Dr. Basuki Nath Bhagat
Family Physician
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have had chronic back pain and neck pain for a few years, worsening over time. For four months, I also felt chest tightness and chest discomfort while walking but no pain, I feel the need to clear the throat more frequently. My back pain is on the right side, and while lying down there is no pain. When bending to the right side, pain under the right lower rib cage. I did a cardiology evaluation, an echo, stress test, and ultrasound. All were found normal, and no remarks. My MRI of the thoracic Spine and lumbar spine are done and not remarkable. Chest x-ray, physician assistant, and oblique, KUB X-ray was done and found normal. Feels chest tightness when getting up after lying down for some time. No discomfort while lying down flat on the back. The blood test was done with inflammation markers, vitamin D, etc. The only finding is vitamin D is insufficient.
Thank you.
Hello,
Welcome to icliniq.com.
I saw the attached files (attachment removed to protect the patient's identity). MRI (magnetic resonance imaging) of the lumbar spine revealed:
1) Intervertebral disc dessication at L4-L5.
2) Mild facet joint arthrosis.
3) The exit foramina mildly narrowed bilaterally.
The above mentioned are the features of degenerative disc disease (DDD). Disc desiccation means degeneration of your disc; it begins to degenerate slowly as you age. The most common or initial sign of disc desiccation is usually stiffness in the back. Later on, if the nerve exit foramina are narrowed more, there may be tingling sensation or weakness of the back, etc. This is the reason for your chronic back pain. An MRI cervical spine revealed cervical spondylosis at level C4/C5 and C5/C6 generalized disc bulge, and mild narrowing of both exit foramina. This is responsible for your chronic neck pain.
In the blood test:
1) Rheumatoid factor and anti-CCP (anti-cyclic citrullinated peptides) are normal, which rule out rheumatoid disease.
2) ANA (antineuclear antibody) is negative, and ESR (erythrocyte sedimentation rate) is normal.
3) Kidney function test with electrolytes is normal.
4) Vitamin D is insufficient, and fasting blood sugar (FBS) is high.
Echo (echocardiogram) report is normal with a negative ECG (electrocardiography). It rules out any heart-related pathology for chest discomfort. I think your chest discomfort is also related to the cervical spine change.
I would suggest the following:
1) First of all, you should visit an orthopedic, neurologist, or neurosurgeon as a specialist doctor can guide you more appropriately.
2) Since you have symptoms of chronic back pain, you should maintain good posture while sleeping or sitting, avoid weight gain and physical activity, which triggers the lower back pain and neck pain.
3) Over-the-counter pain relieving medicine like tablet Ibuprofen or tablet Paracetamol, and skeletal muscle relaxant can help to reduce pain.
4) Take measures to control sugar levels as the fasting value is high.
5) Take a diet rich in calcium like milk and related products. I suggest vitamin D sachet (Cholecalciferol) to regulate your levels.
6) Visit a physical therapist to guide your posture and exercise and strengthen back muscles without triggering pain while performing exercises.
Hope you find my reply helpful.
Thank you.
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