Is plastic surgery an option to get relief from back mice?

Back mice is a colloquial term that has been popularized to named the painful palpable fibro-fatty nodules of the sacroiliac area (The term was coined by Peter Curtis in 1993, In the search of back mouse).

An overlooked medical condition and the wrong dogma

Since back mice is a condition that is still overlooked by mainstream medical practitioners. The first diagnostic orientattion for these lumps is ‘lipoma’ and the dogma is that “Lipomas do not hurt”. But back mice are not lipomas. As the back mice go misdiagnosed, the worried patients look for the answers on the internet as the pain is still there.

The role of the social media

These days internet has become a shelter for patients to search for information and share their symptoms and experiences to help each other. Gladly, the patients of back mice can find the information on:

Apart from the literature, youtube also has some videos providing information on the topic of back mice. The most watched video (with more than 254 thousands views) is “Lumps in Low Back, Top of Hip” where Chiropractor Hilma Volk has provided a comprehensive information in a very simple manner for general audience. Tnere are some some facebook pages where people are discusing their journey through the pain of back mice.

Are the plastic surgeons resolving low back pain?

After my research of reading through these social media forums for back mice, I found that lot of patients are posting stories of their journey through the pain and in some cases ultimately overcoming the pain through surgery performed by plastic surgeons. 

plastic surgery back mice

So, after all the social media stories and the medical research available the question still remains open, “Is surgery the ultimate solution to this condition?” Well, until the mainstream medicine fully understands the cause of these painful fatty lumps and finds a less invasive way to cure these, I think we would have to resort to the plastic surgeons for the severe cases.

Published by Marta Cañis Parera in Novembre 2021

->LINK to a YouTube video where we humorously explain the best way to explore the back of patients to find BACK MICE (spanish)

Explore back micehttps://youtu.be/VbHAkyQ_hfA

35 Replies to “Is plastic surgery an option to get relief from back mice?”

  1. 1. If pressing on it does not hurt, is it still a back mouse? The whole area hurts for weeks after weightlifting.
    2. Is there a non-surgical way to remove or minimize the bump (dry needling, injection, puncturing)?
    3. Can it cause pain in the erector?

    1. Dear Malcolm,

      Thanks for your questions.

      1. If pressing on it does not hurt, is it still a back mouse? Yes. “Back mouse” it is just a term to name the deep fibro-fatty lumps that can be felt in the sacroiliac area. Most of the times they are not painful while pressing on them. Whereas, sometimes, these nodules can be very painful in certain patients (that is what we are currently studying).
      2. Is there a non-surgical way to remove or minimize the bump (dry needling, injection, puncturing)? Yes. Dry needling, anesthetic injection, and other types of puncturing the nodule have been report as being effective methods for pain relief in some patients.
      3. Can it cause pain in the erector? Yes. It is said that can cause associated muscle spasm in the erector.

      I hope I could help you.

      Saludos
      Marta

        1. Hello Malcom,
          As far as I know these treatments have been reported as being effective for managing the pain in a short or long basis, lumps usually persist, but pain goes away. In most people the lumps persist for long time, and pain seem to come and go.

          Saludos,
          Marta

        2. Very interesting work Dr Marta. I suffer from this same back mice just above my left iliac crest. Being a general surgeon myself, I hoping to get a colleague to remove them under LA and send the specimen off to histopath. Is closing the fascial defect and absolute must to prevent a recurrence?

          1. Dear Malcom,

            Some surgeons mentioned that in some of the studies. Indeed, closing the fascial defect was recommended by many surgeons that had published about back mice.

            Marta Cañis Parera

          2. If we are only going as deep as the basic fat pad and the resulting deep fascia; I assume that having a general surgeon or cosmetic surgeon can perform this; with minimal to no risk to any nerves… correct?

    2. God its a curse. I cant do my job any more. I’m in New Zealand, have seen physios, GPs & chiropractors. All of them say they wont operate & pass the buck. But its a matter of persisting until you find a surgeon that will do it.

      I tried ultrasound fat cavitation to shrink them – only seemed to work minimally. DMSO, electro current etc – tried it all.

      I met some old Chinese ladies & they said over there they just cut them out no problem.

