ATTR-CM Back Pain: How to Manage Spinal Stenosis
Rare DiseasesAmyloidosis

How to Manage Back Pain (Spinal Stenosis) if You Have ATTR-CM

How to Manage Back Pain (Spinal Stenosis) if You Have ATTR-CM
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Updated on January 21, 2026
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The same abnormal proteins that can build up in your heart when you have transthyretin cardiac amyloidosis (ATTR-CM) can also leave deposits in your spine, resulting in spinal stenosis.

Spinal stenosis occurs when the spaces in the spine narrow. This puts pressure on the nerves that run through the spine and causes lower back pain and numbness, tingling, and weakness in the lower body.

 Up to about 30 percent of people with wild-type ATTR-CM experience spinal stenosis, and it may affect up to 5 percent of people with hereditary ATTR-CM.

 In some cases, spinal stenosis in the lower back may be diagnosed years before ATTR-CM.

Treating back pain when you have ATTR-CM is important for protecting your independence and supporting your overall quality of life.

Diagnosis: Back Pain or Spinal Stenosis?

Back pain has many causes, including strains, ruptured discs, arthritis, osteoporosis, and spinal stenosis, which can make it difficult to identify the underlying problem.

 The symptoms of spinal stenosis are similar whether or not ATTR-CM is the true cause, says Elizabeth A. Mauricio, MD, a Mayo Clinic neurologist in Jacksonville, Florida.
To diagnose or rule out spinal stenosis in a person experiencing back pain, doctors take a person’s medical and family history, conduct a physical exam, and use imaging tests such as MRI and CT scans.

ATTR deposits are often found during surgery for spinal stenosis.

 But while spinal stenosis can be caused by ATTR-CM, the condition can also result from a number of other causes and conditions, and the protein deposits characteristic of spinal stenosis don’t always cause back pain, says Dr. Mauricio.

Treating Pain From Spinal Stenosis

While your ATTR-CM treatment is key for your heart health, longevity, and quality of life, it may not have an effect on the back pain you’re experiencing.

“No medications that treat ATTR-CM also help with back pain or discomfort,” says Gabriel A. Smith, MD, the Spine Institute director at University Hospitals Health System in Westlake, Ohio. “Certainly, treating ATTR-CM and stopping the amyloidosis would decrease the accelerated rate of deposits all throughout the body.”

However, Dr. Smith is unaware of solid data confirming that these treatments prevent the development of spinal stenosis specifically. Theoretically, they may decrease the risk compared with someone who has ATTR-CM and isn’t receiving treatment.

That means for back pain relief, you’ll have to turn to additional treatments to soothe the back itself.

Supportive Medications

Smith says that certain medications may help alleviate pain caused by spinal stenosis in ATTR-CM:

Conversely, doctors tend to stay away from opioids when treating spinal stenosis. “We try to avoid opioids for neuropathic pain,” says Mauricio. “In the long run, these medications don’t help patients and cause more problems down the road.” Complications of opioid use include sedation, cognitive impairment, falls, fractures, and constipation.

Physical Therapy

Partnering with a physical therapist may also help you address back pain. “Physical therapy can build core strength to help protect your spine and nerves,” says Mauricio. “Stretching, working on balance and mobility, and strengthening core muscles can help people in the long run.”

Ask your primary care physician for a referral to a physical therapist if needed.

Surgery

In some instances, surgery may be warranted to relieve nerve pressure, but it’s not the first treatment your care team will explore.

“We would attempt all measures to alleviate pain and improve quality of life without surgery first,” says Smith.

If you’ve tried physical therapy, anti-inflammatory medications, nerve pain medications, and possibly steroid injections, and none of these options provided long-term relief from your symptoms, you may be evaluated for surgery.

Surgery is a last resort. “Surgery has risks, and with ATTR-CM, we would be taking on cardiac risk in particular,” says Smith. The procedure can be used to improve quality of life for people facing severe pain and weakness, problems sleeping, and interference in activities they love to do. Your healthcare team, including your cardiologist, an anesthesiologist, and a surgeon, will work together to evaluate both the benefits and risks before recommending surgery, he says.

The Takeaway

  • Transthyretin cardiac amyloidosis is closely linked to spinal stenosis, as the same abnormal protein deposits that affect the heart can build up in the spine, often causing back pain and numbness years before an ATTR-CM diagnosis.
  • While treating ATTR-CM may slow the overall accumulation of amyloid proteins, ATTR-CM medications do not alleviate existing back pain or reverse spinal narrowing.
  • Management of spinal symptoms typically begins with conservative approaches, including physical therapy to build core strength and supportive medications such as acetaminophen, NSAIDs, and nerve pain drugs like gabapentin.
  • Surgery to relieve nerve pressure is considered a last resort due to the increased cardiac risks associated with ATTR-CM and is only pursued if noninvasive treatments fail to improve a patient's quality of life.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Transthyretin Amyloidosis (ATTR-CM). Cleveland Clinic. May 1, 2022.
  2. Spinal Stenosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. November 2023.
  3. Formiga F et al. Musculoskeletal Co-Morbidities in Patients With Transthyretin Amyloid Cardiomyopathy: A Systematic Review. ESC Heart Failure. December 21, 2023.
  4. Martyn T et al. Opportunities for Earlier Diagnosis and Treatment of Cardiac Amyloidosis. Methodist DeBakey Cardiovascular Journal. December 6, 2022.
  5. Back Pain. Mayo Clinic. September 26, 2024.
  6. Spinal Stenosis. Mayo Clinic. June 27, 2024.
  7. Spinal Stenosis: Diagnosis, Treatment, and Steps to Take. National Institute of Arthritis and Musculoskeletal and Skin Diseases. November 2023.
  8. Tamasauskas D et al. Transthyretin Amyloidosis in Patients With Spinal Stenosis Who Underwent Spinal Surgery: A Systematic Review and Meta-Analysis. Frontiers in Neurology. October 9, 2024.
  9. Dufort A et al. Problematic Opioid Use Among Older Adults: Epidemiology, Adverse Outcomes and Treatment Considerations. Drugs & Aging. September 7, 2021.
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