OpenHealth Q&A

Chronic Back Pain Struggles

Age: 28, Height: 5’9”, Weight: 295 lbs Medications: Humalog, Voltaren, Singulair, Plaquenil, Dexilant, Lipitor, Flexeril, Gabapentin, Lamictal, Pristiq, Vitamin D, Kyleena IUD Medical Background: Type 1 Diabetes (A1C 6.3), Asthma, Anxiety Disorder, Preiser’s Disease, Palindromic Rheumatism, Barrett’s Esophagus Greetings! For the past seven years, I have been suffering from debilitating back pain that has left many doctors perplexed about the underlying issues and potential solutions, drastically impacting my quality of life. I’ll strive to provide an in-depth recount of my experience. The ordeal began in late 2018, when I experienced persistent swelling and pain in multiple joints throughout my body. The symptoms fluctuated, and over-the-counter medications like Motrin were somewhat effective. Upon consulting a physician, I tested negative for rheumatoid factor, and my doctor opted for a wait-and-see approach. As 2019 progressed, the pain intensified. My fingers began to buckle, and Motrin ceased to provide any relief. One morning, as I prepared for work, excruciating pain shot through my lower back, radiating toward my hips, pelvis, and thighs, despite no prior injuries. My physically demanding job became intolerable; walking long distances or lifting objects was accompanied by severe discomfort, forcing me to take frequent breaks and ultimately ceasing my exercise routine. Naproxen proved ineffective, prompting a referral to a rheumatology specialist. Rapid weight gain marked my journey through 2020, which I attribute to the reduced physical activity I once engaged in. My weight skyrocketed from approximately 170 lbs to 240 lbs. Several tests conducted by my rheumatologist revealed negative rheumatoid factors but indicated elevated CRP, C3, and C4 levels. Consequently, she diagnosed me with palindromic rheumatism and prescribed Plaquenil, which notably alleviated discomfort in my fingers, knees, and wrists, yet failed to address my back pain, which continued to escalate. I explored physical therapy for six weeks, but it yielded no positive results. In 2021, a lumbar X-ray provided the following findings: "No fractures detected. Vertebral body heights appear normal. No suspicious bony lesions or degenerative alterations were observed. Mild curvature of the thoracolumbar spine was evident, but no spondylolisthesis was present." Despite returning to physical therapy for another three-month stint, I noted no improvements, and my physician could offer no further insights. During 2022 and 2023, I endured continual, unabated pain amid the ongoing search for answers. Last year, I transitioned to a more reputable medical practice, which immediately called for additional tests and X-rays. Results indicated negative outcomes for lupus, rheumatoid arthritis, and Sjogren’s syndrome, with a positive HLA-B27 marker. Another lumbar X-ray revealed "a mild S-shaped curvature, stable. No acute osseous injuries." The cervical spine examination displayed mild to moderate reversal of the appropriate cervical lordosis at the C5 level, possibly due to muscle spasms or positioning, with no fractures or abnormal findings. I was then prescribed Meloxicam and trialed it for four months, but it failed to alleviate my symptoms. Additionally, I received a diagnosis of Preiser’s disease affecting my right hand. Come January of this year, an MRI of both the lumbar region and sacrum was performed without contrast. Results for the lumbar area were as follows: "Mild curvature of the lumbar spine towards the left, with no signs of acute fractures or spondylolisthesis. The heights of lumbar vertebral bodies remain intact. At L5-S1, no disc herniations, stenosis or significant arthropathy were noted. At L4-L5, minimal facet arthropathy was present, also with no disc herniation or stenosis reported." The scan of the sacrum indicated small, benign effects in the sacroiliac joints with no notable abnormalities or erosions. Currently, I have been prescribed Voltaren, which has offered minimal relief for my back pain (though it aids my wrist discomfort). I have an upcoming appointment, and I am anxious about possibly hearing that no viable treatment exists for my condition. I am reaching out in hopes that someone might shed light on what might be transpiring with my health or suggest possible courses of action. My constant pain has severely curtailed my ability to enjoy life. I long for the days of hiking, spending time at the beach, and pleasantly walking my dog. There are better days and worse days, but the current situation feels more daunting than ever. Standing for extended periods to cook or vacuum is often unmanageable. The pain consistently radiates from my lower back into my hips, pelvis, and thighs. While resting on a soft surface brings significant relief, hard surfaces inflict sharp pain. The MRI process was excruciating due to this discomfort. I can only manage slight distances before needing to take a break. I often find myself arching backward instinctively to try to relieve some of the pain, though I'm uncertain of the reasoning behind this instinct. Any guidance would be greatly appreciated, and I thank you for taking the time to read my story.

