Fibro-fatty nodules and low back pain - The back mouse masquerade

BACKGROUND Few useful interventions exist fur I,patients with persistant lo w back pain, We suggest that a fibro-fatty nodule ("back mouse") may tie Lm identifiable and treatable cause of this and other types of pain, METHODS We describe 2 patients with painful nodules in the lower back and l ateral iliac crest areas. In both cases, the signs and symptoms were unusua l and presented at locations distant from the nodule. One patient complaine d of severe acute lower abdominal pain, and the other had been treated for chronic recurrent trochanteric bursitis fur several years. RESULTS In both patients, symptoms appeared to be relieved by multiple inje ction of the nodule. DISCUSSION There is agreement that back mice exist. Referred pain from the nodules might explain the distant symptoms and signs in these cases. Multip le puncture may be an effective treatment because it lessens the tension of a fibro-fatty nodule. CONCLUSIONS Randomized trials on this subject are needed. In the meantime, physicians should keep back mice in mind when presented with atypical and u naccountable symptoms in the lower abdomen, inguinal region, or legs.