What causes persistent low back pain in a heart patient?

Question

Hello doctor,

My father is a heart patient who has been experiencing persistent low back pain. I would like to provide a detailed overview of his medical journey so far:

We initially consulted an orthopedic specialist who diagnosed early osteoarthritic changes. He prescribed calcium supplements, but after two weeks, there was no improvement in my father's condition.

Following this, we sought the expertise of a physiotherapist who recommended an MRI scan. After reviewing the MRI report, the physiotherapist prescribed some physiotherapy sessions, which provided partial relief from the pain. However, upon reviewing the MRI report myself, I noticed three specific findings: bilateral psoas muscle issues, bilateral psoas abscess, and hemangioma.

To explore further options, we consulted a neurologist who advised my father to engage in normal exercises and use a belt for support.

Despite these consultations and treatments, my father's pain persists, primarily localized in his lower back. Notably, the pain tends to intensify after waking up in the morning or during the evening, but it does not affect his mobility while walking. As of today, the back pain has become notably severe, and it radiates from his back to his legs. Currently, my father also takes medications for heart and tuberculosis.

Given the complex nature of my father's condition and the persistence of his pain, we are seeking your expert guidance on the next steps. Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Based on the information provided, it appears he is dealing with a bilateral psoas abscess and spondylodiscitis, which is a concerning medical situation.

I would suggest the following:

Investigations: It is essential to conduct a comprehensive set of tests, including CBC (complete blood count), LFT (liver function tests), RFT (renal function tests), blood culture sensitivity, urine culture sensitivity, ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), and HbA1C.
MRI LS (magnetic resonance imaging - lumbar spine): This is crucial for a detailed evaluation of the lower spine. Make sure to include both contrast and non-contrast imaging.
Medical consultation: Seek immediate attention from a local doctor or specialist, as your father may require a course of intravenous antibiotics followed by oral antibiotics. This step is critical for addressing the abscess and infection.
Long-term management: Prepare for the possibility that your father may experience low back pain for an extended period. Pain management and monitoring will be essential.
Physiotherapy: Consider physiotherapy, with a focus on interferential therapy (IFT) for around 3-4 sessions. This can help with pain relief and muscle rehabilitation.
Strict rest: Ensure that your father gets ample rest to aid in his recovery.

This is a challenging situation, and timely medical attention is crucial. Kindly consult with a healthcare professional for a thorough assessment and personalized treatment plan.

I hope this helps you.

Thank you.