[42F] With severe lower back pain radiating to leg and numbness

Patient Description

A 42-year-old female presents with excruciating pain on the left side of her lower back that radiates down to her foot, persisting for a little over a month. The pain originated in the middle of her spine and has progressively worsened, making it difficult for her to walk or stand for extended periods. She cannot lay down at night due to the severity of the pain and has to sleep sitting up. The patient reports frequent numbness in her left foot, especially when driving for long periods, and recently noticed numbness on the right side of her face and neck. The pain in her leg is rated around a seven, while the sensitivity in her lower back is a ten. She has not experienced any leg weakness, changes in bowel or bladder function, or fever and chills, but has had muscle spasms in her back and leg. The patient smokes cigarettes and takes around 15 tablets of 200 mg ibuprofen daily for pain management, along with using muscle creams like Bengay or Icy Hot. An X-ray performed by a chiropractor indicated a herniated disc. She has no pre-existing conditions, chronic illnesses, or known drug allergies.

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Arora's Assessment

What might be happening

Based on the information you have provided, the most likely diagnosis is:

  • Herniated Disc: This occurs when the soft cushion of tissue between the bones in your spine pushes out. This can cause severe pain, numbness, and weakness in the affected area. The pain radiating from your lower back down to your foot, along with numbness, is consistent with sciatica, which is often caused by a herniated disc pressing on the sciatic nerve.
    • Typical Treatments: Treatment often includes physical therapy, pain relief medications, and sometimes corticosteroid injections. In severe cases, surgery may be necessary to remove or repair the herniated portion of the disc.

What you can do

While you should definitely consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take to help manage your symptoms:

  1. Pain Management: Since you are already taking ibuprofen, ensure you are not exceeding the recommended daily dosage. Overuse of NSAIDs like ibuprofen can lead to serious side effects, including gastrointestinal issues. Consider discussing alternative pain management options with your doctor.
  2. Physical Therapy: Gentle exercises and stretches can help relieve pressure on the sciatic nerve. A physical therapist can guide you through exercises tailored to your condition.
  3. Heat and Cold Therapy: Applying heat or cold packs to the affected area can help reduce inflammation and alleviate pain.
  4. Posture and Ergonomics: Pay attention to your posture, especially when sitting or driving. Use supportive seating and avoid prolonged periods of sitting or standing.
  5. Rest and Activity Modification: While it's important to stay active, avoid activities that exacerbate your pain. Rest when needed, but try to keep moving gently to prevent stiffness.
  6. Symptom Tracking: Use MDandMe to journal your symptoms, track your progress, and share longitudinal medical notes with your healthcare provider. This can help in tailoring your treatment plan.

What you should look out for

Seek medical attention more urgently if you experience any of the following:

  • Severe or Worsening Pain: If your pain becomes unbearable or significantly worsens.
  • Loss of Bowel or Bladder Control: This could indicate a more serious condition called cauda equina syndrome, which requires immediate medical attention.
  • Increased Numbness or Weakness: If you notice increased numbness, tingling, or weakness in your leg or foot.
  • Fever or Chills: These could indicate an infection or other serious condition.

Remember, while these tips can help manage your symptoms, they are not a substitute for professional medical advice. Please consult a healthcare provider for a formal diagnosis and appropriate treatment plan.

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5 mo ago

People Also Ask

What are the common symptoms of a herniated disc?

Common symptoms of a herniated disc include severe back pain, pain that radiates down the leg (sciatica), numbness or tingling in the affected area, and sometimes weakness in the leg or foot. The pain often worsens with movement and can make it difficult to perform daily activities.

How can I manage pain from a herniated disc at home?

To manage pain from a herniated disc at home, you can use heat and cold therapy, practice gentle stretching and exercises as recommended by a physical therapist, maintain good posture, and avoid activities that worsen the pain. Over-the-counter pain medications can also help, but it's important to use them as directed.

When should I seek urgent medical attention for back pain?

You should seek urgent medical attention if you experience loss of bowel or bladder control, severe or worsening pain, increased numbness or weakness in your leg or foot, or if you develop fever or chills, as these could indicate a more serious condition.

What are the risks of taking too much ibuprofen for pain management?

Taking too much ibuprofen can lead to serious side effects such as gastrointestinal bleeding, ulcers, kidney damage, and increased risk of heart attack or stroke. It's important to follow the recommended dosage and consult with a healthcare provider for alternative pain management options if needed.

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