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Suggest Treatment For Chronic Back Pain

Posted on Thu, 4 May 2017

Question: I have been having severe back pain since March 23 and have had four emergency room visits. I was sent by ambulance on 4/11 with poor vitals, bp 180/120, pulse 110. Each ER has diagnosed me with a compression fracture of T10, next it was T10 and T12, and finally it was T10, T12, and T11. I've had no falls or accidents. An appointment has been set up for May 5th with a spine specialist in XXXXXXX Here is my concern and everything is starting to fall into place. I am on a chemotherapy drug. On March 15 I had major dental work done. Nine days later I presented with severe back pain which is ongoing, along with the diagnosis of 3 new compression fractures in my back. I was reading an article last night about an infection called Osteomyelitis. I do not have a fever and white cell count came back ok. However, I read that some patients do not present with a fever or a white cell count. I also had an MRI at the hospital, however without the contrast XXXXXXX (I am allergic to shellfish). I read that to diagnose Osteomyelitis the contrast XXXXXXX is used, is that accurate, or would the MRI without the contrast XXXXXXX have picked it up? Please note that nothing the doctors have prescribed to me is alleviating the pain. My back is hot to the touch and swollen. The pain is excruitating. I am currently on oxycodone and methacarbamol. No relief at all. Could my suspicions be right about the bone infection? Are there specific blood tests that could identify it? Is it accurate that a bone scan or PET could help identify this? I've never in my life have had bone fractures just happen for no reason in my spinal column, and again this all presented 9 days after major dental work (prior to this I had not been to the dentist in 7 years). Thank you for your help.

Answered by Dr. Dr. U N Sahoo (3 hours later)

Brief Answer:
Bone problem

Detailed Answer:
Hi,

Thanks for your question on HealthcareMagic,
I do understand your pain and discomforts,

As per your history is concerned please follow my points as asked by you-:

1) You have fractured bones without any history of injury so, in my opinion, let us first rule out osteoporosis which causes bones to become weak and brittle that a fall or even mild stresses like bending over or coughing can cause a fracture.it most commonly occurs in hip, wrist, or spine.

So please get done a bone density scan. Treatments which your doctor may prescribe you be Bisphosphonates and hormone as in form of Estrogen mainly.

Besides this, you need to modify your lifestyle like this-

a) Take Calcium 1200 mg daily.

b) Take vitamin D3 800 IU daily.

c) Make a plan for regular exercise.

2) Your second point was regarding osteomyelitis and it is caused by infection only. Fever is the main sign of it but without fever, it can happen as well. It is diagnosed by blood tests, blood cultures, X-rays, MRI and it's treatment is antibiotics and surgical drainage.

3) I may say that MRI can be done in both ways so you can talk to your radiologist in case you have any allergy to any substance.

4) You can share your reports here if you want me to confirm your case but I do not see it in favor of any infection as of now.

5) Your dental problem has no relation to your present problem.

Hope this helps, if you have any doubt then feel free to ask.

Thanks

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. U N Sahoo (14 hours later)

Thank you so much for the helpful medical information. I'm still worried about the dental work though. I read that bacteria can sometimes enter your bloodstream through dental procedures. Thus, possibly creating the Ostomyelitis in my body. Otherwise, very helpful information. Thank you.

Answered by Dr. Dr. U N Sahoo (39 minutes later)

Brief Answer:
Bone problems

Detailed Answer:
Hi,

Thanks for your follow up questions

“As” per your worried I may say that it is correct that bacteria enters via blood stream. There are certain factors which can lead to it like recent injury, circulation disorders like diabetics, intravenous lines or catheters, low immune system due to chemotherapy and drug use etc so to confirm do only blood test and if infection present then your doctor will do an image guided needle bone biopsy to confirm which germ is present.So talk with your doctor to confirm it.

Hope that helps

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Vaishalee Punj