  2. Greeings Marta,

    After further research, it appears my lump begins at the Inferior Iliac Spine, instead of the oft mentioned Superior. Also, it is diagonal instead of transverse, and more linear than oval. Does this still sound like an episacral lipoma?

    I saw a dermatologist today and mentioned the site. Although it felt soft to me, the doctor said it felt harder than it should and she was not sure it was a lipoma, and ordered an MRI, I guess to rule out other back pain sources. If it’s clear, the next step I’ll ask for is an ultrasound.

    1. Dear Malcom,

      The gluteal area around the iliac spine, is also a place were the back mice could be found. They could be called ‘gluteal mice’. But not EPISACRAL lipoma. Ultrasound is a better examination method for the time being for this fibro-fatty lumps.

      Saludos,
      Marta

  3. Sorry Marta last question. Do you know if the people who had it successfully removed had it simply excised, or was there also a “defect” in the fascia that needed to be repaired. Of the two videos I saw on YouTube it was a simple excision. But how would a dermatologist/plastic surgeon know, and be qualified to fix a “hernia”? Are there two different variants of back mice, one that simply begins on top of the fascia, and one that punctured through it?

    1. Dear Malcom,

      According to the literature, the surgeons not always found a fascial defect. Sometimes the surgeons described a clear fascia defect in the thoracolumbar fascia that they repaired, but other times that was not found, nevertheless the pain was relief. So probably, as you mention, it may be “different variants of back mice”.

      What seemed to me a common finding is that many surgeons described that the painful lumpy fibro-fatty tissue appeared edematous and under tension: “the lumps of fat popped out as soon as excision was performed as a sign of confined tension”. They commonly described that the edema was confined under a thin fibrous capsule.

      A dermatologist/plastic surgeon could be perfectly qualified to fix that. Of course, we first need to better understand this overlooked condition. And specially the local irritated peripheric nerves that cause the pain, the superior cluneal nerves.

      Saludos,
      Marta

  4. Marta, is it possible for it to not be in encapsulated at all? Just a nonuniform, jagged piece of fat with no shape whatsoever?

    1. Hello,

      According to the studies, sometimes the back mice can be felt just like an LOCALIZED INDURATION of the fibrous-fatty tissue. So, yes!.

      Saludos,
      Marta

  5. Hi Marta,

    Just got my ultrasound:
    “No discrete sonographic correlate for the indicated palpable abnormality.
    Please note that an unencapsulated lipoma could potentially be sonographically occult.
    At the indicated site of palpable abnormality, there is no discrete solid mass or focal fluid collection. No lymphadenopathy. No inflammatory changes in the imaged soft tissues.
    Limited comparison imaging of a similar area on the contralateral side is also unremarkable.”

    So it sounds like they saw nothing, but said if I had an unencapsulated lipoma, it may not show up anyway. I have an MRI scheduled now, which I understand has rarely shown the lipoma.

    Have you had patients who had the condition but ultrasound showed nothing? I don’t know what to do at this point. Thanks so much.

  6. Hello Malcolm,

    Yes, it has been described that sometimes the painful fatty mass (back mice) is not really visible in the ultrasound (and it is mainly not visible in MRI).

    But if the LOCAL ANESTHETIC INJECTION into the palpable fatty mass can give relief of the symptoms, then that is a clue for diagnosing LOCAL CLUNEAL NERVE IRRITATION (due to back mice).

    The main reason that science is overlooking this condition is that it is really challenging to be understood and diagnosed. The FIBRO-FATTY tissue (fascia) and its abnormalities like ‘back mice’ have been neglected as a pain generators and nerve irritators because of its anatomical and phisiological complexity.

    Unfortunately, there are many questions that remain to be answered.

    Best whishes,
    Marta

  7. Dear Dr. Parera,

    Question: Where can I find a physician to investigate my suspected “back mice” near me or somewhere is the Midwestern US?

