Question
QUESTION: Hello. I have been having episodes of severe back pain since February 2013. I had a peptic ulcer and perforated bowel in February but had surgery to fix the issue. However, before and since then I've had these episodes of pain. They come on suddenly and last for hours on end. Bengay and other painkillers do not do anything for the pain (I use OTC medicines however, right after surgery I was having the pain and not even the perscription pain medicine I had would help it. What might be the cause? The pain is not isolated in one area of the back but is all over.

ANSWER: Hi Carly,

Sorry to hear about what you have been through and your current pain.

I think it is difficult to ascertain what is going on. Not sure how long you had this pain before surgery. I assume that it would be unrelated to your surgery, since you had this before and after, and you indicate the surgery was successful in repairing your gastrointestinal issues. Not sure if you had any injuries.

The problem is the diffuse type symptoms. Not quite sure if it is lower, upper back pain or both. The fact that it is diffuse ("all over") and not relieved by pain medications adds to this difficulty.

Usually, when there is back pain for no apparent reason and it does not respond to rest or changing positions, it may be a symptom referred from an internal organ. I would assume there has been diagnostic testing in relation to this, as well as post surgical evaluations. Physical examinations should indicate if there is a musculoskeletal component that would warrant x-rays, or other testing like blood work or more sophisticated diagnostic imaging; seeking possible diagnoses such as ankylosing spondylitis or rheumatoid arthritis.

I wish I could be more specific in giving you some direction, my apologies.

Kind Regards,

Dr. Steve  

---------- FOLLOW-UP ----------

QUESTION: Thank you Dr. Steve.

I've wondered if there could be another cause that is not related to the back itself. I had gastric bypass four years ago and wonder if that might have anything to do with it but I'm not sure.

I'm a bit afraid to go to a doctor for fear that they will say that it's nerve related and can't help me or they won't find anything wrong at all even though there is pain.

Answer
Hi Carly,

It's possible. It is also possible that it is more than one problem. You can get a basic idea of the pain referral patterns from internal organs by looking at this image: location of referred visceral pain.

You have got to try to find something that may be causing the pain - a pain generator. If it is nerve related, that should be able to be diagnosed. Testing reflexes, muscle testing, sensory examination with a pinwheel (doesn't hurt) and even nerve conduction tests (not very pleasant) can help diagnose nerve problems, as well as diagnostic imaging like MRI scans.

Blood testing is pretty basic.

If you mean "nerves" like anxiety, if it is difficult to find a pain generator, it may be that there was something there, and now there is not. This does not mean the pain is not real. Those with chronic pain, over a long period, can have a hypersensitivity in the brain. This is like a pain or sensations from a phantom limb. It is real. Many will respond to medications for depression/anxiety. The problem is that there may be a pain generator. It is true that those with chronic pain may have depression and anxiety. Sometimes depression and anxiety can cause pain. It is difficult because you know you have pain and if the medication does not help the pain, just the attitude, you get frustrated. What comes first, the pain then the depression from the pain, or depression then the pain from the depression? Maybe a combination of both?

Anyway, try to rise above the bit of fear and look into it. See if the doctor will perform some basic tests and possibly refer you to a specialist. You can also see if it may be musculoskeletal related by seeing a good chiropractor.

Regards,

Dr. Steve