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Final Program


Final Program

925 - Chronic Back Pain as a Manifestation of Demyelinating Disease

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • NP

    Nikit Patel, DO

    Resident Physician
    Jefferson Moss-Magee Rehabilitation Hospital
    Philadelphia, Pennsylvania, United States

    • Co-Author(s)

  • AM

    Alyssa Marulli, md

    Assistant professor, Department of PM&R
    MossRehab, Thomas Jefferson University
    elkins park, Pennsylvania, United States

Case Diagnosis: This report presents a case of chronic back pain as a symptom in a 49-year-old male with a demyelinating disease, likely multiple sclerosis (MS). 

Case Description: This patient with history of lumbar discectomy presented with a 2-year history of bilateral low back pain, worse with standing, and radiating in an L4 distribution. His pain was managed with gabapentin and ibuprofen. He completed multiple therapy courses and used a cane up until requiring a rollator walker prior to presentation. Physical exam revealed lumbosacral junction tenderness, decreased cervical and lumbar extension, slowed rapid alternating hand movements worse on the right, positive Rhomberg, and negative Spurling's and slump tests. Cervical-spine MRI showed spondylotic changes at C6-C7 with spinal stenosis abutting the central cord. At one month follow-up, he had new neck pain with left arm numbness. Follow-up exam revealed 3+ reflexes, bilateral clonus worse on the right, and positive Hoffmann's sign worse on the left. MRI brain showed concern for demyelinating disease. At this time, he noted MS in an aunt and was referred to Neurology for further workup.

Discussions: Chronic back pain is a common musculoskeletal complaint amongst patients. However, its association with central nervous system pathologies may be overlooked. In multiple studies, prevalence of back pain in MS patients ranged from 16.8% to 20%1,2. Pertinent family history and thorough neurological examination are crucial in identifying neurological causes of chronic back pain. If suspicion for demyelinating conditions is high, MRI imaging should be obtained.

Conclusions: This case highlights the importance of recognizing chronic back pain as a symptom in demyelinating conditions. Treating back pain in MS patients is important to reduce disability, enhance quality of life and improve overall patient outcomes.