    History: I am a 43 y/o, 5’8″, 180lb, 7th yr registered nurse with an athletic build who has had lower back pain and referred hip/thigh/leg pain for years (even before nursing) and recently discovered the masses you describe after an occupational injury while applying a lidocaine based cream to the area. I suspect that they may have been there for a long time as symptoms are reproduceable with palpation of the “lumps”. I was referred to orthopedic pain physician by my occupational health clinic. I am a personal acquaintance of this ortho pain doc and thought he would be open to my recent discovery. I asked him to palpate the area with a lubricant as I read in one of your articles. I also had a coworker use an ultrasound to locate and mark those areas with a surgical marker for the physician’s convenience. Nonetheless, he gave a single poke and said “it’s probably just a lipoma” and sent me on my way for an MRI. He’s a good physician and I trust him. However, as I suspected, he deemed the injury to be of soft tissue and my spinal anatomy demonstrated only moderate disc herniation of L4-S1 consistent with aging. I agreed to a steroid injection and nerve block that provided minimal relief for 48 hrs. I am resorting to cosmetic liposuction “360” in hopes of a solution.** Furthermore, my sister and mother both have the same pain complaints and I was able to palpate similar “lumps” in the same areas…possible genetic component?

    Note: I am so thankful for your publication “Historical Review of Studies on Sacroiliac Fatty Nodules (Recently Termed “Back Mice”) as a Potential Cause of Low Back Pain” which I shared with the Interventional Radiologists I work with.

    I am in my final semester as an MSN-FNP student and I look forward to investigating back mice, tremendously, and providing service where patients feel “heard.” I have proposed this topic for my capstone project and will be requesting to make my presentation to a group of medical professionals at the acute care facility where I work for my final grade.

    Can you advise? Where do you suggest I seek a consultation for this issue?

      1. Dear Tiffany,
        Yes, the intra-nodule local anesthetic injections can be done without imaging.
        Saludos,
        Marta

    1. Dear Tiffany,
      Thanks for your message, and sharing your story within the blog.

      Unfortunately, I do not know a “specific” physician in US with who you could seek consultation. Not even here in Spain… yet.

      I am really happy to listen that you look forward to investigate back mice, we still need a lot of questions to answer, and the webpage is there to share the information so we move forward with it.

      Best wishes,
      Marta

    2. I would like to find someone in southeast Louisiana that can help me with back mice. I’ve had this for 10 years. It doesn’t show up on mri or ultrasound.

  8. Do these “back mice” get progressively worse? Im 23 and have been having right side lumbar pain when standing/walking for long periods of time for the last year or two but over the summer it started to get worse and these last few weeks its gotten to where anything over 15-20 minutes on my feet is unbearable. While massaging the are last week I found a strange lump deep under in there just above the crest and also found one on me left side in the same spot although I’ve never had any issues with that side. I am planning on seeing the doctor this week but am worried about what route he will want to take. I just want to be pain free and be able to live my life like a normal guy!

    1. Dear Andrew,
      Back mice (fibro-fatty lumps in the lower back) can be a common finding in many people. Often they are not painful under palpation. An often they appear in both sides in the lower back.
      We suspect that the back mice is causing the pain by cluneal nerve irritation if while pressing the nodule the back pain is triggered.

      As far as I know, indeed the back mice can become progressively worse.

      Saludos,
      Marta

      1. Thanks for your reply! I went to my doctor and he pressed around on them and said they could not be the source of my back pain (go figure!) He firmly believes its a muscular issue but I don’t see how a muscle strain would slowly get worse over the course of a couple years, those are usually worse in the beginning and slowly get better or stay the same. He did agree to order an MRI that I am having on Friday. Hopefully they can see something but if not I am almost certain its this lump that is causing the pain! I only get it when standing up or walking so I don’t know how to prove to them this is the issue.

        1. Andrew, I’ve had painful bi lateral mice for two decades. I had a disk injury before they appeared and recently had spine surgery, decompression. I still have the pain in my lumps. My GP was clueless. I’m going to keep trying to find help. I’m in Arizona. If you find a surgeon who can help you let us know. I’ll do likewise. Mary Anna

          1. I am also in Arizona and struggling to find a doctor willing to remove mine. If you find anyone please let me know!

          2. After suffering a traumatic fall; I too have fallen pray to the dreaded back mouse. I even flew to the Mayo Clinic in Arizona… I saw a neurosurgeon there and their hernia specialist. Both said my MRI was clear of hernias and told me they will NOT operate on me. Despite having these lumps on my back.

