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Suggest Treatment For Severe Pain In The Back
Question: Since the last three months I am having severe pain in the lower and upper back, all the x-rays and MRI done were normal. The ortho that I was consulting advised me to see a rheumatologist. The doctor did one more blood test which is attached herewith. The result for one of the test CPK is far more than the reference range. Please advise me what does this mean, 1) can this cause back pain. 2) what are the reasons for increase in CPK. 3) What disease this can lead to?
However doctor advised me to do some more test, the result for which will be available in 3-5 days time, kindly let me know what are these tests. Thanks.
However doctor advised me to do some more test, the result for which will be available in 3-5 days time, kindly let me know what are these tests. Thanks.
Brief Answer:
Unlikely.
Detailed Answer:
Dear Sir,
Thank you for posting your query on HCM.
Well your doctor has rightly ordered for all tests and I have seen your Cpk report , however it is unlikely that it is giving rise to back pain but cannot be ruled out .
I would like to know few things-
Do you have any kind of weakness in proximal muscles?
Do you get early morning stiffness?
Any history of blood in stools, uveitis , psoriasis?
Any history of radiating pain in legs?
Any history of backache in family?
Your profession and work schedule?
Have you been tested for HLA B 27?
If you provide detailed history I will be able to help you better.
Take care.
Dr. Shruti
Unlikely.
Detailed Answer:
Dear Sir,
Thank you for posting your query on HCM.
Well your doctor has rightly ordered for all tests and I have seen your Cpk report , however it is unlikely that it is giving rise to back pain but cannot be ruled out .
I would like to know few things-
Do you have any kind of weakness in proximal muscles?
Do you get early morning stiffness?
Any history of blood in stools, uveitis , psoriasis?
Any history of radiating pain in legs?
Any history of backache in family?
Your profession and work schedule?
Have you been tested for HLA B 27?
If you provide detailed history I will be able to help you better.
Take care.
Dr. Shruti
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Dear Dr. XXXXXXX
Please find below the answers;
1. Do you have any kind of weakness in proximal muscles? - I just have pain in back. Sometime back while when this pain started I used to have burning and tingling sensation in the legs, however after medication and pyshio that has reduced.
2. Do you get early morning stiffness? - No
3. Any history of blood in stools, uveitis , psoriasis? - Had done one urine analysis test in July; during that time blood was found. Doctor advised to increase water intake, report was re-done after 1 week, no blood traces found in the new test.
4. Any history of radiating pain in legs? - No
5. Any history of backache in family? - No
6. Your profession and work schedule? - Office work; I do treadmill for around a hour daily (approx 4 kms)
7. Have you been tested for HLA B 27? - Didn't understand
Regards,
XXXX
Please find below the answers;
1. Do you have any kind of weakness in proximal muscles? - I just have pain in back. Sometime back while when this pain started I used to have burning and tingling sensation in the legs, however after medication and pyshio that has reduced.
2. Do you get early morning stiffness? - No
3. Any history of blood in stools, uveitis , psoriasis? - Had done one urine analysis test in July; during that time blood was found. Doctor advised to increase water intake, report was re-done after 1 week, no blood traces found in the new test.
4. Any history of radiating pain in legs? - No
5. Any history of backache in family? - No
6. Your profession and work schedule? - Office work; I do treadmill for around a hour daily (approx 4 kms)
7. Have you been tested for HLA B 27? - Didn't understand
Regards,
XXXX
Brief Answer:
Needs to repeat CPK.
Detailed Answer:
Dear Sir,
Thanks for reverting back.
CPK is a muscle enzyme and can be raised in various situations ,even exercising can raise that . Even treadmill running can lead to it . My advise is to stop doing exercise for some time may be 5 days or a week and then repeat it . Also LDH, Aldolase are also muscle enzymes ,they should be done along with CPK.
If it comes normal nothing to worry. Your backache seems to be mechanical only. HLAB 27 is a gene which is found in people who have ankylosing spondylitis.They can present with backache . So this condition needs consideration.
Get your Vitamin D and calcium levels checked . Metabolic deficiencies can also lead to backache.
Rest when you get your reports let me know.
Take care.
Dr. Shruti
Needs to repeat CPK.
Detailed Answer:
Dear Sir,
Thanks for reverting back.
CPK is a muscle enzyme and can be raised in various situations ,even exercising can raise that . Even treadmill running can lead to it . My advise is to stop doing exercise for some time may be 5 days or a week and then repeat it . Also LDH, Aldolase are also muscle enzymes ,they should be done along with CPK.
If it comes normal nothing to worry. Your backache seems to be mechanical only. HLAB 27 is a gene which is found in people who have ankylosing spondylitis.They can present with backache . So this condition needs consideration.
Get your Vitamin D and calcium levels checked . Metabolic deficiencies can also lead to backache.
Rest when you get your reports let me know.
Take care.
Dr. Shruti
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear Doctor,
Thanks for your feedback. My vitamin D and calcium levels are ok, I am attaching the recent test done for the same.
The doctor told me the same thing that CPK can go up if i am doing regular exercise and for this reason only he advised to do the other test. Can you tell what are those test? and what may come out from the results. My doctor wants to clear doubt of arthritis. Does arthritis cause pain the back as well?
