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What is the treatment for prolonged lower back pain ?

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Practicing since : 2008
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I am male, 35, about 91 kg, and have not major medical problems (except this one of course!) Since 2007, I had pain in my lower back. It felt like two round balls, one on each side, that were radiating pain. The pain was on and off for a while until one day I couldn't walk. Any movement would cause an electric shock type pain in my left and right upper back (shoulder blades) especially when I move my leg. This happened only once and doctors did not see anything wrong even with an MRI! Now, 4 years later, the two round things are not radiating pain anymore. However, the pain is everywhere! My neck, shoulders, chest, back, and all sorts and types of pain especially when I wake up. Once I am vertical, things start to quiet down. Arcoxia does seem to fix it all quite nicely but I really need a correct diagnosis. My left side always feels weaker and more prone to pain than the right. I did bloodwork, checked my heart, and all seemed fine. My vitamin D is low about a 6 from a normal 25. Kidneys and liver seem fine. Some people told me it could be sciatica, others say it's a disc problem. Further, recently a doctor told me I had varicose veins in my left testicle. So, the left side seems to be having more problems than the right. Finally, when I wake up sometimes I feels a part of me is swollen but when I touch it, it is not swollen, just gives me that feeling. Sometimes it's the knee, the eye, the ankle, and mostly left side. Any idea what's wrong?
Posted Fri, 4 May 2012 in Back Pain
Answered by Dr. Raju A.T 5 hours later

Thanks for your query,

I would be able to answer better if you can provide me with some details i feel important here like :
1) Detailed description of the ' round things ', The site, number , consistency, associated symptoms and treatment ?

2)Which part of the body was scanned with MRI ?

3)Do you feel numb or sensation of pins and needles in the affected limb?

4)Do you have any problems related to eyes or urination ?

5)Have you ever got blood tests , specially like CRP and RA factor , If yes please share the reports with me ?

Will be waiting for the same.
Above answer was peer-reviewed by
Follow-up: What is the treatment for prolonged lower back pain ? 2 hours later

Thank you for your time and interest.

1- The round things are not actually visible on the skin. It just felt like two small (dime-sized) round things, at the lower end of my backbone. The pain used to radiate from either the left side or the right side, but rarely together. Until the day when I was hospitalized because I couldn't walk and felt the electrical shock to my back (mostly left side) everytime I moved my leg, or even sniffed my nose! It lasted only 24 hours and did not occur again. However, the pain since 2007 has become widespread. My neck, then shoulder blades, then legs, and now shoulders, arms, knees. The pain is mostly left-sided and feels worse when I first wake-up and during cold temperatures.

2. My lower back was scanned with MRI and the Doctor did not identify anything wrong. I also had an X-ray for my pelvis which was fine too.

3. In my back, I mostly feel radiating pain, mild electric shock, and tightness. Sensation of numbness, pins and needles is persistent on my left side of body especially when I first wake up. Once I stand and start walking a little, the numbness, tingling etc. all starts to decrease.

4. No problem to eyes or urination. However, I have developed a chronic habit of sniffing my nose (taking short breaths through my nose) and I do not know if this is related or just me being paranoid!

5. Tests I did include:

25 August 2010-- Vent Rate 69 BPM, PR int: 154ms, QRS dur: 85ms, QT/QTc: 370/389ms, P-R-T axes: 33 62 60. Written on the paper is the following: Sinus Rythm, possible left atrial enlargement (-0.1MV P WAVE IN V1/V2) Borderline ECG Unconfirmed Report. At that time, the doctor told me all is fine according to the EKG, heart sonar, Treadmill Test, and 3Channel Holter monitoring for 24 hours.

08 Feb 2010-- ESR 36 (High) Min 0 XXXXXXX 10...URIC ACID, RHEUMATOID FACTOR, ASO TITRE all normal.

08 Feb 2010
TEST 1 ALL NORMAL except lymphocytes 23.1 (LOW) with normal range 25 to 40. PLATELET COUNT 222. EOSINOPHILS 3.9. WHITE CELL COUNT 6.94 (min 4 XXXXXXX 11) RED CELL COUNT 5.26 (min 4 XXXXXXX 6.5) HAEMOGLOBIN 14.6 (min 13 XXXXXXX 17.5)

25 August 2010
TEST 2 ALL NORMAL except EOSINOPHILS 07 (normal 1-6). PLATELET COUNT 180 (normal 140-440). WHITE CELL COUNT 7.70, RED CELL COUNT 5.06, HAEMOGLOBIN 14.9.

25 August 2010
Free Tri iodo Thyronine (FT3) 5.5 (min 2.8 XXXXXXX 7.1)
Free Thyroxine (FT4) 1.2 (min 0.9 XXXXXXX 1.7)
Thyroid Stimulating Hormone (TSH) 3.67 (min 0.27 XXXXXXX 4.20)

LOW 6.15 (min 20 XXXXXXX 32)

SGOT (ASAT) TEST: 17 (less than 38 for male)

SODIUM: 142 (min 132 XXXXXXX 145)
POTASSIUM: 4.1 (min 3.7 XXXXXXX 5.4)
BLOOD UREA: 2.7 (<8.3)
URIC ACID: 313 (min 202 XXXXXXX 416)
CREATININE: 67 (min 53 XXXXXXX 97)

Cholesterol: 4.49 (Desirable 5.17)
Triglycerides: 2.5 (<65 yr: <2.3)
HDL: 0.8 (normal more than 0.9)
LDL: 2.6 (normal less than 4)
VLDL: 1.12 (min 0.1 XXXXXXX 1.0)
Fasting Blood Glucose 6.4 (min 4.2 XXXXXXX 6.4)
SGPT (ALAT) 20 (male <41)

Liver appears normal in size and shows diffusely increased parenchymal echotexture.
Portal vein and common duct were normal in caliber.
Gallbladder: normal wall thickness. No intraluminal pathology seen. No peri GB collection.
Spleen appears enlarged, measured 15.6cm craniocaudally. It shows regular contours and pancrease appears normal.
Both kidneys appear normal in size and echotexture. No evidence of back pressure changes of definite renal calculi seen.
IMPRESSION: Mild fatty liver infiltration. Splenomegaly.

Sorry for being so detailed but this is all I have done and I have yet to get a definite diagnosis. I would like to add that I feel pain in my lungs (ribs?) but no cough. The pain is minimal by itself but increases if I touch my ribs or chest. The pain is on the sides of my body and sometimes feel like a muscle strain so I stretch to calm it down. Sometimes it feels like my lungs are somewhat tight or pressured.

Also, the pain in my chest (left side) continues. I feel my heart throbbing sometimes with pain right under the left nipple area. I am a smoker and it might be from that. The doctors checked my heart and could not find anything wrong.

I might be dealing with a number of medical issues, or one major issue causing all of these things to happen. I hope you have a diagnosis, or at least guide me to the next step. Waiting for your greatly appreciate reply.
Answered by Dr. Raju A.T 14 hours later
Hi again,

Thanks for the information. More detail it is in, more will be our understanding about the case.

The symptoms you have are typical of radicular (spinal cord defects ) involvement.May not be in the lower spine . Since you have symptoms in the neck, chest and upper limbs its a must to rule out defects in the cervical(neck) spine and the spinal cord.

The tests above do not show any readings guiding towards the cause of the problem you have.I would ask you to get a cervical spine and Brain MRI scan which can surely provide some insights into the cause.

Get back to us with the reports no matter what they say.Meanwhile do take Multivitamin supplements specially those containing Vit B12 this will improve nerve health and bring down the tingling sensation and the pain to some extent.

Wish you good health.
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