[58F] With lower right back pain and associated symptoms

Patient Description

A 58-year-old female presents with persistent ache and sometimes sharper pain on the lower right side of her back for the past 2 days. The pain worsens with walking and is somewhat alleviated by muscle rub. She also reports associated symptoms of achiness and an upset stomach, described as cramping and sometimes nauseated, located in the lower, outside part of the abdomen. The cramping pain is rated 6 out of 10 in severity. The patient denies any recent injuries, changes in physical activity, fever, chills, changes in bowel habits, or vomiting. She reports a decreased appetite. The pain sometimes radiates down her leg. Her medical history includes stage 3b kidney disease, NASH, type 2 diabetes, arthritis, GERD, peripheral neuropathy, hypothyroidism, and migraines. She is on a low carb, low sodium, low fat, moderate protein diet. She has allergies to tetanus and niacin. Current medications include rapid and long-acting insulin, Carvedilol, Levothyroxine, Amlodipine, and Fenofibrate.

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Arora's Assessment

What might be happening

Based on the symptoms and your medical history, here are some possible explanations for your condition:

  1. Musculoskeletal Issues:

    • Muscle Strain or Ligament Sprain: Persistent ache and sharper pain in the lower right side of your back, especially when walking, could be due to a muscle strain or ligament sprain. This is common and can occur without a specific injury.
    • Sciatica: Pain radiating down your leg suggests that the sciatic nerve might be involved. This can cause lower back pain that extends down the leg and is often due to a herniated disc or spinal stenosis.
  2. Kidney-Related Issues:

    • Kidney Stones or Infection: Given your history of stage 3b kidney disease, the pain in your lower back could be related to kidney stones or a kidney infection. These conditions can cause significant discomfort and sometimes radiate pain to the lower abdomen or groin.
  3. Gastrointestinal Issues:

    • Irritable Bowel Syndrome (IBS): Cramping and nausea in the lower abdomen could be related to IBS, especially if you have a history of gastrointestinal issues like GERD.
    • Diverticulitis: This condition involves inflammation of the diverticula in the colon and can cause lower abdominal pain, cramping, and changes in bowel habits.

What you can do

For Back Pain:

  • Rest and Avoid Strain: Try to rest and avoid activities that exacerbate the pain. Gentle stretching and low-impact exercises like walking can help.
  • Apply Heat or Cold: Use a heating pad or ice pack on the affected area for 15-20 minutes several times a day.
  • Over-the-Counter Pain Relief: Consider taking over-the-counter pain relievers like ibuprofen (Advil) or acetaminophen (Tylenol) as directed.
  • Physical Therapy: If the pain persists, consult a healthcare provider about physical therapy to strengthen your back muscles and improve flexibility.

For Upset Stomach and Cramping:

  • Dietary Adjustments: Continue following your low-carb, low-sodium, low-fat, and moderate-protein diet. Avoid foods that can trigger gastrointestinal discomfort, such as spicy or fatty foods.
  • Hydration: Drink plenty of water to stay hydrated, especially if you are experiencing nausea.
  • Over-the-Counter Remedies: Antacids or anti-gas medications may help alleviate some of the cramping and discomfort.

For Kidney Health:

  • Monitor Symptoms: Keep an eye on any changes in your symptoms, such as increased pain, fever, or changes in urine output.
  • Stay Hydrated: Drink plenty of water to help your kidneys function properly.
  • Consult Your Doctor: Given your history of kidney disease, it's important to consult your healthcare provider to rule out any kidney-related issues.

What you should look out for

Given the complexity of your symptoms and your medical history, it's important to seek medical care if you experience any of the following:

  • Severe or Worsening Pain: If your pain becomes severe or does not improve with rest and over-the-counter treatments.
  • Fever or Chills: These could indicate an infection that requires prompt medical attention.
  • Changes in Urine: Blood in your urine, changes in urine output, or severe pain during urination.
  • Severe Nausea or Vomiting: Persistent nausea or vomiting that prevents you from keeping fluids down.
  • Unexplained Weight Loss: Significant weight loss without trying.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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5 mo ago


People Also Ask


What could be causing the pain in my lower right back and abdomen?

The pain in your lower right back and abdomen could be due to musculoskeletal issues like a muscle strain or sciatica, kidney-related issues such as kidney stones or infection, or gastrointestinal issues like IBS or diverticulitis.


How can I manage the pain and discomfort at home?

To manage the pain and discomfort at home, you can rest and avoid activities that worsen the pain, apply heat or cold to the affected area, take over-the-counter pain relievers, and make dietary adjustments to avoid gastrointestinal discomfort.


When should I seek medical attention for my symptoms?

You should seek medical attention if you experience severe or worsening pain, fever or chills, changes in urine, severe nausea or vomiting, or unexplained weight loss.


Could my existing medical conditions be contributing to my current symptoms?

Yes, your existing medical conditions such as stage 3b kidney disease, type 2 diabetes, and GERD could be contributing to your current symptoms. It's important to consult with your healthcare provider to determine the exact cause and appropriate treatment.


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