[30F] With chronic back pain, fatigue, and potential carpal tunnel syndrome

Patient Description

A 30-year-old female presents with chronic, persistent lower back pain that radiates and is described as a dull, achy sensation, rated as an 8 on the pain scale depending on the day. The pain is exacerbated by work, gym activities, and general movement, and is particularly severe in the morning and at night. The patient has a history of depression, anxiety, and chronic migraines, which are often associated with her menstrual cycle and present with aura, light sensitivity, and nausea. She is currently taking 20mg of Lexapro for depression and anxiety, and rizatriptan as needed for migraines. She reports no relief from high-strength ibuprofen for her back pain, and stretching provides only minimal relief. Additionally, the patient experiences hand and wrist pain, with noted weakness and achiness, particularly in the joints, which has been present for less than a year. No recent injuries have been reported, and there is no known family history of musculoskeletal or autoimmune conditions, except for carpal tunnel syndrome in her mother. The patient has not experienced any recent unexplained weight loss, fevers, or chills.

Arora's Assessment

What might be happening

Based on the information you've provided, possible explanations for your symptoms include:

Musculoskeletal Strain: Given your history of heavy lifting at the gym and a new job in production, it's possible that your back and hand pain could be due to musculoskeletal strain. This typically presents as a dull, aching pain that worsens with movement and improves with rest.
- Treatment usually involves rest, physical therapy, and over-the-counter pain relievers.
Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. It's often considered when there's a history of chronic body pain, fatigue, and depression/anxiety, as you've described.
- Treatment often involves a combination of medications, exercise, stress-reduction measures, and cognitive-behavioral therapy.
Carpal Tunnel Syndrome: This condition, often linked to repetitive hand movements, can cause pain, numbness, and weakness in the hand and wrist, which you've reported. It's more common in women and can be associated with other conditions like hypothyroidism, diabetes, and rheumatoid arthritis.
- Treatment can range from rest and splinting to corticosteroid injections or surgery in severe cases.

What you can do

Schedule an appointment with your primary care provider to discuss your symptoms. They may refer you to a specialist, such as a rheumatologist, for further evaluation.
Try to maintain a regular sleep schedule to help manage your fatigue.
Consider gentle exercises like yoga or swimming, which can help with body pain and stiffness.
Over-the-counter pain relievers may help with your pain, but always check with a healthcare provider before starting a new medication.

What you should look out for

If your pain becomes severe or debilitating
If you develop new symptoms, such as a fever, unexplained weight loss, or severe fatigue
If your symptoms significantly interfere with your daily activities

Please remember that while I strive to provide accurate information, I'm an AI and my advice should not replace a consultation with a healthcare provider.

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10 mo ago

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