# Back Pain and IBS



## eric (Jul 8, 1999)

FYINovember 2004 ï¿½ Volume 127 ï¿½ Number 5 Back pain and irritable bowel syndrome ï¿½ Previous article in Issue ï¿½ Next article in Issue ï¿½ View print version (PDF) ï¿½ Drug links from Mosby's DrugConsult ï¿½ Genetic information from OMIM ï¿½ Citation of this Article ï¿½ View on PubMed ï¿½ Download in citation manager format ï¿½ Download in Medlars format ï¿½ Related articles in PubMed Dear Sir:In the June issue of GASTROENTEROLOGY, Longstreth and Yao1 drew attention to an excess of cholecystectomy, appendectomy, hysterectomy, and back surgery in patients with irritable bowel syndrome (IBS). Various explanations were offered in both the paper and the accompanying editorial2 but relatively little attention was given to why patients should have an excess of back surgery.In 1986, we showed that patients with IBS suffer from a wide range of disparate symptoms not necessarily of a gastrointestinal nature.3 These included gynecological and urological complaints but it was also particularly noteworthy that backache was extremely common, occurring in 68% of individuals. In subsequent publications we found the figure to be even higher at 75%4 and 81%.5 Furthermore, patients reported that this symptom was especially intrusive4 and we demonstrated that it also had good discriminant value in helping to substantiate the diagnosis of IBS,5 and in differentiating it from other gastrointestinal disorders. I was therefore slightly surprised that none of these data were quoted, especially as they do suggest a possible reason why patients with IBS might be referred to an orthopedic surgeon for an opinion.We routinely enquire about low backache in our IBS clinic and a large proportion of patients will admit to having this symptom. However, they usually go on to say that they have previously consulted their doctor about this problem who has told them they have some form of degenerative disease of the spine, especially if a subsequent x-ray shows an degree of ï¿½wear and tear,ï¿½ even if only mild. We have also noted an excess of back surgery in our patients, which seldom proves to be helpful, although we have not published this finding.It is my view that this backache does not originate from the spine and is possibly attributable to some form of referred pain from the gut. My reasons for coming to this conclusion are because it is not accompanied by any physical signs suggesting spinal pathology, it seldom gets worse with time, it often mirrors the course of the IBS in terms of its severity, and lastly, once this relationship has been pointed out to the patient they cease being so bothered by it and subsequently even notice for themselves, that there is a relationship to their gastrointestinal symptoms.The noncolonic symptoms of IBS are a major problem and a constant source of diagnostic confusion and inappropriate treatment6 although the gynecological consequences are now better recognized.7 Nevertheless, if they were sought after and understood earlier in a patients encounter with the medical profession, much inappropriate investigation and referral could still probably be avoided. It is my experience that patients cope surprisingly well with these troublesome symptoms once they appreciate that they are linked to their IBS and are not indicative of some underlying pathology that is being overlooked.P.J. Whorwell aaEducation and Research Centre, Wythenshawe Hospital, Manchester, EnglandReferences1. Longstreth GF, Yao JF. Irritable bowel syndrome and surgery: a multivariable analysis Gastroenterology 2004;126:1665-1673. MEDLINE ABSTRACT FULL TEXT 2. Talley NJ. Unnecessary abdominal and back surgery in irritable bowel syndrome: time to stem the flood now? Gastronterology 2004;126:1899-1903. 3. Whorwell PJ, McCallum M, Creed FH, Roberts CT. Non-colonic features of irritable bowel syndrome Gut 1986;27:37-40. MEDLINE 4. Maxton DG, Morris JA, Whorwell PJ. Ranking of symptoms by patients with the irritable bowel syndrome BMJ 1989;229:1138-1139. 5. Maxton DG, Morris J, Whorwell PJ. More accurate diagnosis of irritable bowel syndrome by the use of ï¿½non-colonicï¿½ symptomatology Gut 1991;32:784-786. MEDLINE 6. Azpiroz F, Dapoigny M, Pace F, Muller-Lissner S, Coremans G, Whorwell PJ, Stockbrugger RW, Smout A. Nongastrointestinal disorders in the irritable bowel syndrome Digestion 2000;62:66-72. MEDLINE 7. Whorwell PJ. Abdominal pain In Pain in Obstetrics and Gynaecology, eds A.B. Maclean, R.W. Stones, S. Thornton. London: RCOG Press; 2001209-213. http://www2.us.elsevierhealth.com/scripts/...017408&nav=full


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