut, and now I was paying the price. All other grains as well as dairy are usually a problem, but I had been avoiding those. The only choice was to go on a really restricted diet and start taking a pile of gut calming nutrients like glutamine, aloe vera, DGL, alpha lipoic acid, zinc carnosine, and probiotics.
It took a couple weeks, but the restricted diet and supplements did their work. The back pain settled down and the gut tenderness on palpation went away. It has been a couple years now since I have had the stabbing back pains. My body is telling me that I have gotten too loose with my diet. I have had cheese several times this last month. I wanted to see if I was still reacting to it. I guess the answer is yes. Unfortunately once the gut gets riled up, it increases sensitivity to all sorts of other things. The inflammation causes holes to be torn in the gut lining and when that happens the immune system goes crazy trying to stop the flood of half digested proteins and bacteria that leak through the holes into the lymph and blood systems.
So now I am back on my glutamine and what not shakes and restricted to eating my bone broth vegetable stew. Hopefully the gut will settle down quickly and stop telling my mid-back to spasm.
I write about this lovely process, because every day I see patients who are experiencing referred pains to their spines. The most common is a referral to the low back when the colon or kidneys/bladder are inflamed. Usually they do not know that they have a problem in these areas. We seem to be good at ignoring discomfort in these areas. Other examples are pain between the shoulder blades or right shoulder from gall bladder inflammation, mid-back pain from pancreas, stomach, and hiatal hernia problems. Most everyone is aware of the left arm pain referral patterns from heart trouble in men, but women more commonly have pain referring to the mid and upper back.
I can adjust these pain situations in the spine, but they will keep coming back until the underlying actual cause is taken care of. Many of you have experienced me putting you on a low residue diet for Ileocecal valve and colon issues to help with your low back pain. Sometimes the instability caused by the referred pain can trigger a larger back problem, like sciatica, by destabilizing the supportive muscles in the low back. Then even once the originating cause on the organ level is healed, the back can be left with problems that resulted from relatively minor lifting or turning movements while it was unstable. These have to be resolved through correcting the spine. I may have to have some corrections made to my lower mid-back and ribs once I get my gut settled down.
When do I look for referred pain patterns? My first clue is when the patient says “But I didn’t do anything to cause my back to go out!” Once we eliminate too much sitting or work ergonomics as a cause, then I start looking for organ inflammation as the cause behind the back problem. So if your back seems to “go out for no reason,” this may be the reason. It takes a little more time and work to get these kind of back problems to settle down, but they do settle down.