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Q. Please advise treatment for persistent right lower back pain.

Answered by
Dr. Akshay Kumar Saxena
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 18, 2016 and last reviewed on: Nov 25, 2019

Hi doctor,

I had an injury in the left SI joint two years ago. Because of it, I am lying, walking and sitting only on my right side. Now left side is fine, but I have developed tingling and burning pain in the right lower back. My MRI, x-ray of spine and SI joints are normal. Blood tests for ankylosing spondylitis, RA factor, hemogram, LFT, KFT are normal. Pain in the right lower back continues. Pain is like pins and needles and also like burning. I had a bone scan done which showed some abnormalities. I have enclosed my bone scan report for your reference. Please advise the treatment for persistent pain in right lower back area.

#

Hi,

Welcome to icliniq.com.

  • You have mentioned injury to your left SI joint (sacroiliac joint) two years ago which is fine right now. But, you have not mentioned the exact nature of the injury and treatment received for it.
  • Also, your main problem right now is pain in the lower back region mainly towards the right side. In your case you have actually enclosed a bone scan report but initially I would like to see the following.
  • Your detailed clinical examination done by a qualified physical therapist or an orthopedic surgeon including detailed assessment of sensory, motor power and evaluation of deep tendon reflexes.
  • Also, x-rays of lower back region (anteroposterior and lateral - flexion and extension views) are needed and MRI scan of your lower back region.
  • Blood test reports including CBC (complete blood count), ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), serum vitamin D and B12 levels, serum electrolytes and besides them your inflammatory profile markers including RA factor (rheumatoid arthritis), Anti-CCP antibodies (anti-cyclic citrullinated antibodies), HLA B27 levels (human leukocyte antigen), etc., which you have already done

I also need from you few clinical details:

  1. What is the intensity of your lower back pain on a scale of 1-10?
  2. Apart from pain in the lower back, do you also have any pain radiating down in your legs or any other neurological symptoms like numbness, paresthesias, weakness in legs, etc?
  3. How much distance can you walk on a daily basis and what are your analgesic requirements?
  4. Apart from your back, do you have any stiffness in any other joints of the body also?
  • I have also gone through your bone scan report (attachment removed to protect patient identity) which is quite non-specific and mentions degeneration in multiple joints of your body including upper limbs, but there are no symptoms. So, we will concentrate on your lower back symptoms only.
  • Do let me know whether you have previously taken any long term treatment, any drug allergy, etc?

Differential diagnosis:

1. Mechanical back pain.
2. Inflammatory polyarthropathy or spondyloarthropathy.

Regarding follow up:

Follow up with the investigations reports to an orthopaedician and traumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist


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