[25F] With chronic widespread pain and neurological symptoms

Patient Description

A 25-year-old female has been experiencing chronic low back pain for two years, initially linked to a disk protrusion at the L5-S1 level causing mild compression of the neural foramen. The pain has since spread to the hips, legs, and other areas, described as sharp, hot, throbbing, dull, and achy, with a severity of 8 out of 10. It is exacerbated by movement, weight-bearing activities, and prolonged sitting or lying down. Various treatments, including hydrocodone, meloxicam, duloxetine, lidocaine patches, ibuprofen, escitalopram, muscle relaxants, nerve blockers, pelvic floor therapy, and physical therapy, have been ineffective. The patient also experiences fatigue, lightheadedness, memory loss, impaired cognition, rapid heartbeat, and shortness of breath, with episodes of losing balance and confusion. There is difficulty walking, hand shakiness, and slurred speech. No known allergies, autoimmune diseases, or recent travel history. Current medications include Modafinil (400mg/day) and Escitalopram (20mg/day).

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Arora's Assessment

What might be happening

Your symptoms suggest a complex presentation that may involve multiple underlying issues. Here's a breakdown of what might be happening:

  1. Chronic Pain and Neurological Symptoms:

    • The chronic low back pain radiating to your leg and hips, along with the MRI findings of a disc protrusion at L5-S1, suggests nerve compression, which can cause pain, numbness, and weakness in the affected areas. This is often referred to as radiculopathy or sciatica.
    • The widespread pain, fatigue, and cognitive issues like brain fog and forgetfulness could be indicative of fibromyalgia, a condition characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues.
    • The shakiness, slurred speech, and difficulty walking could be related to neurological issues, possibly exacerbated by the nerve compression or another underlying condition.

  2. Lightheadedness and Cardiovascular Symptoms:

    • The lightheadedness, rapid heartbeat, and shortness of breath could be related to autonomic dysfunction, which affects the part of the nervous system that controls involuntary actions. This can sometimes occur in conjunction with chronic pain syndromes.
    • Anxiety or panic attacks can also cause similar symptoms, especially if you're experiencing stress related to your chronic pain.

What you can do

Pain Management:

  • Continue working with your healthcare provider to explore pain management strategies. This may include adjustments to your current medications or exploring other options like nerve blocks or alternative therapies.
  • Physical therapy can be beneficial, even if previous attempts haven't worked. Consider seeking a specialist in chronic pain or a different physical therapist for a fresh approach.
  • Gentle exercises, such as swimming or yoga, may help maintain mobility without exacerbating pain.

Cognitive and Neurological Symptoms:

  • Keep a journal of your symptoms using MDandMe to track patterns and triggers, which can be helpful for your healthcare provider.
  • Ensure you're getting adequate rest and managing stress, as these can impact cognitive function and overall well-being.

Lightheadedness and Cardiovascular Symptoms:

  • Stay hydrated and consider increasing your salt intake if advised by your doctor, as this can help with lightheadedness.
  • Practice slow, deep breathing exercises to help manage episodes of rapid heartbeat and shortness of breath.

What you should look out for

  • If you experience worsening neurological symptoms, such as increased difficulty walking, severe headaches, or changes in vision, seek medical attention promptly.
  • Any new or worsening symptoms, such as chest pain or fainting, should be evaluated by a healthcare professional as soon as possible.

Remember, while I can provide information and suggestions, it's important to consult with your healthcare provider for a formal diagnosis and personalized treatment plan.

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1 mo ago

People Also Ask

What is radiculopathy and how is it related to my symptoms?

Radiculopathy is a condition caused by compression or irritation of a nerve in the spine, leading to pain, numbness, or weakness radiating along the nerve. In your case, the disc protrusion at L5-S1 may be compressing nerves, causing the pain and neurological symptoms in your back, hips, and legs.

Could my symptoms be indicative of fibromyalgia?

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain, fatigue, and cognitive difficulties. Your symptoms of widespread pain, fatigue, and cognitive issues like brain fog could suggest fibromyalgia, but a healthcare provider would need to evaluate you for a formal diagnosis.

What is autonomic dysfunction and how might it relate to my cardiovascular symptoms?

Autonomic dysfunction involves the part of the nervous system that controls involuntary actions, such as heart rate and blood pressure. It can cause symptoms like lightheadedness, rapid heartbeat, and shortness of breath, which you are experiencing. This condition can sometimes occur alongside chronic pain syndromes.

How can I manage my chronic pain more effectively?

Managing chronic pain often requires a multi-faceted approach. This can include medication adjustments, physical therapy, and alternative therapies like yoga or swimming. Working closely with a healthcare provider to tailor a pain management plan to your specific needs is crucial.

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