            I even had a lipoma surgeon do a small incision and he confirmed I had hernia fat that had torn through the fascia.

            Even after explaining all of these medical findings to the Doctors at the may clinic; they still refused. Beyond frustrating. I’m now talking to a hernia specialist in Brisbane Australia.

  9. I am so glad I found this page!! I have been suffering since last September with “back mice” in my lower left back. I have had an ultrasound and an MRI. I was told by 2 surgeons – one general and one neurological that surgery wasn’t a good option. Possible injections, physical therapy and accupuncture.

    I have been doing PT and acupuncture for 2 months and the pain is getting worse. I was also told to “take it easy.” I am a 58 year old single woman who lives by herself and cannot “take it easy” as they say. I can barely bend over to feed my cats anymore.

    I scheduled another appointment with the neurological surgeon to at least start injections for the pain. I am going to ask for a referral to a surgeon who will remove this ASAP. I would love to find someone who knows how to do this and has done several so I will see what he says and get back to all of you. I wonder how much fascia damage I have as I may have injured it last fall. I went on a long cross country 11,000 mile car trip over 2-1/2 pos where it became progressively worse. Now as I am more stationery it comes and goes but when it does come its horrendously painful. I ice and heat and take OTC pain relief. I cannot believe more attention isn’t paid to this issue. How many are suffering from this!????

  10. I have been diagnosed with hypermobile Ehlers Danlos and now Dercum’s Disease this week. Is the mouse similar in structure to the other painful lipomas I have around my body (ribs, thighs, upper arms, hips). I’m hoping I can get someone to just ultrasound my entire body 😂

  11. I’m having at least 4 back mice on my lower back. I’m wondering if that’s causing my sciatic pain? Also I have a swollen lymph node in my left groin. Is this the reason for the swollen lymph node? It’s constant pain and I can see them. What I’m the world causes these?

    1. Hi Laura,
      The best way to be sure that the painful nodes are back mice is performing an ultrasound by somebody that knows about this subject. Swollen lymph nodes should be investigated a part and, as far as I know, they are not associated with the back mice in common cases.

      Regards,
      Marta

  12. Hi all .I’ve had the same Lower back pain for over 30 years .It would come and go over time .
    In the last year it has given me constant pain .
    I have had all the treatments massage ,osteo chiro you name it .Pain doesn’t disappear.
    I’m actually struggling to work as it’s affecting my life tremendously.
    I had a CT scan done six months ago and nothing showed up .Two weeks ago my doctor sent me for an ultrasound and I was diagnosed with a lipoma .
    I’m booked in for surgery next week to have it removed by a general surgeon.I will have to have a general anaesthetic for it .
    Hoping that removes all that nerve pain I’ve been experiencing.
    Even my surgeon was adamant that lipomas don’t cause pain .For some reason they refuse to recognise that these back mice cause so much pain .Will keep you informed on my pain post surgery .

    1. Dear Mary,
      I hope that you get better. The surgeon should know about the cluneal nerves prior to surgery.
      Regards,
      Marta

  13. Glad to find this site and your research. I am a pain management anesthesiologist in the Kansas City, Kansas area and have been specifically treating these for the last 10 years when I first identified these as a source of pain in my patient population. I didn’t know until relatively recently about the names for it. My treatment protocol which seems to work for my patients is similar to what I have read recently, i.e., 1) inject with 10cc of local/steroid under ultrasound guidance into and around the lipoma/fascial layer several times as needed, and 2) if unsuccessful or not long lasting, refer to a local plastic surgeon for excision. This has been very successful with, I would estimate, ~90% favorable outcomes. The hard part was finding a plastic surgeon that was willing to do this. Most said they didn’t know what I was talking about and couldn’t help them.
    Thanks for maintaining this website and info.
    Daniel Bruning, M.D.

    1. Dear Dr Bruning,
      Thanks for you message. It is good to know doctors that may treat patients suffering form this condition in Uniated States. Since many times they ask about it on this website.
      Regards,
      Marta

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