Regards,
Thanks for your feedback. My vitamin D and calcium levels are ok, I am attaching the recent test done for the same.
The doctor told me the same thing that CPK can go up if i am doing regular exercise and for this reason only he advised to do the other test. Can you tell what are those test? and what may come out from the results. My doctor wants to clear doubt of arthritis. Does arthritis cause pain the back as well?
Regards,
Brief Answer:
You can wait also before further testing.
Detailed Answer:
Dear Sir,
Thank you for reverting back.
The tests pertaining to muscle weakness are CPK, LDH , Aldolase which I think havent been requested yet. Your RF and Anti CCP are negative which rule out rheumatoid arthritis. Rest the tests you have sent are ANA, ENA, Anti dsDNA etc are for SLE which I dont think you are having.
Only relevant test for back pain would be HLA B27 which your doctor hasnt requested.To me your back pain seems mechanical.
Take care.
Dr. Shruti
You can wait also before further testing.
Detailed Answer:
Dear Sir,
Thank you for reverting back.
The tests pertaining to muscle weakness are CPK, LDH , Aldolase which I think havent been requested yet. Your RF and Anti CCP are negative which rule out rheumatoid arthritis. Rest the tests you have sent are ANA, ENA, Anti dsDNA etc are for SLE which I dont think you are having.
Only relevant test for back pain would be HLA B27 which your doctor hasnt requested.To me your back pain seems mechanical.
Take care.
Dr. Shruti
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. XXXXXXX
Hope you are doing good. I have got one of the test result, rest two are expected next week. The result of ANA is "Border Line", kindly advice what is the meaning of this and what are the implication. Does this suggest any severe disease, the infection of which may turn up in the future.
You mentioned before that ANA and the other test are for SLE, what is that?
Thanks & Regards.
XXXX
Hope you are doing good. I have got one of the test result, rest two are expected next week. The result of ANA is "Border Line", kindly advice what is the meaning of this and what are the implication. Does this suggest any severe disease, the infection of which may turn up in the future.
You mentioned before that ANA and the other test are for SLE, what is that?
Thanks & Regards.
XXXX
Brief Answer:
Follows.
Detailed Answer:
Dear Murtaza,
Thanks for reverting back.
Am doing good . Thank you so much for your concern.
I have seen your report , your ANA is borderline and the pattern is homogenous , at present considering your symptoms I dont think it has got much relevance but we need to repeat it after 3-6 months . ANA positivity is indicative of lupus but it can be positive in normal population also in 5% people .
Plus anti ds DNA , ENA levels are further specialised testing in this context , your doctor has already sent them . I need to have a look at those reports to tell you what exactly the picture is like and correlate with your clinical complints also.
Have you anytime got recurrent oral ulceration, photosenstivity , rashes over body or face or any of your family member had that ? Plus I would like to know if your experience colour change of your fingers in winter season or ever noticed fingers turning blue during cold exposure.
Dr. Shruti
Follows.
Detailed Answer:
Dear Murtaza,
Thanks for reverting back.
Am doing good . Thank you so much for your concern.
I have seen your report , your ANA is borderline and the pattern is homogenous , at present considering your symptoms I dont think it has got much relevance but we need to repeat it after 3-6 months . ANA positivity is indicative of lupus but it can be positive in normal population also in 5% people .
Plus anti ds DNA , ENA levels are further specialised testing in this context , your doctor has already sent them . I need to have a look at those reports to tell you what exactly the picture is like and correlate with your clinical complints also.
Have you anytime got recurrent oral ulceration, photosenstivity , rashes over body or face or any of your family member had that ? Plus I would like to know if your experience colour change of your fingers in winter season or ever noticed fingers turning blue during cold exposure.
Dr. Shruti
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
Thanks for the quick feedback.
In response to the question I have never experienced any recurrent oral ulceration. I don't have any rashes, i am just experiencing itching near the groin area, if that is anyway related to this test or symptoms.
I was referring to internet for ANA, there are reference of cancer for positive ANA, is there any possibility of any type of cancer? Please advice.
Regards,
XXXX
Thanks for the quick feedback.
In response to the question I have never experienced any recurrent oral ulceration. I don't have any rashes, i am just experiencing itching near the groin area, if that is anyway related to this test or symptoms.
I was referring to internet for ANA, there are reference of cancer for positive ANA, is there any possibility of any type of cancer? Please advice.
Regards,
XXXX
Brief Answer:
Follows.
Detailed Answer:
Dear Murtaza,
You dont have any features suggestive of SLE plus it is very uncommon in males . So lets not worry about it until we have some other conclusive evidence.
Everything written on internet doesnt mean its applicable to you . So be relaxed . ANA can be falsely positive in malignancies but you dont have to be bothered about that . Every test has to be interpreted in context of clinical features.
Dr. Shruti
Follows.
Detailed Answer:
Dear Murtaza,
You dont have any features suggestive of SLE plus it is very uncommon in males . So lets not worry about it until we have some other conclusive evidence.
Everything written on internet doesnt mean its applicable to you . So be relaxed . ANA can be falsely positive in malignancies but you dont have to be bothered about that . Every test has to be interpreted in context of clinical features.
Dr. Shruti
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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