[48M] Experiencing neck pain, numbness, and fatigue

Patient Description

A 48-year-old male reports severe neck pain on the right side, extending into the shoulder, with a history of worsening at night and when looking down at his phone. The pain has been present for approximately 7 months and is associated with a clicking sound when moving the neck. The patient experiences numbness in the fingertips, particularly when smoking cigarettes or methamphetamine, and has muscle cramps and weakness that worsen with sleep. The cramps are rated 5/10 in severity and are triggered by kneeling or crouching. The patient has been using methamphetamine for 25 years, which he states is necessary for maintaining physical drive. Without it, he experiences extreme fatigue, sleeping for days at a time. The patient also reports a decline in long-distance vision over the past year, which he attributes to aging. There is no known history of pre-existing medical conditions, allergies, or medication use. The patient has a family history of thyroid issues and notes that fatigue is exacerbated after eating.

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Arora's Assessment

What might be happening

Based on the information you have provided, possible diagnoses include:

  • Chronic Pain Syndrome: This is a condition characterized by persistent pain that continues for longer than 3 to 6 months or beyond the normal healing time for an injury. Your symptoms of neck, arm, and shoulder pain, along with muscle cramps, stiffness, and weakness, could be indicative of this condition.

    • Treatment typically involves a combination of medications, physical therapy, and psychological therapy.
  • Substance Use Disorder: Your long-term use of alcohol, marijuana, and methamphetamines, along with your reliance on these substances for energy and drive, suggest a possible substance use disorder. This condition can cause a wide range of physical and psychological symptoms, including fatigue, muscle weakness, and changes in bowel and bladder function.

    • Treatment usually involves a combination of detoxification, counseling, medication, and long-term follow-up to prevent relapse.
  • Dehydration: Your symptoms of muscle cramps and stiffness, along with your admission that you don't drink water regularly, could be signs of chronic dehydration. This condition can cause a variety of symptoms, including fatigue, muscle cramps, and dizziness.

    • Treatment involves increasing your intake of fluids, particularly water.
  • Vision Changes: Your recent difficulty with long-distance vision could be due to presbyopia, a natural part of aging that affects your ability to focus on close objects. However, it could also be a sign of other eye conditions, such as cataracts or macular degeneration.

    • Treatment depends on the underlying cause and may involve glasses, contact lenses, or surgery.

Please note that these are possible diagnoses based on the information you have provided, and you should consult a healthcare professional for a formal diagnosis and treatment plan.

What you can do

  1. Consult a healthcare professional: Given the severity and duration of your symptoms, it's important to seek medical attention. A healthcare professional can provide a formal diagnosis and develop a treatment plan tailored to your needs.

  2. Stay hydrated: Try to drink at least 8 glasses of water per day, and more if you are physically active or it is hot outside.

  3. Seek help for substance use: If you're ready to seek help for your substance use, there are many resources available, including counseling, support groups, and medication.

  4. Regular eye check-ups: Regular eye exams can help detect vision problems early and keep your eyes healthy.

What you should look out for

Reasons to seek immediate medical attention:

  • If your pain becomes severe or unmanageable
  • If you experience severe dizziness or fainting
  • If you notice sudden changes in your vision
  • If you have difficulty breathing or chest pain
  • If you have thoughts of self-harm or suicide

Remember, 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 appropriate examination, testing, and care recommendations.

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10 mo ago

People Also Ask


What could be causing my neck pain and clicking sound when moving my neck?

The neck pain and clicking sound could be due to chronic pain syndrome or cervical spine issues, such as arthritis or a herniated disc. It's important to consult a healthcare professional for a proper diagnosis.


How does long-term methamphetamine use affect my physical health?

Long-term methamphetamine use can lead to a range of health issues, including muscle weakness, fatigue, cardiovascular problems, and neurological changes. It can also exacerbate existing conditions and lead to substance use disorder.


Why do I experience numbness in my fingertips, especially when using substances?

Numbness in the fingertips can be caused by nerve compression or damage, which might be exacerbated by substance use. It could also be related to poor circulation or other underlying health issues.


What are the possible reasons for my declining long-distance vision?

Declining long-distance vision could be due to presbyopia, a common age-related condition, or other eye conditions like cataracts or macular degeneration. An eye examination can help determine the cause and appropriate treatment.


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