Help figuring out what's causing pain

[Encyclojessica]

For the last 2 months I have been experiencing a worsening in my lower back pain. It started off as an annoyance and quickly became debilitating. I went to the hospital since I couldn't see my family doc and they advised me it was a muscle strain. The emerge doc told me to rest for a few days then begin stretching and slowly incorporate some exercises. He also suggested massage, physio, hot and cold etc. all the normal stuff for a muscle strain. I have had muscle stain in my lower back a few times so I was familiar with the routine so I followed the same steps I had done in the past with no relief. Instead, it got worse. I also noticed that the pain was different than it was when I had a muscle strain. The muscles were not tender to the touch, they didn't burn when I stretched and they were lower in my back, right around my butt crack. After 2 weeks of it getting worse I saw another doc. She had suggested that I may have previously broken my tailbone (I have fallen on my butt pretty hard 2 times from about 5-6 feet onto a rock and once on ice). She suggested baclofen and some rest. I was unable to take baclofen because I got heart palpitations and I had no idea what was going for about 24 hrs after just one, 10 mg dose. She didn't order X-rays or any tests but suggested I make an appointment with my doc. About a week later I noticed swelling in my lower back, I got freaked out and went back to emerge. The emerge doc took an X-ray (I later found out that the position I was in during the X-ray was the wrong position and that he ordered it for the wrong part of my back) he came back saying that the spacing in my vertebrae looked fine and prescribed the max dose of baclofen (yep, even though I can't take it). Clearly I didn't have confidence in his diagnosis so I went to a walk in clinic just to ask for something other than baclofen. I was given cyclobenzaprine to tide me over till I saw my family doc. Finally after more than 6 weeks of worsening pain I saw my doc. By this time my pain was still worse and I began to have cramping in isolated parts of my butt, groin, legs and feet. Within about 3 min he told me that I was not experiencing muscle strain (I think I already knew that) and the previous recommendations would not help (I knew that too). So he prescribed gabapentin. I started with 100 mg 3 times a day for 1 week then 300 mg 3 times a day for 1 month and a follow up with him. I have not noticed much of a difference in the back pain, maybe a slight improvement but the isolated pain in my groin, legs, feet etc is the same.

I'm wondering if anyone can offer some insight as to what the pain might be caused by, why I'm getting isolated pain and if the gabapentin helps and I stop taking it after a month will the pain come back? He said when I follow up with him in a month he will refer me to a sports injury specialist if I'm still experiencing pain.

This pain has gotten in the way of everything, I can't walk my dog, I can't stand long enough to make dinner, I can't go to the gym, plant my garden, sit for over an hour, drive or lift anything. I wake up with pain and it worsens throughout the day. I'm going crazy. I can't take anti inflammatories cause I get sick (I've tried them all for bursitis and tendinitis). I just don't know what to do anymore, the pain is so depressing.

Help please

 

[David Baxter PhD]

Are you taking any medications at all other than those you've tried to help with the back pain? For example, medications for headaches, high blood pressure (hypertension), cholesterol, birth control or HRT, etc.?

Do you have any other medical conditions?

 

[Encyclojessica]

I'm taking trazedone for sleep, Wellbutrin and cipralex for depression, anxiety, BPD etc. I've been on those medications for years

 

[David Baxter PhD]

Thank you. Those are unlikely candidates for causing the type of pain you describe but make sure your doctors are aware that you are taking them - there are some rare side effects with various medications that are difficult to find in the drug compendiums.

Beyond that, soft tissue injuries are difficult to diagnose or verify. Did the pain begin with a specific event or injury? Have you had an ultrasound? Have you been checked for vascular health (e.g., using Doppler ultrasound or MRIs or similar procedures)?

Generally, when you're trying to investigate something like this, it's best to have it coordinated by your family doctor. Are you able to make appointments within a short period of time with your doctor?

 

[Encyclojessica]

There was no trauma or injury prior to the pain. I have had 2 bad falls but both for over 2 years ago. The only test that has been done was a urinalysis and an X-ray. My blood pressure has been checked and is fine, I'm 30 and in decent shape, I eat very well, no processed foods etc.

As for my family doc he can be hard to see at times because he is often away for a week and usually only works 3-4 days per week when he's in the office

 

[David Baxter PhD]

Back in 2007, I had an increase in peripheral pains and cramps primarily in my leg with no other symptoms. My blood pressure was also fine - but as it turns out that's because BP is usually measured in one of the arms.

The pain very suddenly became worse and by the time I went to the hospital my right foot was cold. It turned out that I had an arterial aneurism behind me knee that must have been developing for some time and this was shedding clots downward into the lower leg and foot. Eventually the small capillaries in the foot became clogged and suddenly I was in an emergency surgery situation.

