Persistent back ache and pain


Q: History: 37 year old male. Generally healthy with no known diseases or conditions. I've had a bit of autoimmune type stuff in the past (irritable bowel, persistent pityriasis versicolor). Family history of autoimmune has lupus, father possible rheumatoid arthritis. Grandfather died of a connective tissue disease. I've also had some bloodwork that was a bit off....high ALT, elevated uric acid, slightly positive rheumatoid factor, elevated calcium, low vitamin D....results were generally just out of range with the exception of the vitamin D which was quite low. A neurologist put me on vitamin D and low grade nortriptyline (30mg) for migraines. Chronic history of migraine; headache pattern changed about six months ago, eventually had MRI with contrast that was all clear. No longer on the nortriptyline and headaches have improved.

I've had back pain for the past six weeks or so. It's there everyday and resembles sort of a dull ache. There are a couple tender points right on my spine. I don't remember injuring it and it is never a sharp pain or positionally or movement related. Worse at night when lying flat and though it doesn't wake me up, if I am awake I notice the pain. Sleeping position doesn't seem to make a difference. My wife is a physical therapist and she's given me some exercises and I've tried ice and heat. It involved my lower back a bit but seems to be concentrated on my mid-back. No other symptoms as far as weight loss or fevers, night sweats, etc. Am experiencing some fatigue but it's not horrible. The back pain is not debilitating but seems to be chronic and noticeable. Occasionally it feels like I'm breathing through a straw but that comes and goes. No chest pain at all. Any ideas?

Symptoms:  Dull, back pain can be all over. Sometimes tender spots right on spine, sometimes on the side as well, feels almost like a side stitch when exercising

A:   Hello,
Welcome to ATD. Thank you for the query.

With your description and family history, it is likely that you are suffering from ankylosing spondylitis.
In layman terms, one can describe it as a condition affecting the joints of Spine by bridging new bone between them. This differs it from flexibility hence the restricted range of motion. Over a period, one has to go through anti-inflammatory, disease-modifying medications along with exercises and physiotherapy.

You must be having pain relapses once in a while. It may be related to your unaccustomed activity or posture. So I would advise you to take Rest and improve posture till the pain subsides. The trick is not to do things that you fear would aggravate your symptoms, like excessive walking, working out, bending/leaning forward/backward or twisting back etc. You seem to have relief in forward bending which stretches your paraspinal muscles. That’s a good thing since it relieves muscle spasm.

The new bone formation if extends into canal carrying spinal cord may lead to stenosis. The pressure is taken by either the cord itself or the traversing or exiting spinal nerve. If you have symptoms like tingling numbness in one/both legs or pain radiating from behind your thighs up to toes, then lumbar canal stenosis is a possibility. Let me know if you have those.

Meanwhile, till you see your rheumatologist, refrain from any major physical activity, take adequate rest and use hot fomentation. Use medications under your physician’s guidance.

Hope this answer was informative. If you need more advice, I'm available for follow-up.
Good day.

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