Q. I have lower and upper back pain for the past two years. Please help.

Answered by
Dr. Naval Mendiratta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 05, 2019

Hello doctor,

For the last two years, I have back pain in the upper and lower region. I am uploading here with my reports for your reference. Please suggest diagnosis and medicines to cure this disease.

Dr. Naval Mendiratta



Welcome to icliniq.com.

I have gone through your reports. (attachment removed to protect patient identity).

I would like to ask you a few more queries to see where your disease is heading for. We do have a limitation of clinical examination, but I would do my best to guide you here.

When is the pain more? Is it the morning time or constant throughout the day? Do you have difficulty in turning position at night? Any family history of similar complaints? Any history of redness of eyes or disturbed bowel habits? Do you wake up well in the morning or you feel your body is stiff? Do let me know these queries.

As per your lab reports, most of them are fine except for a couple of things.

1. CRP (C-reactive protein) levels are not done which are important markers for arthritis.

2. HLA-B27 (human leucocyte antigen) has been done by an outdated technique. We prefer doing it by PCR. Never the less let me know these queries and I would guide you to the next best investigation.

Probable diagnosis:

? Spondyloarthropathy.

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Thank you doctor,

The answers to your queries are:

The pain is more when constantly seating after two to three hours and at night before sleeping as well as when the climate is cool. I do not have any difficulty in turning position at night. Regarding family history, my mom is having arthritis, and yes I have disturbed bowel habits, taking much time. I wake up well in the morning but there is little stiffness in the lower back and in the left leg toe.

Please suggest what further tests need to do and medicines?

Dr. Naval Mendiratta



Welcome back to icliniq.com.

Well, as per your clinical symptoms it looks more of a degenerative disease than an inflammatory one. When it comes to the spine, we approach it in two ways. Either there is a lot of inflammation for which you got the test done but it does not match your symptoms. Another way is the disc problem or the nerve problem. I would suggest you go for an MRI (magnetic resonance imaging) of the whole spine along with the focus on dedicated parts where there is a problem. Also meanwhile get a physiotherapist to help you as they will speed up the recovery part.

Once you have the MRI do let me know and we can plan further treatment for you.

Investigations to be done:

MRI Screening of the whole Spine (if any problem at a specific part, dedicated images of that part).

Differential diagnosis:

Mechanical backache.

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