Hi, Noted your history of feeling tired, run down, headache, throbbing pain in back but no fever; wants to know whether there can be no fever in spite of infection. Yes, if the infection is due to chronic problems like tuberculosis, there may not be fever; as also in cases of infection by gram negative bacteria can have septicemia and bacteremia without any fever at all. Hence I would advise you the following: Consult your Doctor for clinical evaluation and have basic investigations of blood, urine, stool. Special tests of blood for tuberculosis, culture and sensitivity can help a lot. Get an MRI or CT scan of the affected part of the back to know the exact diagnosis which can be a cold or hot abscess, aspiration of pus if present and send to the lab. Once the cause is found , say like tuberculosis a specific treatment can be started to get a relief. Remember, such cases may take time to show results. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. T. Chandrakant, General Surgeon