Back Pain Mystery Solved… It Was Lyme Disease
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.
Clinical Insight: Back pain in Lyme disease may mimic disc disease or muscle strain, but in some patients it reflects a broader inflammatory, neurologic, or migrating pain pattern.
Back pain can be one presentation of Lyme disease and is discussed alongside other multisystem symptoms in our Lyme disease symptoms guide, where musculoskeletal, neurologic, and autonomic patterns are explained in context.
But sometimes, the cause isn’t structural at all.
After 37 years treating Lyme disease, I had a patient whose back pain defied every explanation—until we found an answer where no one had thought to look: Lyme disease, making it an often-overlooked Lyme disease symptom.
Back pain in Lyme disease is part of a broader pattern of chronic Lyme disease pain, where symptoms may involve nerves, joints, or muscles and do not always follow typical mechanical patterns.
This helps explain why Lyme disease pain behaves differently from common mechanical back pain, often fluctuating or appearing without a clear structural cause.
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.
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 symptoms
- Pain worsens despite appropriate treatment
- Neurologic symptoms are present such as numbness, tingling, or burning pain
- Fatigue, brain fog, or mood changes are also present
- The patient lives in or has visited a tick-endemic area
Clinical Takeaway
Back pain does not always follow mechanical rules. Lyme disease can inflame nerve roots (radiculitis), creating symptoms that mimic sciatica or disc-related pain without visible structural damage. When back pain is unresponsive to treatment and comes with symptoms that don’t add up—fatigue, brain fog, neurologic symptoms—consider a broader explanation.
Frequently Asked Questions
Can Lyme disease cause back pain?
Yes. Lyme disease can inflame nerve roots, producing back pain similar to disc-related or sciatic pain.
Why doesn’t Lyme disease back pain show on MRI?
MRI detects structural damage. Lyme-related inflammation may not appear on imaging.
Does Lyme disease back pain respond to treatment?
Yes. Many patients improve when underlying infection is treated.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I’d appreciate learning more about the connections between gynaecological health issues, bladder prolapse and late stage Lyme disease. Given how this disease has destroyed collagen in the skin which is the bodies largest organ; it certainly does not stop there. Chronic UTIs compounded by multiple uses of antibiotics to control infections, creates the perfect breeding ground for mold, whether ingested or environmental. How can late stage Lyme patients find any balance in treatment?
There have found retreatment has helped some patient get better based on the hypothesis that there is a persistent tick borne infection.
I avoided hysterectomy after being diagnosed with chronic Lyme. I never did antibiotics. My doctor used alternative methods and the symptoms I was having began to disappear. Symptoms that were bewildering to my gynecologist. I of course had other symptoms, but they weren’t aware of the connection. No blame to them, after all they were very good at their specialty. I had read another woman’s story online after I was diagnosed and her story was very similar to mine. I felt like I was reading my words. It helped me to understand that I was not alone and that what I was experiencing was very real.
I have patients who live with their chronic illness ascribing every symptom to something.
I had severe thoracic back pain for Years !!!! Excruciating!!!Night sweats , vision problems , fatigue , anxiety , depression. .Mood instability and intense anxiety . Went undiagnosed for years!!! Finally an infectious disease specialist ran testing for Lyme and I ended up with an Advanced case of Lyme . Treatment with long term antibiotics removed all my symptoms except for the vision problems . LD basically destroyed my ENTIRE life for years going undetected ! . Kudos to the Drs that listen to their patients and think ” outside the box”
This disease is Horrific !
You mentioned the western blot was positive. I am wondering if you did the initial antibody test and what that showed? I have a lot of Lyme symptoms including severe joint and back pain. My antibody test came back negative but those tests are known to be unreliable.
Hello Dr Cameron and thank you for your attention to this disease.
My case is very similar to the one above, with some differences.
It took 5 weeks after my initial illness in 2024 to be tested, confirmed, and treated with antibiotics for a Lyme infection. By the time I started my antibiotics I had already progressed into the 2nd stage of Lyme with a heart arrhythmia which is how the Lyme infection was diagnosed. After my 3 weeks of antibiotics I was still not feeling like myself. My doctor at the time insisted that my heart arrhythmia was gone and that I had been treated properly.
3 months later I developed debilitating sciatica and suffered a disc extrusion in the lower lumbar. I had surgery. I had a 5 month period after surgery, relatively pain free, before I developed lower back pain which has now lasted 8 months and seems to be getting worse. I’ve followed my Physical Therapy treatment for close to a year now. I’ve had follow ups with the neurosurgeon and new imaging which showed some degenerative changes, I am 55 years old, but nothing causing nerve compression. My PCP did another Lyme blood last month which showed some antibody markers but not enough to qualify for an active Lyme infection, so I was told. The only diagnosis I have been given for my back pain is facet and SI joint arthritis. It seems too coincidental to me to suddenly have these debilitating back issues 6 months after my Lyme infection. My PCP is not yet willing to try additional antibiotics for a chronic Lyme treatment. Would you be inclined to agree? Thank you again. I really do appreciate your videos and your willingness to share your clinical experience with those still suffering. Sincerely, Shane
When symptoms persist or evolve after Lyme, I evaluate them clinically rather than relying on blood tests alone. Imaging findings don’t always explain pain severity. Your concerns are reasonable.
Hello again Dr. Cameron. In addition to the details listed above in the last week I have developed a small fluid filled cushion on top of my right knee-cap. I went to my PCP. They diagnosed this as Prepatellar Bursitis. They also said that this is non-arthritic and would not qualify to be clinically diagnosed as Lyme type arthritis. Would you agree with the assessment that this kind of swelling/bursitis is non-typical for Lyme arthritis?
Thank you again,
Shane Hayden
I have patients with bursitis in other areas. I have colleague who are reluctant to diagnose Lyme arthritis unless the knee is documented
Possibly had a bite as a child on a scout camping trip in 1980’s in UK. Hand swelled up big with a red circle and central bite mark. Never got diagnosed but have been unwell with joints and other issues, fatigue and sore throats since. Been through many tests and experts as an adult, 10 years in private healthercare. Have had Lymes test but all negative.
Only things that have helped ciprofloxacin and clarithromycin which were prescribed for other things.
But they temporarily cured my back and hips.
Now they don’t work well. What else could I take in terms of antibiotics and does it need to be IV or tablet?
I was diagnosed with Lyme in late July 2023. My symptoms began in June 2023. They were very disabling and severely disrupted my life. After 5 doctor’s appointments and 4 incorrect diagnoses I was finally diagnosed.
I was given a 12 day supply of doxycycline. I experienced a very stiff neck for 3 months and in September I woke up with shooting nerve pain from the middle of my back into my right breast. I was referred to an orthopedic doctor. I had an MRI. I was diagnosed with a swollen T5-6 disc. I was given a cortisone shot in November 2023. I continue to have back and nerve pain and a host of neurological issues, brain fog and fatigue. I did enjoy long walks, but have reduced those because of physical discomfort. Could all this be from the Lyme bacteria that is still in my body?
i have seen it. I also have to rule out other causes