[47F] Experiencing severe and worsening back pain

Patient Description

A 47-year-old female has been experiencing severe and progressively worsening back pain for a few weeks. The pain is present in the shoulder, center back, and lower back. Attempts to alleviate the pain with patches, ibuprofen, meloxicam, heat, and massage have been unsuccessful. The pain is exacerbated by sitting and worsens throughout the day, especially in the morning. Additionally, the patient is experiencing severe pain in the right shoulder, radiating down the arm just below the elbow. There is no reported relief from any interventions. The patient also reports a fever and lack of appetite, along with changes in urine color and presence of blood. No recent injuries, loss of bowel or bladder control, or weakness or numbness in the legs have been reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are a few possibilities:

  • Musculoskeletal Pain: This is often due to strain or overuse, and can cause pain in the back, shoulder, and arm. It's usually associated with specific movements or postures, and can be worse in the morning or after long periods of inactivity.

    • Treatment often involves physical therapy, pain management with over-the-counter or prescribed medications, and lifestyle modifications such as improving posture and ergonomics.
  • Kidney Infection or Stones: These conditions can cause severe back pain and can be associated with changes in urine, nausea, and fever. Kidney stones can cause sharp pain that may come in waves, while an infection is usually a constant ache.

    • Treatment for kidney stones can range from pain management and drinking lots of fluids to help pass the stone, to medical procedures to remove or break up larger stones. Kidney infections typically require antibiotics.
  • Gallbladder Disease: This can cause pain in the right shoulder and between the shoulder blades, along with nausea and changes in appetite. It's usually triggered by eating, especially fatty foods.

    • Treatment can range from dietary changes to surgery to remove the gallbladder.

What you can do

Given the severity of your symptoms and their persistence, it's important to seek medical attention as soon as possible. A healthcare professional can conduct a thorough examination and order tests such as blood work, imaging, or a urinalysis to help determine the cause of your symptoms.

What you should look out for

If your symptoms persist or worsen, or if you develop new symptoms such as severe abdominal pain, vomiting, blood in your urine, or difficulty breathing, seek immediate medical attention. These could be signs of a more serious condition that needs urgent treatment.

Please remember that this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for accurate information.

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10 mo ago

People Also Ask


What could be causing severe back and shoulder pain that doesn't improve with common treatments?

Severe back and shoulder pain that doesn't improve with common treatments could be due to musculoskeletal issues, kidney problems, or gallbladder disease. It's important to consult a healthcare provider for a proper diagnosis.


How can changes in urine color and the presence of blood be related to back pain?

Changes in urine color and the presence of blood can be related to kidney issues, such as infections or stones, which can also cause back pain. These symptoms should be evaluated by a healthcare professional.


What are the symptoms of a kidney infection or stones, and how are they treated?

Symptoms of a kidney infection or stones include severe back pain, changes in urine, fever, and nausea. Treatment may involve antibiotics for infections or procedures to remove or break up stones.


When should someone with persistent back pain and additional symptoms seek immediate medical attention?

Immediate medical attention should be sought if symptoms persist or worsen, or if new symptoms like severe abdominal pain, vomiting, or difficulty breathing develop, as these could indicate a serious condition.


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