Answers (1)

3/20/2025, 2:11:05 AM

OpenHealth AI

Thank you for sharing your detailed story about your chronic back pain. It’s clear that this condition has significantly affected your quality of life, and I understand how frustrating and exhausting this must be for you. Given your background and the progression of your symptoms, there are a few key points to consider regarding your situation, along with some actionable steps you can take to help manage your pain.

Main Points:

1. Chronic Back Pain with Multifarious Causes: Your pain may stem from a combination of factors, including your musculoskeletal health, underlying conditions like palindromic rheumatism, and potentially weight-related strain.
2. Existing Management Strategies Have Limited Effect: Medications and therapies you've tried, such as Voltaren and physical therapy, have not provided sufficient relief.
3. Potential for Lifestyle Modifications & Alternative Therapies: Given your challenges, exploring additional approaches may be beneficial in managing your pain.

Explanation:

Chronic back pain can be multifactorial and often worsens due to decreased physical activity, as you noted with your weight increase. Conditions such as palindromic rheumatism and your elevated HLA-B27 marker may also contribute to your symptoms. The complexity of your case, with symptoms not responding well to conventional pain management strategies, suggests that exploring a comprehensive, multidisciplinary approach could be beneficial.

Next Steps:

1. Consider Weight Management: Since you are experiencing pain that may be exacerbated by your current weight, lightly focusing on a gradual, achievable weight loss plan could relieve some pressure on your spine. This does not mean extreme dieting but rather small, sustainable changes, such as increasing your activity level if possible and adjusting dietary habits.

   • Action: Begin with gentle, low-impact exercise routines, like swimming or cycling, which are easier on your back.

2. Physical Therapy Revisit: Even though past physical therapy didn’t yield results, a different physical therapist specializing in chronic pain management may provide tailored exercises and techniques for pain relief and increased strength.

   • Action: Ask your healthcare provider for a referral to a different type of physical therapist, possibly one with experience in treating patients with chronic pain conditions.

3. Pain Management Techniques: Consider exploring other pain management options such as acupuncture, chiropractic care, or mindfulness practices. These therapies can help with pain control and improve overall wellbeing.

   • Action: Research local practitioners or clinics specializing in alternative therapies and see if they offer initial consultations.

4. Cognitive Behavioral Therapy (CBT): Given your history of anxiety and the psychological impact chronic pain can impose, seeking counseling that focuses on chronic pain management may help you develop coping strategies.

   • Action: Inquire with your healthcare provider about referring you to a mental health professional experienced in chronic pain management therapy.

5. Discuss Medication Options: If you haven't seen significant relief from Voltaren, discuss with your doctor the possibility of trialing other medications or combinations that may be more effective for your specific pain patterns.

   • Action: Prepare a list of your current medications and their effects before your upcoming appointment to discuss alternatives with your doctor.

6. Pain Diary: Keep track of your pain levels, triggers, and what interventions provide relief. This information can be invaluable for your healthcare team to fine-tune your treatment plan.

   • Action: Start a simple daily log where you note pain intensity and activities to share during your medical appointments.

Your concerns are valid, and it’s important to advocate for your health. These steps aim to provide a more holistic approach to managing your pain and improving your quality of life. Please remember, you’re not alone in this struggle, and ongoing support is crucial. If you feel overwhelmed at any point, don’t hesitate to reach out for assistance or further clarification on these strategies.