Your Back Pain: When to See a Family Doctor

Q: Your Back Pain: When to See a Family Doctor

● There are many causes of lower back pain, with the majority being due to muscle strains in the lumbar region. <br>Most cases will recover within a few weeks, but there is a possibility of recurrence. <br>Given your age, pain during bending or exertion is primarily related to lo

I don't know which doctor to see?

Hello Doctor, I have been experiencing pain in my lower back and pelvis for over three months.
The pain occurs only when I perform certain movements, such as bending over, especially when exerting effort; when I’m not exerting myself, I feel fine.
Last month, on a particularly cold day, I experienced sharp pain, but at other times, it’s just a dull ache.

I was hospitalized for acute gastroenteritis on December 7, 2016, where blood and urine tests showed some abnormal results (neutrophils at 89.5, reference range 42-74; C-reactive protein at 5.78, reference range <5; urine protein 2+, urine occult blood 2+, and urine sediment showing 33 red blood cells, reference range <20).
The nurse asked if I was menstruating, but I said no, as it had been 9 days since my last period.
At that time, due to the gastroenteritis and fever, I didn’t eat much and my urine was very concentrated.

Now, I’m worried that there might be an issue with my kidneys.
I have seen an orthopedic doctor twice and a rehabilitation doctor once.
During my first visit, I had an X-ray for scoliosis that showed a 10-degree curve, and I also asked about my back pain.
The doctor advised me to exercise more.
The rehabilitation doctor also recommended more exercise, but I only run occasionally.
They mentioned that this is common among young people.

Aside from the back pain, I don’t have any other symptoms; there’s no numbness in my legs, night sweats, or anything else.
I sleep well at night and drink a lot of water, which leads to frequent urination.
My menstrual cycle is also regular.
I’m really unsure about what to do, as this has been troubling me for a long time!
Recently, I’ve noticed that the muscles or bones in my right thigh feel tight and stiff, but there’s no pain or impact on my mobility; it just feels strange.
I’ve checked and there’s nothing unusual upon palpation, but there is a very small lymph node in the groin area.
I consulted a surgeon who examined it and told me not to worry about that lymph node.
When I mentioned it to the orthopedic doctor, he said he didn’t know either and suggested I wait a while before following up.
I hope you can help me with these concerns.
Thank you, Doctor.

HAHA123, 10~19 year old female. Ask Date: 2017/02/08

Dr. Chen Taicheng reply Family Medicine

● There are many causes of lower back pain, with the majority being due to muscle strains in the lumbar region.
Most cases will recover within a few weeks, but there is a possibility of recurrence.
Given your age, pain during bending or exertion is primarily related to lower back muscle issues, followed by intervertebral disc problems.
If pain occurs during rotation or extension of the lumbar region, issues such as spinal joint problems or spondylolisthesis should be considered.
Since there are no neurological symptoms, the likelihood of spinal cord or nerve compression is low.
● A small number of cases may involve issues related to the kidneys or ureters (such as stones), or conditions within the pelvic cavity involving the uterus or ovaries (such as endometriosis), which can also cause lower back pain.
● In cases of gastroenteritis, abnormal blood and urine test results can be repeated after recovery to check for persistent abnormalities, which can help rule out the aforementioned urinary system diseases.
● Most inguinal lymph nodes are reactive and can be monitored for one to two months; if they persist, further evaluation by a general surgeon may be warranted.
(Regarding inguinal lymph nodes and scoliosis, I have provided a separate detailed response; please refer to https://goo.gl/VRHV3V) ● Issues in the lumbar region may also involve the right thigh; it is advisable to seek further evaluation from an orthopedic or rehabilitation specialist at a major hospital.
If no results are found, consider consulting a neurologist, urologist, or gynecologist to rule out potential causes.
Wishing you good health, Dr.
Chen Tai-Cheng, Family Medicine, Taoyuan Hospital.

Reply Date: 2017/02/08

More Info

When dealing with persistent back pain, especially in the lower back and pelvis, it is crucial to understand the potential underlying causes and when to seek further medical attention. Based on your description, it seems you have been experiencing discomfort for over three months, which is concerning enough to warrant a thorough evaluation by a healthcare professional.

Your symptoms, particularly the pain that occurs during specific movements such as bending and exerting effort, could be indicative of a musculoskeletal issue. This might include muscle strain, ligament sprain, or even a herniated disc. The fact that you mentioned a sharp pain during colder weather could suggest that your muscles or ligaments are sensitive to temperature changes, which is not uncommon. However, the absence of other symptoms such as numbness, tingling, or weakness in your legs is a positive sign, as these could indicate nerve involvement.

Given your medical history, including the acute gastroenteritis and the abnormal lab results from that time, it is understandable to be concerned about potential kidney issues. However, the symptoms you describe do not strongly suggest a kidney problem, especially since you are not experiencing any urinary symptoms like changes in frequency, urgency, or pain during urination. The presence of a small lymph node in the groin area, which your surgeon has evaluated and deemed not concerning, is also a good sign. Lymph nodes can sometimes become reactive due to various benign conditions, including infections or inflammation, and are not always indicative of a serious issue.

You mentioned that you have already seen orthopedic and rehabilitation specialists, who advised you to increase your physical activity. This is generally sound advice, as regular exercise can strengthen the muscles that support your spine and improve flexibility, potentially alleviating some of your pain. However, if you find that your pain persists despite these recommendations, it may be time to consider further evaluation.

Here are some steps you can take moving forward:
1. Follow-Up with Your Family Doctor: If you haven't already, schedule an appointment with your family doctor to discuss your ongoing symptoms. They can perform a comprehensive evaluation, including a physical examination and possibly imaging studies like X-rays or MRIs, to rule out any serious conditions.

2. Physical Therapy: If you haven't yet tried physical therapy, this could be beneficial. A physical therapist can provide you with tailored exercises to strengthen your back and core muscles, improve your posture, and teach you proper body mechanics to prevent further injury.

3. Pain Management: Discuss pain management options with your doctor. This could include over-the-counter pain relievers, prescription medications, or alternative therapies such as acupuncture or chiropractic care.

4. Lifestyle Modifications: Continue to stay active, but also consider incorporating low-impact exercises such as swimming or cycling, which can be easier on your back. Additionally, maintaining a healthy weight can reduce stress on your spine.

5. Monitor Symptoms: Keep a journal of your symptoms, noting when they occur, their intensity, and any activities that exacerbate or relieve the pain. This information can be valuable for your healthcare provider in determining the best course of action.

In conclusion, while your symptoms may not currently indicate a serious underlying condition, it is essential to remain vigilant and proactive about your health. Persistent pain should not be ignored, and seeking further evaluation from your family doctor or a specialist is a prudent step. They can help you navigate this issue and develop a comprehensive treatment plan tailored to your needs. Remember, early intervention can often lead to better outcomes and a quicker return to your normal activities.

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