Question: Hi .. I am having pain in mid back slightly to the right side of the spine .. also stitch-like pain around the right rib. The pain has been a constant for a year and half now. I have had all kind of tests done and MRI of the spine also to rule out any major illnesses. The only thing detected was a gallstone of size 4.6mm. I have problems of gas and bloating and this pain is a constant .. it seems to start in the mid back (slightly to the right side of the spine) and goes all the way up to the upper back and shoulder blades. I get a little relief when the gas eases but the cramping in stomach and pain in the right side never goes away. This pain is also lately extending to the left side around the left rib though not as severe as the right side pain. I am a female, 32 yrs of age and this issue started 2 months after I had a C-Section with my first baby 1 and half years ago. I have seen General physicians, physio, ortho, gynae but nothing seems to help. What could be the issue? My pain is sharp and stabbing and is a constant. Please advise.

Just as an add on, this problem gets worst 2-3 days around the time my periods are about to start. I feel this is not from the gallstone as the stone was detected only 2 months ago and it wasn't there in the ultrasounds done 8 months ago whereas this pain has been constantly with me for 1.5 yrs. I have had full abdomen ultrasounds done and no abnormalities were detected with any other organs. I also suffer from constipation (not the severe kinds, but motions are passed around 3-4 times a week and I have a feeling of incomplete motions). I am sure this is some kind of gastro issue. The pain goes right up the upper back, shoulder blade, under/inside the right rib towards the back, around the chest and just behind the breast bone. Painkillers also don't seem to help. The problem gets worst at night when I lie down and I am not able to sleep due to this, having a disturbed sleep and waking intermittently. Most of the times I feel some relief if I lie on my stomach.
Here are answers to your questions:

1) Do you get fever frequently ? Even low grade ?

Ans: No I don't get fever frequently. Last I got fever was in February 2012 which lasted for 20 days and I had to be hospitalized on the 13th day as the fever was hovering around 103 deg F and oral medications weren't working. Though the test reports all came back negative, doctors suspected it to be para typhoid as the symptoms were typical of typhoid. My gallbladder stone was also detected then. I was treated with Monocef injection and Taxim-O. I have been doing fine ever since though I do feel lethargic at times and not able to sleep properly at night because of this pain. I have a desk job and use laptop a lot and I try to keep a good posture.


2) Do you get gas more when on carbohydrate diet ?

Ans: I mostly eat a typical north Indian diet i.e. chapatis and curry (no strong spices). So my diet does have these carbs and I haven't tried cutting out the carbs totally from diet. Though I have noticed that I get intense heartburn when I have sugary foods, sweets or a banana.


3) Is there aggravation in pain soon after food intake ?

Ans: Mostly no. I haven't noticed aggravation of pain soon after food intake though the gas build up does happen when I take food. I don't eat heavy meals and avoid ghee or butter. On some occasions I do get a bad heartburn right after eating a meal or something sugary.


4) Have you been on any medication for long ?

Ans: No I haven't been on any medication for long. Though after my c-sec delivery I was put on strong medication for 2 months for the healing process and that is the time I started getting this back ache. I did not realise that time that the pain might be coming from gas as the gas buildup was not that apparent. Since then I have tried multiple doctors of all kinds and they have given me different medications but nothing seems to have worked. I have also been given ointments to apply on the back for backache but they didnt help relieve the pain. I haven't been to a gastro yet because all this while I was not thinking that the gas could cause this pain. I do take Vit D supplements and vitamin B12 supplements from time to time on doc advice.


5) Have you taken any medication for the current problem ?

Ans: Last year my GP had put me on Pantodac and antacid syrup for a month as I was getting gas issues. I felt some relief at that time but not totally relieved though I was able to sleep at night. Right now I am not on any medication as I am not able to pin point what the problem might really be and whom to consult. I went to another GP 2 days ago and he recommended me to take the following medication to ease my pain:
- Rabeprazole 20mg for a month
- Tryptomer 10mg for a month
I haven't started on these medicines yet.


6) Have you tried any topical pain killers ?

Ans: I have consulted orthos, physios, gynaes and all of them recommend exercise along with some painkillers as they believe there's nothing wrong with me. They do not seem to actually understand that I am truly in pain. I do go for a 30 min walk everyday for the last month or so, which causes constipation and gas to be better but the sharp pain never leaves me. My general physician did not give me a painkiller though he put me on Pantodac and an antacid syrup. I do take Diclowin tablet on severe pain days and sometimes feel relief.

Please advise. This pain is killing me and putting me in immense tension.

Thanks for looking into my problem. Can you please tell me the exact names of the tests I should get done because lab people need exact tests to be done. Not sure if they do the tests without doctor prescription but I can still try if I know the names of the tests I want them to run.

Thanks

Hi

I just got back the results of tests conducted for Amylase Serum (IFCC) and Lipase Serum. Following are the test results.

Test Name Result Units Ref. Range
------------------------------------------------------------------------------
Amylase, Serum 30.00 U/L (28.00 - 100.00)

Lipase, Serum 11.00 U/L (< 67.00)


I had started on Rabeprazole 20mg and Tryptomer 10mg 2 days before having these tests done. Please advise.

NOTE:
My GP also ran blood tests for Thyroid, Calcium, Vitamin B12 and Vitamin D. All other tests were normal. Only Vitamin D came back as 8.87 ng/ml which is in the insufficient range. Normal range for my lab was 21-100 ng/ml. Could the pain be because of vit D deficiency? My Vit D levels were checked 6 months ago and they were in normal range at that time. And I still had severe back pains. What can cause vitamin D deficiency? Can there be an underlying problem which causes the deficiency? And can my problem be linked only to vit D deficiency or we need to look into something else?