GI System Causes of Low Back Pain

NSAID-Induced Gastropathy or Impairment

    Non-steroidal anti-inflammatory drugs (NSAIDs) can have harmful effects on the entire GI tract ranging from the esophagus to the colon. Most people with NSAID-induced GI impairment can be asymptomatic until the condition is advanced. For those people with symptoms, the most common side effects are stomach upset and pain which can potentially lead to ulceration. Gastrointestinal complications of NSAID use can include ulcerations, hemorrhage, perforation, stricture formation, and exacerbation of inflammatory bowel disease. The risk factors along with clinical signs and symptoms of NSAID-induced gastropathy or impairment are listed below.


Risk Factors

  • Advanced age
  • History of peptic ulcer disease
  • High does of, or the taking of, multiple anti-inflammatory drugs or aspirin (either prescribed or as self care with OTC products)
  • Use of anti-inflammatory drugs and aspirin within the past week
  • Use of other drugs known to damage or exacerbate damage to the GI tract
  • Serious systemic illness
  • Smoking (any amount)
  • Alcohol Use


Signs and Symptoms

  • Asymptomatic
  • Upset stomach and pain
  • Indigestion, heartburn
  • Skin reactions (itching, rash, acne)
  • Tinnitus (ringing in the ears) 
  • CNS Changes (headache, depression, confusion, memory loss, and mood changes)
  • Renal Involvement (muscle weakness, unusual fatigue, restless leg syndrome, polyuria, nocturia, pruritus, and increased blood pressure)
  • New onset of back or shoulder pain
  • Pain relief after eating food
  • Melena



Crohn's Disease

    Crohn's disease is an inflammatory disease that mostly attacks the distal end of the small intestine and colon. It can however occur anywhere along the alimentary canal from the mouth to the anus. Musculoskeletal manifestations occur in 20-25% of patients with an inflammatory bowel disease (IBD) such as Crohn's disease, with spondylarthropathy being the most frequent extra-intestinal complication. The clinical spectrum of spondylarthropathies include axial symptoms, peripheral arthritis, dactylitis, and enthesopathy. Axial involvement can range from isolated inflammatory back pain to ankylosing spondylitis. Diagnostic criteria according to the European Spondyloarthroapthy Study Group (ESSG) is 75% sensitive and 87% specific  in identifying inflammatory spinal pain in those with established disease (Table 1). An alternative classification system that gives improved sensitivity (85%) and specificity (90%) can be found in Table 3. The risk factors for Crohn's Disease and signs and symptoms of low back pain associated with Crohn's Disease are listed below.


Risk Factors

  • Genetic link/family history
  • Perinatal infection (viral>bacterial)
  • Prior episode of gasteroenteritis
  • Smoking


Signs and Symptoms

  • Migratory arthralgias
  • Low back, sacral, or hip pain as a new symptom of an already established disease
  • Symptoms that are difficult to localize
  • Insidious in onset
  • Frequently monolateral and intermittent symptoms at onset
  • More intense at rest
  • Associated with stiffness but relieved by movement
  • Exacerbated by cough or sneezing
  • Accompanied by fatigue