Back Pain Mystery Solved… It Was Lyme Disease
Back pain does not always follow mechanical rules.
Sometimes normal imaging misses the real problem.
Lyme disease can mimic disc disease or sciatica.
Back pain is one of the most common complaints in medicine. For most people, it is caused by something mechanical—disc degeneration, muscle strain, arthritis, or a pinched nerve.
But sometimes, the cause is not structural at all.
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.
I treated a patient whose back pain defied every conventional explanation—until Lyme disease entered the differential diagnosis.
Back pain in Lyme disease is often part of a broader pattern of
chronic Lyme disease pain,
where symptoms may involve nerves, joints, muscles, or inflammatory pathways and do not always follow typical mechanical patterns.
Surgery and Rehab: A Promising Start
My patient had struggled with lower back pain for years. Eventually, he underwent back surgery followed by a dedicated course of rehabilitation.
For the first time in years, he was pain-free. He returned to daily activities, spent more time with his family, and felt like he had his life back.
The Pain Returns — Worse Than Before
Several months later, the pain returned.
But this time, it was different. The pain was severe, deep, and unrelenting.
There had been no new injury. He had not lifted anything heavy. His physical therapy routine remained consistent.
Yet the pain—centered in his lower back—grew worse by the week.
He returned to his neurosurgeon. Repeat imaging showed no recurrent disc herniation, no surgical complications, and no structural explanation for the severity of his symptoms.
A 9-Month Search for Answers
He was referred to pain management. He tried anti-inflammatory medications, additional physical therapy, and trigger-point injections.
Nothing helped.
The pain affected every aspect of his life. Sleep became difficult. Activity worsened symptoms. Fear of triggering pain led him to avoid movement altogether.
For nine months, every path led to another dead end.
No Tick Bite. No Rash. But Something Was Off
What made the case especially puzzling was the absence of classic Lyme disease clues.
There was:
- No known tick bite
- No erythema migrans rash
- No fever
Lyme disease was not even being considered.
But over time, additional symptoms appeared:
It no longer seemed like just a spine problem.
A Broader Workup — and a Surprising Diagnosis
Because his symptoms were no longer isolated to the back, we broadened the differential diagnosis.
Testing was pursued for autoimmune disease, neurologic disorders, and chronic infections.
That is when Lyme disease testing returned positive, including multiple IgG Western blot bands consistent with late-stage infection.
For the first time, the entire symptom pattern began to make sense.
How Lyme Disease Can Cause Back Pain
Lyme disease is caused by the bacterium Borrelia burgdorferi.
Although Lyme disease is commonly associated with joint pain and flu-like illness, it may also inflame nerve roots—a condition known as radiculitis.
Radiculitis can cause:
- Burning pain
- Sciatica-like symptoms
- Deep lower back pain
- Pain radiating into the legs
In some patients, Lyme disease also contributes to
neuropathic pain
that does not respond to surgery, anti-inflammatory medications, or conventional spine treatment.
Importantly, Lyme-related inflammation may not appear on routine MRI imaging.
And in late-stage Lyme disease, many patients do not recall any early signs of infection. Studies suggest a substantial number of patients never see a tick or develop a recognizable rash.
Treatment — and Recovery
Once diagnosed, the patient began treatment tailored to neurologic Lyme disease.
Within several weeks, the severe burning back pain gradually began to improve.
Over time, the fatigue, cognitive symptoms, and sensory sensitivity also started to fade.
Within a few months, he was functioning well again and returning to normal daily activities.
When to Suspect Lyme Disease in Back Pain
Lyme disease may deserve consideration when back pain:
- Does not match imaging findings
- Fails to improve with standard treatment
- Includes burning, radiating, or neuropathic symptoms
- Occurs alongside fatigue, brain fog, or dizziness
- Develops in someone living in or visiting a tick-endemic area
Clinical Perspective
Back pain is often assumed to be mechanical, but Lyme disease may occasionally produce neurologic or inflammatory pain patterns that mimic disc disease or sciatica.
When symptoms persist despite normal imaging and appropriate treatment, clinicians may need to broaden the differential diagnosis beyond structural spine disease alone.
Recognizing accompanying symptoms—such as fatigue, cognitive dysfunction, or neuropathic pain—may help identify a broader systemic illness.
Clinical Takeaway
Lyme disease can inflame nerve roots and cause neuropathic pain patterns that resemble sciatica or structural spine disease.
When back pain does not respond to conventional treatment and is accompanied by fatigue, brain fog, or neurologic symptoms, Lyme disease may deserve consideration.
Frequently Asked Questions
Can Lyme disease cause back pain?
Yes. Lyme disease may inflame nerve roots and contribute to neuropathic or radicular pain that resembles sciatica or disc-related back pain.
Why can Lyme disease back pain look normal on MRI?
MRI scans detect structural abnormalities. Lyme-related inflammation or neuropathic pain may not appear on routine imaging.
Can Lyme disease mimic failed back surgery syndrome?
In some patients, persistent or recurrent pain after spine surgery may reflect an unrecognized inflammatory, neurologic, or infectious process rather than surgical failure alone.
Related Articles:
Podcast: Severe Neuropathic Pain Due to Lyme Disease
Neck Pain in Child With Lyme Disease Due to Radiculoneuritis
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
Hi Dr. Cameron,
After being on meds for nearly 8 weeks, I’ve seen progress and had setbacks, and just came across this article. My pain started with a “herniated disc” with extreme sciatica/nerve pain and later exploded into “vasomotor instability” e.g. Raynauds and secondary Erythromelalgia symptoms. I’m no where near healed, but articles like this are encouraging as they wind back the clock on the mystery of it all, and help bring validating information through the cracks that so many doctors ignored or cared not enough to read into for months or even years.