[28F] With chronic upper back pain and skin changes

Patient Description

A 28-year-old female reports persistent upper back pain between the shoulders, lasting for months, with worsening intensity. The pain is constant and unresponsive to various treatments, including physical therapy, gabapentin, muscle relaxers, ice, massage, heat, and painkillers. The patient experiences muscle spasms and spinal pain, with a CT scan showing slight scoliosis. MRI of the cervical and lumbar regions were clear, but no MRI of the thoracic region was performed. The patient also notes the presence of small red dots on the skin, which have not spread or changed. There is slight numbness but no weakness in the arms or legs. The pain has significantly impacted daily activities and work. The patient has a family history of fibromyalgia but no personal history of autoimmune conditions. The patient is on Wellbutrin, Lexapro, hydrocodone, hydroxyzine, tizanidine, gabapentin, and Seroquel, and has a known adverse reaction to steroids.

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Arora's Assessment

What might be happening

Your symptoms of persistent upper back pain, muscle spasms, and red dots on your skin could be related to several conditions:

  1. Musculoskeletal Issues: The slight scoliosis noted on your CT scan might contribute to muscle strain and spasms. Scoliosis can cause imbalances in muscle tension, leading to discomfort.

  2. Fibromyalgia: Given your family history, fibromyalgia could be a possibility. It often presents with widespread pain and muscle spasms.

  3. Skin Changes: The red dots could be petechiae, which are small blood vessels that have burst. This can occur due to various reasons, including physical strain or medication side effects.

Typical treatments might include physical therapy, pain management strategies, and possibly further imaging or blood tests to rule out other conditions.

What you can do

For Back Pain and Muscle Spasms:

  • Continue with physical therapy exercises as recommended.
  • Use heat or ice packs to manage pain and reduce spasms.
  • Consider gentle stretching and relaxation techniques like yoga or tai chi.

For Skin Changes:

  • Monitor the red dots for any changes in size or spread.
  • Avoid scratching or irritating the area.

General Advice:

  • Keep a journal of your symptoms using MDandMe to track any changes or patterns.
  • Ensure you are following your medication regimen as prescribed and discuss any concerns with your doctor.

What you should look out for

  • If the red dots increase in number or change in appearance, seek medical attention.
  • Watch for any new symptoms like fever, significant weakness, or numbness.
  • If your pain becomes unbearable or significantly impacts your daily life, consult your healthcare provider.

Remember, it's important to follow up with your healthcare provider for a formal diagnosis and treatment plan.

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2 mo ago

People Also Ask

What could be causing persistent upper back pain that doesn't respond to treatment?

Persistent upper back pain that doesn't respond to treatment could be due to musculoskeletal issues like scoliosis, fibromyalgia, or other underlying conditions. It's important to continue working with your healthcare provider to explore further diagnostic options, such as imaging of the thoracic region or blood tests.

Could the small red dots on the skin be related to my back pain or medications?

The small red dots on your skin could be petechiae, which might be related to physical strain or a side effect of medications. It's important to monitor these spots for any changes and discuss them with your doctor, especially if they increase in number or change in appearance.

Is it possible that my family history of fibromyalgia is affecting my current symptoms?

Yes, your family history of fibromyalgia could be relevant, as fibromyalgia often presents with widespread pain and muscle spasms. Discussing this possibility with your healthcare provider can help in exploring appropriate treatment options.

What should I do if my symptoms worsen or new symptoms appear?

If your symptoms worsen or you experience new symptoms like fever, significant weakness, or increased numbness, it's crucial to seek medical attention promptly. Keeping a detailed journal of your symptoms can help your healthcare provider in assessing your condition and adjusting your treatment plan as needed.

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