Back pain is one of the most common complaints in medicine. For most people, it’s caused by something mechanical—disc degeneration, a pinched nerve, or muscle strain. But sometimes, the cause isn’t physical at all. I had a patient whose back pain defied every explanation—until we found an answer where no one had thought to look: Lyme disease.

Surgery and Rehab: A Promising Start

My patient had a long history of lower back pain. After struggling with it for years, he underwent back surgery and engaged in a dedicated course of physical therapy. For the first time in years, he was pain-free. He felt like he had his life back. He returned to daily activities, enjoyed time with his family, and was finally free from the constant burden of discomfort.

The Pain Returns—Worse Than Before

Months later, his pain came back.

But this time, it was different. It was severe, deep, and unrelenting. He hadn’t lifted anything heavy. There was no trauma. His physical therapy routine had remained consistent. Yet the pain—centered in his lower back—grew worse by the week.

He returned to his neurosurgeon. Imaging showed no new issues—no disc herniation, no surgical complications, nothing to explain the pain.

A 9-Month Search for Answers

He was referred to pain management. Tried anti-inflammatories. Tried physical therapy again. Tried trigger point injections. Nothing helped. The pain was taking a toll—physically, emotionally, and socially. He couldn’t sleep well. He avoided movement for fear of worsening his pain.

For nine months, every path led to a dead end.

No Tick Bite. No Rash. But Something Was Off

What made this case even more puzzling was the absence of any red flags we usually look for with infections. There was no tick bite, no erythema migrans rash, and no fevers. Lyme disease wasn’t even on the radar.

But other symptoms began to appear—fatigue, low mood, brain fog, and a growing sensitivity to heat and cold. It no longer seemed like just a spine problem.

A Broader Workup—and a Surprising Diagnosis

Because his symptoms were no longer isolated to his back, we broadened the differential diagnosis. We tested for autoimmune conditions, neurologic disorders, and chronic infections.

That’s when a Lyme disease test came back positive—specifically, multiple IgG Western blot bands consistent with a late-stage infection.

The pieces started to fall into place.

How Lyme Disease Can Cause Back Pain

Lyme disease is caused by the Borrelia burgdorferi bacteria. While many associate Lyme with joint pain or flu-like symptoms, it can also cause inflammation of nerve roots—a condition known as radiculitis—which can feel exactly like sciatica or disc-related back pain.

In some patients, Lyme disease affects the central nervous system and causes neuropathic pain that does not respond to typical treatments like surgery or anti-inflammatories. And in late-stage Lyme, patients often do not recall any early signs of infection. Studies estimate that 30% or more of patients with Lyme disease never see the tick or develop a rash.

Treatment—and Recovery

Once diagnosed, my patient began antibiotic treatment tailored to neurological Lyme disease. Within a few weeks, his pain began to improve. Slowly but surely, the deep, burning back pain that had plagued him for nearly a year began to fade. So did the fatigue, brain fog, and other symptoms.

Within a few months, he was functioning well again—and back to enjoying his life.

What This Case Teaches Us

This case highlights something crucial: Lyme disease doesn’t always follow the rules.

• You don’t need to have joint swelling or fever.
• You don’t need a textbook presentation for it to be real.
• When conventional explanations fall short, it’s time to think more broadly.

Five key takeaways:

1. Chronic back pain may have non-mechanical causes.
   Not all back pain stems from disc problems or muscle strain. Sometimes the root cause is something unexpected—like a persistent infection such as Lyme disease.
2. A normal MRI doesn’t rule out a serious problem.
   Imaging can appear normal even when significant symptoms are present. Lyme-related nerve inflammation may not be visible on routine scans.
3. Failed back surgery syndrome may not always be surgical failure.
   When pain returns after a successful procedure, it may not be the spine at fault. An undiagnosed infection or inflammatory process could be the real culprit.
4. Pain that doesn’t respond to standard treatment deserves further    investigation.
   If physical therapy, injections, and medications fail, it’s time to look beyond conventional explanations and consider underlying systemic causes.
5. Lyme disease can cause neuropathic and radicular pain.
   Lyme disease can inflame nerve roots, creating symptoms that mimic sciatica or spinal disorders—without any visible structural damage.

When to Suspect Lyme Disease in Back Pain

Consider Lyme disease in patients with unexplained back pain when:

• Imaging doesn’t match the severity of the symptoms
• Pain worsens despite appropriate treatment
• There are neurologic symptoms (numbness, tingling, burning pain)
• Fatigue, brain fog, or mood changes are also present
• The patient lives in or has visited a tick-endemic area (Northeast, Midwest, or Pacific Northwest)

Final Thoughts: Look Deeper When Pain Persists

Lyme disease can mimic many conditions. This patient’s story reminds us that when the usual explanations fall short, we must keep asking questions and consider less obvious diagnoses.

Back pain is common. But if it’s unresponsive to treatment and comes with a set of symptoms that don’t quite add up, look deeper.

Because sometimes, it’s not the spine—it’s the infection you didn’t know was there.

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For more:

• https://madisonarealymesupportgroup.com/2022/12/07/lyme-meningitis-leading-to-low-sodium-shoulder-back-pain/
• https://madisonarealymesupportgroup.com/2022/06/29/case-report-severe-back-pain-in-child-caused-by-lyme-disease/
• https://madisonarealymesupportgroup.com/2021/01/07/severe-neuropathic-pain-due-to-lyme-podcast/