Back pain

November 8, 2008 9:05 AM

What kind of back pain is this?

My girlfriend's upper back was in a bit of pain most of the night and she had trouble sleeping. Lots of tossing and turning. This morning she woke up and tried to bend over and her whole back tensed up and she couldn't breathe and almost fainted. She's lying in bed right now, but if she moves slightly, her back hurts and she has trouble breathing. If she's not moving, her back still hurts, but only a little. This is the whole back, not just upper or lower. Any ideas on what happened, or what can be done, short of visiting the doctor (which we'll do if we have to, but prefer not to if we can help it). Thanks for your help.

posted by sepsis to health & fitness (21 comments total)

Hot water bottle (or other adjustable heat source) on tense, knotted muscles.
posted by K.P. at 9:23 AM on November 8, 2008

My guess would be a large-scale muscle spasm. This is not something I've heard of (as a licensed massage therapist); usually muscle spasms in the back stay in one smaller area, such as the neck.

Did she do anything new or unusual to precipitate this? Such as picking up a large objects, moving, starting a new workout, encountering new stress at work?

I wouldn't recommend going to a doctor just yet, depending on her tolerance for waiting it out to see if it resolves itself. Can she get into a hot bath? That would be better than a hot water bottle. And stick with moist heat. No heating pads. Take a bunch of pain relievers of your choice to dull the pain. Can you give her a little massage? If she can't tolerate any back massage, perhaps you could work on her feet to get her mind off the back.
posted by computech_apolloniajames at 9:33 AM on November 8, 2008

@computech_apolloniajames There was nothing new or unusual to precipitate this. Although, the apartment we moved into 3 months ago is on a pretty steep hill that we walk up and down nearly every day. She says it hurts most on her lower back, on her right side. I massaged that a little and now she has an icepack on that spot after taking some Tylenol. I'm pretty sure we don't have a hot water bottle or anything of the sort. Should I just remove the icepack?
posted by sepsis at 9:41 AM on November 8, 2008

if its that acute that she can hardly breath id recommend going to a doctor with it. you could try valerian root. From my own reading about back pain it seems the advice is that gentle exercise is better than rest if its a muscular problem, but if its something worse like a slipped disk you may just aggravate it and you really need someone who knows the difference to have a look. give it a day and go to the docs
posted by chelegonian at 9:45 AM on November 8, 2008

I wouldn't recommend cold, unless she can't tolerate heat. If the muscles are spasming or tight, heat will help them relax and get more oxygen them. Heat will help break the pain-spasm-pain cycle. Cold just shuts everything down and doesn't aid in circulation to the affected area. Another option is to microwave a damp towel for 30 seconds. Presto! Hot towel. Compress and repeat.

Perhaps her lower back is responding to the stress of the new routine of walking up and downhill. Hill walking stresses the glutes and hip flexors, which in turn can affect the lumbar area.
posted by computech_apolloniajames at 10:04 AM on November 8, 2008

Since she said it hurts in both the upper and lower back, and because the pain is on one side, it sounds like a problem with one of the erector spinae. Some sort of spasm or strain. I don't really have any recommendations, but maybe it'll help you with the googling.
posted by Durin's Bane at 10:19 AM on November 8, 2008

She needs to go to a doctor, preferably as soon as possible. If the pain is so bad that she's nearly fainting, and can't sleep, a doctor appointment is the next course of treatment.

Not to be alarmist, but my mother complained of back pain across her back on her lower right side for three months. She thought she pulled a muscle lifting groceries out of her car: it turned out to be something far more serious. Pain as serious as you are describing should be attended to swiftly by a doctor.
posted by annathea at 10:23 AM on November 8, 2008

I've had a half a dozen chiropractors over the years recomend cold over heat for muscle spasm, which is what this sounds like, and gentle activity to help the muscles release. Not lifting, not standing over the sink for too long, just make it a point to get off the sofa and make a lap to the kitchen for a can of something and then go back. Once a hour or so, when you think of it. (Current advice from PTs, not the old 'complete bed rest". Light gentle weight-bearing movements they say make it heal faster.)

If heat works better, it's ok, just didn't want you to think cold was doing any damage.
You can probably see how it's doing by Monday, but make sure it's coming along by then. If it's not making any progress, albeit slow, you might go sooner.

IANAC, and my advice should be regarded for entertainment purposes only.
posted by unrepentanthippie at 10:38 AM on November 8, 2008

A washcloth or small towel soaked in hot water makes a great hot compress. If she has a back spasm, the hot compress will help relax the muscle. You can also try gently stretching the muscle and massaging towards the spine to help the muscle relax.

It may not be the back muscles themselves that are causing her pain. Two other possible causes of back pain:

1)Did she eat something fatty? I once polished off an order of fries after being raw-foodist for an extended period of time and found myself doubled over with back pain. I was unable to move and totally freaked out. It turns out I had a gallbladder spasm, and I was fine again after a few hours, but gallbladder problems can manifest as back pain. It could be anything from a spasm to stones and a doctor would be able to help more.

2) Did she have a UTI or painful urination? Lower back pain could be a kidney infection. Yet another good time to see a doctor.

