[57M] With severe lower back pain and radiating leg symptoms

Patient Description

A 57-year-old male has been experiencing severe, sharp lower back pain for the past two days. The pain worsens with walking or lying down and has been constant without relief. Painkillers and muscle relaxers have not been effective. The patient has had trouble sleeping for the past day due to the pain. The pain radiates down the legs, accompanied by a little numbness, tingling, and weakness in the legs. There have been no changes in bowel or bladder function. The patient has a history of a pinched back nerve and was diagnosed with diabetes two years ago. He does not use tobacco, alcohol, or recreational drugs and has no dietary restrictions or recent travel history. Current medications include Carisoprodol (unspecified dosage) and Tylenol every 4 hours. No known drug allergies.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Sciatica: This condition occurs when the sciatic nerve, which runs from your lower back down to your legs, is compressed or irritated. It can cause sharp pain, numbness, tingling, and weakness in the lower back and legs. Given your history of a pinched back nerve, this could be a likely cause.

    • Treatment: Treatment often includes physical therapy, medications for pain relief, and sometimes steroid injections. In severe cases, surgery may be necessary.
  • Lumbar Disc Herniation: A herniated disc in the lower back can press on nearby nerves, causing pain that radiates down the legs, along with numbness and weakness.

    • Treatment: Treatment may involve rest, physical therapy, pain medications, and in some cases, surgery.
  • Spinal Stenosis: This condition involves the narrowing of the spinal canal, which can put pressure on the spinal cord and nerves. It can cause pain, numbness, and weakness in the lower back and legs.

    • Treatment: Treatment options include physical therapy, medications, and possibly surgery to relieve the pressure on the spinal cord and nerves.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take to manage your symptoms:

  1. Rest and Avoid Strain: Try to avoid activities that worsen your pain, such as heavy lifting or prolonged sitting. Gentle movements and short walks can help keep your muscles active without overstraining them.
  2. Apply Heat or Cold: Applying a heating pad or ice pack to your lower back can help reduce pain and inflammation. Use heat for 15-20 minutes at a time, and cold for 10-15 minutes.
  3. Over-the-Counter Pain Relief: Continue taking Tylenol as directed, but be cautious not to exceed the recommended dosage. You might also consider nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, but consult your doctor first, especially given your diabetes.
  4. Gentle Stretching: Gentle stretching exercises can help relieve tension in your lower back. Be sure to avoid any movements that cause pain.
  5. Use MDandMe: You can use MDandMe to journal your symptoms, track your progress, get insights, and share longitudinal medical notes with your healthcare provider.

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 continues to worsen despite rest and medication.
  • Loss of bowel or bladder control: This could indicate a serious condition called cauda equina syndrome, which requires immediate medical attention.
  • Significant weakness or numbness: If you notice a significant increase in weakness or numbness in your legs, it could indicate nerve damage.
  • Fever or unexplained weight loss: These could be signs of an underlying infection or other serious condition.

Remember, while these suggestions can help manage your symptoms, it's crucial to consult a healthcare professional for a proper diagnosis and treatment plan.

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4 mo ago


People Also Ask


What is sciatica and how is it treated?

Sciatica is a condition where the sciatic nerve is compressed or irritated, causing sharp pain, numbness, tingling, and weakness in the lower back and legs. Treatment often includes physical therapy, pain relief medications, and sometimes steroid injections. In severe cases, surgery may be necessary.


What are the symptoms and treatment options for a lumbar disc herniation?

A lumbar disc herniation occurs when a disc in the lower back presses on nearby nerves, causing pain that radiates down the legs, along with numbness and weakness. Treatment may involve rest, physical therapy, pain medications, and in some cases, surgery.


How does spinal stenosis affect the body and what treatments are available?

Spinal stenosis involves the narrowing of the spinal canal, which can put pressure on the spinal cord and nerves, causing pain, numbness, and weakness in the lower back and legs. Treatment options include physical therapy, medications, and possibly surgery to relieve the pressure.


What should I do if my back pain worsens or I experience new symptoms?

If your back pain worsens or you experience new symptoms such as loss of bowel or bladder control, significant weakness or numbness, fever, or unexplained weight loss, seek medical attention immediately as these could indicate serious conditions requiring urgent care.

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