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Q. I never had an injury. Why do I still have persistent back pain?

Answered by
Dr. Ashaq Hussain Parrey
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 25, 2017

Hello doctor,

I am a 29 year old female. I have been dealing with back pain for over seven years now. I have never been in any type of injury and had MRIs done of my brain, cervical, lumbar, and thoracic spine five years ago. They stated I had three bulging discs and an annular tear. My thoracic spine noted a few scattered hemangiomas and a questionable small vascular anomaly in the midthoracic vertebral body. This is where my pain hurts the most. On the cervical spine MRI, it stated that I had a narrowing of the canal with degenerative disc disease with no spinal cord abnormality. My MRI of the brain came back fine with some inflammation within the paranasal sinuses and moderate lymph nodes in the neck which may be suspicious for shotty adenopathy.

My first positive ANA was four years ago with elevated antistreptolysin O Ab, but never have I had strep throat or ever been diagnosed or treated for it. I had my adenoids removed when I was young. My CBC was all normal except for a slightly deranged RBC and hematocrit levels that were lower than the normal range. My TSH was elevated at 5.870, but I believe I had that retested later on, and it was within normal limits. I was then referred to a rheumatologist due to the positive ANA and other symptoms that I was having. Their results concluded no elevation of dRVVT or a PTT and ruled Lupus screening negative due to my levels being within normal limits. My C3 is at 121, C4 is 31 and rheumatoid factor.

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#

Hello,

Welcome to icliniq.com.

I went through your post. You have not mentioned what you want to know and what your current problem is.

  • You have degenerative disc disease involving both cervical and dorsal spines; however, there is no significant canal stenosis. I am sure you are not also symptomatic for that as you have not mentioned any active symptoms related to it. You have had positive ANA, and the APLA (antiphospholipid antibodies) profile was negative.
  • I would suggest at least to follow a rheumatologist every six months yearly because a rheumatological illness especially the SLE (systemic lupus erythematosus) does not develop suddenly, but is a continuous process that evolves slowly.
  • So, you will need at least a few baseline investigations like urine examination for protein, CBC for a decrease in cell count, anti-DsDNA,(double-stranded DNA), C3, C4, and a clinical examination for rash, photosensitivity, and oral ulcers, etc.
  • If you have symptoms related to your degenerative disc disease, I would suggest you take sustained release Pregabalin 75 mg once at bedtime and calcium with vitamin D supplements. Consult your specialist doctor, discuss with him or her and take the medicines with their consent.

Regards.

For more information consult a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

Thank you doctor,

I do have symptoms of pain. I hurt every day. It is my mid thoracic spine that is painful, right over the spine itself and is also painful to touch. I guess what I am wanting to know is, can there be an underlying cause to why I have back pain and issues? Do you think that I need to get tested again for the elevated antistreptolysin O Ab to make sure there is not anything wrong? I am also a carrier of the G streptococcus bacteria, but I know that is seen in a percentage of normal people. I just do not know if any of this could be a rheumatic fever. Is there any possible way that I could be suffering from having strep throat from when I was younger and never treated for it turning into something long term?

#

Hello,

Welcome back to icliniq.com.

  • You have pain in the thoracic area where you had the prolapsed intervertebral disk as documented in the MRI (magnetic resonance imaging) (attachment removed to protect patient identity). Disc prolapse is an age-related process; however, you are only 23. But, one can still get PIVD (prolapsed intervertebral disc) even at 23 years of age, and it needs to be managed with medications unless it is causing neurological symptoms especially weakness at which point surgery is indicated.
  • The most common cause is wear and tear due to the routine work; however, sudden weightlifting can result in PIVD especially when you are young.
  • A Streptococcal test is not needed in your case. A streptococcal sore throat in young may rarely cause rheumatic fever, but it can be associated with pain and swelling in the peripheral joints of the knees, shoulders, ankles, and wrists, but not the back. It usually occurs between 5 to 18 years of age, and it results in heart valve abnormalities which can be confirmed by an echocardiography. That means you do not have a rheumatic fever.
  • To improve the quality of your life, you need proper physiotherapy from a trained physiotherapist. This will improve the healing of the prolapsed discs as this is not a permanent phenomenon.
  • Secondly, neuropathic pain medications like Gabapentin, Pregabalin, and Flupirtine are the first line medications that do not have adverse side effects. NSAIDs (nonsteroidal anti-inflammatory drugs) should be used only if the pain is severe and that too for short periods as they may result in gastric and renal side effects. Consult your specialist doctor, discuss with him or her and take the medicines with their consent

Hope my answer was helpful.

For more information consult a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist


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