Chronic Back Pain: Key Medical Insights and Tests Explained

Q: Chronic Back Pain: Key Medical Insights and Tests Explained

Hello Ah-Gui： A urine test must be conducted using midstream urine for the results to be of reference value. <br>The determination of whether it is midstream urine is based on the number of epithelial cells present. <br>Your report shows a count of 10-15, which is considered too

Unresolved issues?

Hello Doctor: I have been experiencing chronic lower back pain and have a history of injury.
Recent test results show the following (urinalysis): hematuria reaction is +/- (normal reference is negative), urinary tract inflammation indicator is 1+ (normal reference is negative), (urine sediment microscopy) white blood cells 5-6 (normal is 0-5), epithelial cells 10-15 (normal is 0-5).
(Fatigue test) immunoglobulin protein is 101.6 (normal is <55).
(Blood tests) hemoglobin level is 11.3 (normal is 12.0-15.0), hematocrit is 33.60 (normal is 35.0-45.0).

Could my chronic lower back pain be related to the above issues? I have previously consulted a traditional Chinese medicine doctor who suggested an ultrasound to check for possible stones.
Do you think that is necessary? Could you please provide a brief explanation of the four conditions mentioned above? Thank you.

A Gui, 20~29 year old female. Ask Date: 2004/10/04

Dr. Tang Jieru reply Internal Medicine

Hello Ah-Gui: A urine test must be conducted using midstream urine for the results to be of reference value.
The determination of whether it is midstream urine is based on the number of epithelial cells present.
Your report shows a count of 10-15, which is considered too high, indicating that this test report may not be reliable.
It is possible that the testing personnel did not explain this clearly to you.
I recommend that you undergo the test again.
As for your lower back pain, if it is located in the center, it is less likely to be related to kidney issues; however, if it is on either side or unilateral (left or right), and accompanied by occasional hematuria, it could potentially be caused by kidney stones.
If you have had multiple urine tests showing positive for occult blood, this should be taken into consideration.
Ultrasound and pyelography are both excellent tools for confirming the diagnosis.
Thank you for your inquiry.
Wishing you health and happiness.

Reply Date: 2004/10/04

More Info

Chronic back pain can be a complex issue, often stemming from various underlying causes. Based on the information you've provided regarding your medical history and recent test results, it seems there are several factors to consider.

Understanding Your Test Results
1. Urine Analysis:
- Blood in Urine (Hematuria): The presence of blood in your urine, indicated by a +/- reaction, can suggest several conditions, including urinary tract infections (UTIs), kidney stones, or other renal issues. While this may not directly relate to your back pain, if there is a kidney issue, it could potentially cause referred pain to the lower back.

- White Blood Cells (WBCs): A count of 5-6 WBCs in urine suggests a possible infection or inflammation in the urinary tract, as the normal range is 0-5. This could be indicative of a UTI, which can sometimes cause discomfort in the lower back.

- Epithelial Cells: The presence of 10-15 epithelial cells is generally not alarming, but it can indicate some irritation or inflammation in the urinary tract.

- Immunoglobulin Levels: An elevated level of immune protein (101.6, with a normal reference of <55) could indicate an inflammatory process occurring in the body. This might not be directly related to your back pain but could suggest an underlying condition that needs further investigation.

- Blood Counts: Your hemoglobin level (11.3) is slightly below the normal range (12.0-15.0), which could indicate anemia. Anemia can lead to fatigue and weakness, potentially exacerbating the perception of pain.

Connection to Chronic Back Pain
Chronic back pain can arise from various sources, including musculoskeletal issues, nerve compression, or even referred pain from internal organs. Given your history of injury and the current test results, it is plausible that:
- Musculoskeletal Issues: Previous injuries can lead to chronic pain due to muscle strain, ligament damage, or disc problems. If you have not had imaging studies like an MRI or CT scan, it may be beneficial to assess for any structural abnormalities in the spine.

- Referred Pain: Conditions affecting the kidneys or urinary tract can cause pain that radiates to the lower back. If your urine analysis indicates a UTI or kidney stones, treating these conditions may alleviate some of your back pain.

- Inflammatory Conditions: The elevated immunoglobulin levels suggest some form of systemic inflammation, which could be contributing to your pain. Conditions like autoimmune diseases or infections could be at play.

Recommendations
1. Further Testing: Given the potential connection between your urinary symptoms and back pain, it would be wise to follow your doctor's advice regarding ultrasound examinations to check for kidney stones or other abnormalities. Imaging studies can provide valuable insights into the structural integrity of your spine and surrounding tissues.

2. Consultation with Specialists: Consider seeing a urologist for your urinary symptoms and a spine specialist or orthopedic doctor for your back pain. They can provide a comprehensive evaluation and tailor a treatment plan based on your specific needs.

3. Physical Therapy: Engaging in physical therapy may help strengthen the muscles supporting your back, improve flexibility, and reduce pain. A physical therapist can design a program that addresses your specific pain patterns and functional limitations.

4. Pain Management: Depending on the severity of your pain, your doctor may recommend medications, including non-steroidal anti-inflammatory drugs (NSAIDs) or other pain relief options.

5. Lifestyle Modifications: Maintaining a healthy weight, practicing good posture, and incorporating regular low-impact exercise can also contribute to managing chronic back pain.

Conclusion
Chronic back pain can be multifactorial, and understanding the underlying causes is crucial for effective management. Your recent test results suggest potential urinary issues that may be related to your back pain. It is essential to follow up with appropriate specialists and consider further imaging studies to clarify the diagnosis and guide treatment. Always communicate openly with your healthcare providers about your symptoms and concerns to ensure comprehensive care.

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