Early diagnosis of a situation like this can be made with Doppler ultrasound or an MRI or CT scan but it's not likely to show up with a routine physical exam. At the very least, you'd need a comparative measure of blood pressure in both arms and at both ankles to reveal a problem.

A later experience of sudden back pain which gradually got worse and was not helped at all by the usual remedies (heat, cold, analgesics, muscle relaxants) eventually turned out to be a side-effect of Lipitor.

When anyone goes to a doctor, the likely initial response is try the obvious and rule out the simple before investigating further. But if the simple diagnoses and treatments don't help, you really should proceed to ruling out more complex (and often more serious and/or more difficult to diagnose) origins. An ER doctor or a doctor in a clinic rarely has the continuity of medical care and medical history to do this, especially if you're going from one doctor to the next where the records from the previous examination aren't likely to be available.

I am not trying to be alarmist here. I'm just pointing out that I too had always been healthy. I have no history or family history of heart disease and yet within a very short period of time worsening pain in one of my legs turned out to be a signal of a serious problem. Had I waited any longer to go to the hospital, I almost certainly would have lost my leg and had one of those clots managed to break off and be returned via a vein to my heart it could have been even worse.

Certainly, try the suggested solutions. But if you have no relief or only partial relief, don't leave it there. When a doctor prescribes a course of treatment, if s/he doesn't hear back to say it's not working the assumption will always be that it worked and the issue has been resolved.

 

[Budoaiki]

Hi Jessica,

I have some questions that may help you. First as Dr. Baxter asked when did you first notice it? You mentioned tendonItus and bursitis in what areas and for how long? Were those the result of traumatic injury or wear and tear?

Also the body is a remarkable thing sometime when dealing with injury your body compensates with sympathetic muscle sequences to perform normal movements to allow the injured area to heal. This can be affected by the balance electrolytes
(Which can be affected by digestion of medications that are often incased in baking powder for proper delivery and extra fluid is needed for your body to process baking powder and diuretics tea coffee ect which are easily replenished with a healthy diet).
, temperature, humidity and of course stress through blood pressure and physical tension. Also there are genetic factors as well is there a history of low back pain in your family, if your doctor hasn't already mentioned that. As has already been said muscle pain especially back pain is hard to diagnose as there are so many variables that can cause it and the amount of
Nerves branching from the spine.

I was diagnosed with fibromyalgia after a car accident and years of physio and numerous other things before finding the cause, which I am still dealing with so I can understand your frustration and I hope this helps

 

[forgetmenot]

MRI is the best way to see what is happening i have shooting pain crippling pain as well from my back down my leg It is sciatic nerve Neurontin works only thing that stops it some is Neurontin on 300mg three times day when i stop it the pain comes back Insist of getting more test ok doppler ultra sound and MRI don't let this go undiagnosed

 

[Encyclojessica]

I get tendinitis and bursitis in my hips and shoulders and tendinitis in my elbow. I have been told that the shoulder and hip problems are likely caused by being a gymnast for about 15 years. I have also had some very physically demanding jobs like landscaping, occasional construction work and tree planting. The tree planting is the worst one of them though. Last time I went I slipped and tore my MCL and that was when I fell from about 5 feet onto my butt, the dr told me I'd have to quit but I was too stupid/proud and I didn't. As far as family history I seem to be the only one with this problem. My mother was in a bad motorcycle accident and almost lost her leg so she certainly has hip and knee problems but it was caused by a trauma, not wear and tear like me. I have a very healthy diet, I don't consume coffee, tea, pop, energy drinks etc. I drink water and milk almost exclusively. I have about 5 alcoholic drinks per year so it's unlikely that dehydration is the issue. The lower back pain was not followed by any memorable event, no trauma, no lifting or anything like that. I have had lower back strain a few times before but it felt and acted much much differently. From my understandings doc plans on ordering an MRI if the gabapentin has not helped after 1 month. Although I understand the need to wait and see if this medication is helpful, realistically asking me to wait another month is just torture

 

[Budoaiki]

I feel for you Jessica,

I am glad they have an MRI scheduled those can take a while to get at least where I live it four month wait list. In the mean time do you still keep up with a regular stretching routine? Carefully adding in new moves could help test your range of motion and perhaps give you more info as well and help circulatory system as I am sure you already know. I use temperature, excursive and diet to manage mine and best I can meditation and martial arts exercises also help me keep up range of motion but It's still a roll of the dice when I do some activities if I'll have a flare up. I had an MRI they found an anatomical variant that made me more susceptible to low back injury that didn't show up In x-ray a small gap in S1 vertebrae. I hope they find the cause but be sure to go over the MRI results thoroughly with your doctor.

 

[AJensen89]

Meditation has always helped me. This is a fantastic thing. I try to do it every day, but of course it doesn't always work out. I hope you will be fine!