[21F] Experiencing back pain and appetite issues

Patient Description

A 21-year-old female presents with constant dull and sharp pain in the lower to upper back, exacerbated by physical activity, such as work, resulting in sharp stabbing pains. The pain has been present for approximately 2-6 weeks and gradually worsened over time. The patient also reports appetite issues, with difficulty eating, headaches, runny nose, fever, shortness of breath, nausea, and phlegm. Despite multiple consultations and diagnostic tests, including a CT scan, ultrasound, blood tests, and urine tests, no abnormalities were found. The patient denies any recent injuries, physical strain, muscle tenderness, weakness, or numbness in the limbs. There has been recent weight loss attributed to decreased appetite. The patient has irregular menstrual cycles due to SubQ Provera Shot birth control, which she used for four years, discontinued for a year, and has recently resumed. No changes in symptoms have been noted since restarting the birth control. The patient denies use of tobacco, alcohol, or recreational drugs and has not traveled recently.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations:

  1. Musculoskeletal Issues: The sharp, stabbing pains in your back that worsen with movement could be related to musculoskeletal problems such as muscle strain or inflammation. These issues can sometimes be difficult to detect on imaging tests like CT scans or ultrasounds.

  2. Appetite Issues and Nausea: Your loss of appetite and nausea could be related to a gastrointestinal issue or even stress and anxiety, which can affect your digestive system.

  3. Respiratory Symptoms: The runny nose, fever, shortness of breath, and phlegm suggest a possible respiratory infection, such as a viral or bacterial infection. These symptoms can sometimes cause referred pain in the back, especially if there is inflammation near the lungs.

  4. Unifying Diagnosis: While it's challenging to pinpoint a single unifying diagnosis without further information, a viral infection could potentially explain many of your symptoms, including fever, respiratory issues, and general malaise.

It's important to follow up with a healthcare provider for a thorough evaluation, as they can provide a formal diagnosis and appropriate treatment.

What you can do

For Back Pain:

  • Consider gentle stretching exercises to help alleviate tension in your back muscles.
  • Apply heat or cold packs to the affected area to reduce pain and inflammation.
  • Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may help manage the pain, but consult with a healthcare provider before starting any medication.

For Appetite Issues and Nausea:

  • Try eating small, frequent meals throughout the day instead of large meals.
  • Opt for bland, easy-to-digest foods like crackers, toast, or rice.
  • Stay hydrated by sipping on clear fluids like water, broth, or herbal tea.

For Respiratory Symptoms:

  • Rest and allow your body to recover.
  • Use a humidifier to keep the air moist, which can help ease congestion.
  • Over-the-counter medications, such as decongestants or antihistamines, may provide relief for runny nose and congestion.

Consider using MDandMe to journal your symptoms, track your progress, and share your medical notes with your healthcare provider.

What you should look out for

Seek medical attention if you experience any of the following:

  • Severe or worsening pain that does not improve with rest or over-the-counter medications.
  • Difficulty breathing or shortness of breath that worsens.
  • Persistent fever or symptoms that do not improve over time.
  • Any new or concerning symptoms that arise.

Remember, it's important to consult with a healthcare professional for a comprehensive evaluation and personalized medical advice.

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People Also Ask


What could be causing my back pain if imaging tests show no abnormalities?

Back pain without abnormalities on imaging tests could be due to musculoskeletal issues such as muscle strain or inflammation, which might not always be visible on scans. It's important to consider other factors like posture, physical activity, and stress.


How can stress or anxiety affect my appetite and cause nausea?

Stress and anxiety can impact the digestive system by causing changes in appetite, leading to nausea and difficulty eating. This is because stress can affect the hormones and neurotransmitters that regulate digestion.


What are some common symptoms of a respiratory infection?

Common symptoms of a respiratory infection include a runny nose, fever, shortness of breath, cough, and phlegm production. These symptoms can vary depending on whether the infection is viral or bacterial.


How can birth control like the SubQ Provera Shot affect menstrual cycles?

The SubQ Provera Shot, a form of hormonal birth control, can cause changes in menstrual cycles, including irregular periods or even the absence of periods. These effects can persist for some time after discontinuation and may resume upon restarting the shot.


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