[20F] With severe lower back pain, nausea, and other systemic symptoms

Patient Description

A 20-year-old female has been experiencing severe lower back pain radiating down her legs and sometimes up to her neck and shoulders, causing headaches. The pain is described as a combination of grinding bones, electrical shocks, and being punched in the joints. This pain has been constant for about a week and is rated 7 out of 10 in severity. Various methods for relief, including pain medication, hot/cold showers, baths, massages, and a heating pad, have been ineffective. Additionally, the patient reports severe nausea, unable to keep anything down except water. She wakes up sweating at night, even in a cold room, with sweating significant enough to drip from unusual spots. She also experiences dizziness, feeling lightheaded whether lying down, sitting, or standing, with a severity of 7 out of 10. There is also shortness of breath at random times during the day, numbness in her legs when attempting to walk, and weakness in her arms. There have been no recent injuries or accidents, no changes in bladder or bowel control, no fever, and no unexplained weight loss. The patient has no pre-existing conditions or chronic illnesses and is not currently taking any medications.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, several potential conditions could be contributing to your discomfort:

  • Sciatica: This condition occurs when the sciatic nerve is compressed, often due to a herniated disc or spinal stenosis. It can cause severe lower back pain that radiates down the legs, and sometimes up to the neck and shoulders. The pain can be sharp and electric, similar to what you're describing.

    • Treatment: Physical therapy, anti-inflammatory medications, and sometimes corticosteroid injections. In severe cases, surgery may be required.
  • Fibromyalgia: This is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. It can also cause headaches, dizziness, and sleep disturbances.

    • Treatment: Medications like pain relievers, antidepressants, and anti-seizure drugs. Lifestyle changes, including exercise and stress management, can also help.
  • Spinal Disc Herniation: A herniated disc can press on nerves in your spine, causing pain that radiates to other parts of your body, including your legs and neck. This can also lead to numbness and weakness.

    • Treatment: Physical therapy, pain medications, and in some cases, surgery.
  • Meningitis: Although less likely, the combination of severe headaches, neck pain, and fever-like symptoms (night sweats) could indicate meningitis, an infection of the protective membranes covering the brain and spinal cord.

    • Treatment: Immediate medical attention is required. Treatment typically involves antibiotics or antiviral medications.
  • Chronic Fatigue Syndrome (CFS): This condition is characterized by extreme fatigue that doesn't improve with rest and may worsen with physical or mental activity. It can also cause muscle pain, headaches, and dizziness.

    • Treatment: Symptom management through medications, cognitive behavioral therapy (CBT), and graded exercise therapy.

What you can do

While you should see a healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Rest: Try to get as much rest as possible to help your body recover.
  2. Stay Hydrated: Continue drinking water to stay hydrated, especially since you're experiencing nausea.
  3. Gentle Stretching: Engage in gentle stretching exercises to relieve some of the tension in your muscles.
  4. Over-the-Counter Pain Relievers: Although you've tried some, consider alternating between different types (e.g., ibuprofen and acetaminophen) to see if that provides more relief.
  5. Seek Support: Ask friends or family for help with daily tasks to avoid straining yourself further.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Severe or worsening pain: If your pain becomes unbearable or significantly worsens.
  • Inability to walk or move: If you completely lose the ability to walk or move your legs.
  • High fever or chills: If you develop a high fever or chills, which could indicate an infection.
  • Severe headache with neck stiffness: This could be a sign of meningitis and requires urgent medical attention.
  • Difficulty breathing: If your shortness of breath worsens or you feel like you can't breathe.

Please consult a healthcare provider as soon as possible to get a formal diagnosis and appropriate treatment. Your symptoms are concerning and warrant professional medical evaluation.

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6 mo ago


People Also Ask


What could be causing severe lower back pain that radiates down the legs and up to the neck and shoulders?

Severe lower back pain radiating down the legs and up to the neck and shoulders could be caused by conditions such as sciatica, spinal disc herniation, or fibromyalgia. These conditions can lead to nerve compression or widespread musculoskeletal pain.


Why might someone experience severe nausea and night sweats without a fever?

Severe nausea and night sweats without a fever could be related to conditions like fibromyalgia or chronic fatigue syndrome, which can cause systemic symptoms. It's important to rule out other causes such as infections or hormonal imbalances.


What are the potential causes of dizziness and lightheadedness in various positions?

Dizziness and lightheadedness in various positions can be caused by several factors, including dehydration, low blood pressure, or conditions like chronic fatigue syndrome or fibromyalgia. It's important to monitor these symptoms and consult a healthcare provider for a thorough evaluation.


How can numbness in the legs and weakness in the arms be related to back pain?

Numbness in the legs and weakness in the arms can be related to back pain if there is nerve compression, such as in the case of a herniated disc or sciatica. These conditions can affect nerve signals, leading to sensory and motor symptoms.


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