Chronic Back Pain (Neuropathy)

Types of neuropathy in the back or spine

Neuropathic pain in the back or spine include:

• Cervical radiculopathy – chronic pain radiating down the arm
• Lumbar radiculopathy – chronic pain radiating down the leg
• Failed back surgery syndrome – pain that starts after surgery and persists

Causes of neuropathy in the back or spine

Although in some cases it is not possible to diagnose the exact cause of back or spine neuropathy, some causes include:

• Diabetes
• Regional pain syndrome
• Injury
• Infections
• Substance abuse 
• Exposure to toxins 
• Cancer

Risk factors for neuropathy in the back or spine

• Age — back or spine neuropathy is more common as you age and typically starts after age 30.
• Weight — being overweight puts excess stress on the back
• Improper lifting — using the back instead of the legs to lift heavy objects can increase your risk of developing back or spine neuropathy.
• Smoking — smoking can keep your body from delivering nutrients to the discs in the back.
• Psychological conditions — people who suffer from depression and anxiety have a greater risk of developing back or spine neuropathy.

Symptoms of neuropathy in the back or spine

Symptoms of back or spine neuropathy vary from case to case and person to person. Some people may have constant pain, and others may have pain that occurs periodically. Some patients may have pain that is triggered by a specific stimulus.

Typically, pain from neuropathy is categorized as follows:

• Cold, burning, deep pain
• Severe, electric, shooting, stabbing or sharp pain
• Persistent tingling, weakness and numbness
• Pain that travels from nerve path down to legs, hands or arms

Other symptoms of back or spine neuropathy include:

• Discolored skin that appears pink, red or blue (related to blood flow changes)
• Swelling
• Difficulty sleeping
• Depression
• Sensitivity to light touch 
• Low sensation to differences in temperatures

Diagnosis for neuropathy in the back or spine

Neuropathy in the back or spine can be diagnosed in a full medical exam with your primary care doctor or orthopedic physician.

Medical History
Your physician will take a full medical history to determine what your symptoms are, where they are located, when they occur and how severe they are.

Physical Exam
Your healthcare provider will do a physical exam to evaluate the back and spine for signs of back or spine neuropathy, as well as look for other potential causes for your symptoms. The doctor may check reflexes, strength of your muscles and ability to feel certain sensations.

Diagnostic testing
The primary care doctor may order a blood test, imaging test or nerve functioning tests.

• Blood tests are performed to detect vitamin deficiencies or abnormal immune function
• Imaging tests – a CT scan or MRI may be ordered to look for herniated discs, tumors or other abnormalities
• Nerve function tests – an electromyography can record electrical activity in the muscles that will detect nerve damage

Treatment for neuropathy in the back or spine

Early intervention is important to treat back or spine neuropathy in case more aggressive treatments are eventually needed. The goals of treatment for back or spine neuropathy is to manage the symptoms.

Nonsurgical treatments for back or spine neuropathies

Medications
Medications can relieve pain associated with back or spine neuropathy. Types of medications your doctor may prescribe include:

• Pain relievers and anti-inflammatory medications
• Anti-seizure medications
• Topical treatments
• Antidepressants

Therapies

• TENS therapy - transcutaneous nerve stimulation, where electrodes are placed on the skin and deliver a gentle electric current.
• Plasma exchange 
• Physical therapy - physical therapy can help improve strength in weakened muscles.

Surgical treatment for back or spine neuropathy

Surgery could be indicated if the back or spine neuropathy is caused by pressure on the nerves from something like a tumor. Surgery may be needed to reduce pressure on the nerve.

Recovery from neuropathy in the back or spine

Because neuropathy is a chronic condition, the symptoms may never fully go away and can occur periodically even years after the initial episode. It is important to work closely with your provider to develop a treatment plan that will relieve the symptoms of the condition.