Acute Low Back Pain and Related Symptoms: A Patient's Guide

Health Consultation

Hello, Dr.
Fang: I have several questions I would like to ask you:
1.
I have been troubled by unexplained left lumbar pain for a long time.
On a certain day last month, I experienced pain while standing and sitting, and I had to lie flat; otherwise, as soon as I got up, I would be in so much pain that I had to lie down again within a minute.
My family didn't know what was wrong with me and just let me cry in pain.
It was only at night that I asked my family to take me to the hospital, where I received three injections for pain relief, but they were ineffective.
The doctor then arranged for me to be hospitalized, and I was later diagnosed with "acute lumbar fasciitis." I was discharged five days later and rested at home for another five days.
During these ten days, I still found it difficult to sit or stand, fearing that the situation would happen again.
It has only recently improved a little.
I would like to ask, is this condition really what the doctor referred to as "acute lumbar fasciitis"?
2.
Additionally, I have recently been experiencing intermittent pain in my left temple, accompanied by soreness in the left side of my nose bridge, and I often have tinnitus.
Coincidentally, I have a cold, so I am unsure if there is any connection.
3.
Since last month, I have been experiencing a discharge resembling mucus during non-menstrual periods.
Sometimes it is clear, and at other times it appears yellow-green.
In more severe cases, it can be dark brown or nearly black, but it usually lasts only one or two days before returning to clear or yellow-green.
My gynecologist said this is a normal phenomenon during ovulation, but I have never experienced this before.
Is it related to sexual activity? Over the past week, it has become more severe, with continuous bleeding (which does not resemble menstruation and has no foul odor).
Sometimes it occurs in the morning and is absent in the afternoon, or there may be none all day and then it returns at night.
It comes and goes like this, and I am really troubled.
Medication has not helped.
I truly don’t know what to do.

Dan Gao Mei, 20~29 year old female. Ask Date: 2003/04/16

Dr. Fang Sijie reply Family Medicine

Dear Cake Sister,
A.
Myofascial Pain Syndrome is characterized by localized muscle pain accompanied by distinct trigger points and specific referred pain.
It can affect muscles, tendons, and ligaments throughout the body, but is most commonly found in the head, neck, shoulders, and lower back.
Typically, it presents as chronic muscle tightness or soreness, and applying pressure to the trigger points can elicit a sharp, electric-like response.
Patients often report feelings of fatigue, poor sleep, and stiffness or soreness upon waking in the morning.
B.
Headaches can be classified based on clinical symptoms as follows:
1.
Tension-type headache – the most common form, typically presenting as a band-like tightness around the head; patients may feel a sense of tightness and pulsation akin to a throbbing headache.
2.
Vascular headache – this type is purely a throbbing headache occurring in areas with large blood vessels, such as the temples and neck.
It is more common in women around their menstrual cycle due to hormonal changes that cause vasodilation.
Some patients may also experience this type after alcohol consumption or with changes in weather.
3.
Classic migraine – also a type of vascular headache.
4.
Traumatic headache – patients often have a history of head trauma, resulting in damage to the scalp, muscles, bones, or even the meninges, leading to scar tissue that frequently causes headaches, typically at the site of injury.
5.
Allergic headache – often occurring at night or in the early morning, this type is triggered by allergens, such as histamine, which can cause headaches, particularly in the morning.
6.
Headaches due to intracranial pathology – these are the headaches we are most concerned about.
They arise from increased intracranial pressure, which can stretch the meninges and cause pain.
Characteristics include a.
Severe headaches that differ from typical tension-type headaches and can only be relieved after the pressure is alleviated.
The severity of the headache correlates with intracranial pressure and may be accompanied by vomiting, which is a projection-type vomiting where the stomach shows no symptoms but expels its contents.
b.
Another type of headache due to brain pathology occurs at the site of the lesion; any condition that increases intracranial pressure, such as meningitis, encephalitis, brain tumors, hemorrhages, trauma, or surgery, can lead to headaches.
7.
Sudden severe headache – this is the most critical type to consider.
It occurs suddenly and is extremely intense; patients often recall the exact time it began.
This headache is so severe that it can lead to vomiting, confusion, and loss of consciousness, affecting the entire head and even extending to the neck and lower back.
This type of headache indicates a sudden increase in intracranial pressure, possibly due to subarachnoid hemorrhage, and these patients typically require immediate medical evaluation and surgical intervention.
C.
Abnormal uterine bleeding in women can have many causes, which vary with age.
It is advisable to consult a gynecologist for further evaluation.

Reply Date: 2003/04/16

More Info

Acute low back pain can be a debilitating condition that significantly impacts daily life. Understanding its causes, symptoms, and management strategies is essential for patients experiencing this issue. Based on your description, it seems you have been diagnosed with acute lumbar myofascitis, which is an inflammation of the muscles and fascia in the lower back. This condition can arise from various factors, including muscle strain, poor posture, or even trauma.

Understanding Acute Low Back Pain
1. Causes: Acute low back pain can result from muscle strains, ligament sprains, herniated discs, or conditions like myofascitis. In your case, the diagnosis of acute lumbar myofascitis suggests that the pain is likely due to muscle inflammation, possibly exacerbated by prolonged sitting or standing, improper lifting techniques, or sudden movements.

2. Symptoms: Common symptoms include localized pain in the lower back, which may radiate to the buttocks or thighs. Patients often report difficulty in standing or sitting for prolonged periods, and pain may worsen with movement. In severe cases, muscle spasms can occur, leading to a significant reduction in mobility.

3. Diagnosis: Diagnosis typically involves a thorough physical examination and a review of the patient's medical history. Imaging studies, such as X-rays or MRI, may be ordered if there is suspicion of structural issues like herniated discs or fractures.

Management Strategies
1. Rest and Activity Modification: Initially, rest is crucial to allow the inflammation to subside. However, prolonged bed rest is not recommended, as it can lead to muscle weakness. Gradually reintroducing light activities, such as walking, can help maintain mobility.

2. Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen or naproxen), can help reduce inflammation and alleviate pain. In some cases, stronger prescription medications may be necessary.

3. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can design a personalized exercise program that focuses on strengthening the core muscles, improving flexibility, and promoting proper posture. Techniques such as heat therapy, ultrasound, or electrical stimulation may also be employed to relieve pain.

4. Ergonomic Adjustments: Assessing and modifying your work environment can prevent further strain. Ensure that your workstation is ergonomically designed, with proper chair support and desk height to minimize stress on your back.

5. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, chiropractic adjustments, or massage therapy. While the evidence for these treatments varies, they may provide additional relief for some individuals.

Addressing Associated Symptoms
Regarding your additional symptoms, such as the pain in your left temple and nasal discomfort, these may be unrelated to your back pain. The temporal pain could be tension-related or even a migraine, especially if it is accompanied by ear ringing. It is advisable to consult a healthcare provider for a comprehensive evaluation.

The unusual discharge you mentioned could be related to hormonal changes or other gynecological issues. Since you have noted changes in your menstrual cycle and discharge, it is essential to follow up with your gynecologist for further evaluation, especially if the symptoms persist or worsen.

Conclusion
In summary, acute low back pain, particularly myofascitis, can be managed effectively with a combination of rest, pain management, physical therapy, and ergonomic adjustments. It is crucial to monitor any additional symptoms and consult with healthcare professionals to address them appropriately. If your condition does not improve or worsens, further diagnostic imaging or specialist referrals may be necessary to rule out other underlying conditions. Always prioritize open communication with your healthcare providers to ensure a comprehensive approach to your health concerns.

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