Mark W. McFarland, DO
When back pain shifts and does not seem to stay in one specific location, it can be particularly confusing and worrisome. “What’s causing it and how do I treat it if it won’t stay in one spot?” is a question I often hear from patients. This nomadic pain phenomenon is not uncommon, and there are many reasons why you may feel pain move around to different locations in your back and/or neck.
To comprehend the dynamic nature of neck and back pain, an anatomy review may be helpful. The spine is a very complex structure composed of bones (vertebrae) stacked one upon another in a column, intervertebral discs that act as cushions between those vertebrae, and muscles, ligaments, and tendons supporting the spine and assisting with movement.
Then we have the spinal cord, through which all of the brain’s instruction and requests for feedback must flow. Out of the spinal cord come numerous nerve roots that control sensation and movement to the organs, limbs, skin, etc. It’s no wonder that this intricate system of systems occasionally has a glitch, resulting in nomadic pain. Let’s demystify the causes for this traveling pain, and how best to address it through proper diagnosis and treatment
Muscle Strain and Sprain
Overuse, injury, overstretching, poor posture, or sudden movements can lead to muscle strains and ligament sprains. Inflammation and pain may radiate and refer to other areas of your neck and/or back. As your body adjusts and compensates with new movement and posture to protect the injured area, secondary nomadic pain may develop in one or more areas. This is commonly seen in this type of injury.
Degenerative Disc Disease
Degenerative disc disease is another issue that causes nomadic pain. Intervertebral discs act as cushions between the vertebrae. As the discs wear down or degenerate over time, inflammation, spinal instability and radiating or shifting pain can occur, especially if nerve roots are irritated or compressed. Pain may then radiate along the path of the affected nerve(s), as in a condition known as sciatica. A herniated disc in the lower back, for example, can compress the sciatic nerve, causing pain to radiate down the leg. Disc issues in the neck can lead to pain radiating down the arms.
Facet Joint Dysfunction
The facet joints, small joints which connect the vertebrae to one another and enable movement, can also be a source of nomadic pain. Inflamed joints can result in pain that moves from one side of the spine to the other. Often worsened by certain movements or positions, it may seem like the pain is constantly changing locations. Arthritis or injury to these joints can cause localized pain to refer to adjacent areas.
Myofascial Pain Syndrome
Myofascial pain syndrome involves trigger points (small knots) within the muscles that are often tender to touch and can refer pain to other areas. The neck, shoulder and upper back are primo spots to find trigger points, although they can be found all over the body in muscle tissue in some people.
Referred Pain
Pain felt in one area of the body isn’t actually due to a problem in that location but referred from an issue elsewhere in the body. Classic examples are an inflamed gallbladder, a bad hip joint, or a raging kidney infection that can cause severe back pain. Competing nerve signals confuse the brain, leading to pain that seems to move around.
Nerve Compression
Also known as radiculopathy, occurs when nerves originating from the spinal cord are pinched or irritated. Pain travels along the path of the nerve and can vary in intensity and shift depending on movement of the body. Nerves typically don’t compress themselves and their pinching is caused by disc degeneration, herniation or bulging, bone spurs, spinal stenosis due to arthritic changes, etc.