Pain is out body's way of alerting us that something is wrong. There are lots of organs that when unhappy map out to back pain, so it is definitely worth seeing a doctor to rule out the unpleasant possibilities.
posted by abirae at 10:40 AM on November 8, 2008

It is obviously impossible to diagnose a medical issue from a short paragraph but if this pain is persisting, is in the upper back (or side or front of the chest wall), is associated with shortness of breath and is (as it sounds) pleuritic in nature (that is, hurts most when she takes a deep breath in) I think she should be assessed by a doctor. This could be totally benign pain but it could also be indicative of a pulmonary embolism (clot in the lungs). They are likely going to ask lots of other questions: did the pain come on all of a sudden, does she have leg pain, is she on any hormones (birth control pill/patch etc), family history of clots etc etc. If I were your girlfriend, I would go to the ER sooner rather than later.
posted by madokachan at 10:42 AM on November 8, 2008

Back spasm is a possibility, in which case the above posters' mild recommendations are correct. However, other possibilities include an acutely ruptured disc, pyelonephritis, and meningitis, as well as an unusual presentation of something like appendicitis or pancreatitis. All of these things are painful enough to spasm the back, so you get the findings of back spasm on top of a dangerous illness that requires treatment.

Here is a pro-tip. We have specialists in the world who train their entire lives in order to know how to sort these kinds of problems out for people. These specialists are called "doctors." If someone suddenly cannot stand up owing to pain, that person needs to see one.
posted by ikkyu2 at 10:43 AM on November 8, 2008 [2 favorites]

I'm still concerned that she has trouble breathing, especially since the pain is low and one side - that could be a kidney problem and lord knows we need our kidneys. So again, I would suggest going to see a doctor.

I was going to share another muscle spasm tip, but my main tip is to see a physician. The muscle spasm tip that my physician taught me is that in addition to a hot compress, taking four advil/motrin (ibuprofen) will reduce inflammation as well as reducing the pain. It worked like a charm when my husband had muscle spasm pain. I hope that it's nothing serious, but please rule out the big things first! Better safe than sorry.
posted by abirae at 10:48 AM on November 8, 2008

IANAD, but I agree with the other posters that it might not be a benign muscle spasm that she's experiencing. I've had severe lower back pain that turned out to be from a kidney stone, and severe upper back pain that turned out to be from a gallstone. In my experiences, the pain was breathtaking and in the latter case, I fainted (and I'm not especially wimpy about pain, I swear). Both situations required a doctor's care, which is what I'd say your girlfriend needs. That level of pain shouldn't be brushed aside. I hope she's back to health quickly!
posted by katie at 10:56 AM on November 8, 2008

I woke up one morning with similar symptoms. A big spasm in the middle of my upper back, between the shoulder blades. I could only take shallow breaths because anything deeper would pull at the spasm and hurt like hell.

Solution: pain killers with muscle relaxants. Check your local pharmacy's analgesic aisle. Here in Canada there's a few different formulas under the Robax name (Robaxacet = muscle relaxant + acetominophen, Robaxisal = muscle relaxant + ASA, Robax Platinum = muscle relaxant + ibuprofen, and Robaxin = plain muscle relaxant). If there's an analgesic that she can't take, choose one without that medication.

They really eased the spasm and let me breathe properly, but my back was still sore-ish and stiff for a day or two because it was such an intense spasm.

If they don't help, then it sounds like time for a doctor.
posted by CKmtl at 11:47 AM on November 8, 2008

See a doctor, for sure.
But in any case, NO HEAT. Just cold, as you were doing, for a day or two. After that, with doc's OK, alternating hot and cold (10 minutes of each, several cycles, every few hours). Never just heat-- it just adds to the inflammation instead of helping knock it down and relax the muscles.
posted by beagle at 12:03 PM on November 8, 2008

Yes, definitely use some sort of muscle relaxant, along with whatever other treatments (heat/cold/whatever). I like methocarbamol, but that may not be available without a prescription where you are.
posted by number9dream at 12:20 PM on November 8, 2008

Also, sepsis, if you get a chance please let us know how she is doing. I know I'm not the only MetaFilter poster who worries...
posted by abirae at 1:42 PM on November 8, 2008

That was totally me a year ago. Turns out I mysteriously tore two discs in my neck, and the inflammation caused multiple pinched nerves. My diaphragm decided to participate in the pain, and if I moved ever so slightly, I couldn't breathe. Thankfully my husband had just had surgery and had some vicodin which is the only way I got through that first day. Went to a chiropractor who couldn't do anything quickly. Went to an orthopedist the next day and got a script for vicodin and an anti-nausea. Also got a wonderful "ice" pack-- actually a big gel pack, like an 8.5" x 11" x 0.5" gel pad that goes in the fridge. That was a lifesaver. DO NOT USE HEAT. DO NOT USE HEAT. DO NOT USE HEAT. That can exacerbate inflammation and swelling. In short, get your girlfriend to an osteopath or pain management doctor asap. Most likely X-rays and an MRI will follow-- this is a good thing to see what is going on in her back. Ask for a prescription for a strong pain killer as well as an anti-nausea. (It was NOT fun wretching while in extreme, breath-taking pain.) Ice the area often. Also consider asking about cortisone shots under live x-ray. They helped me a bit. Ice and rest has been the biggest help.
posted by orangemiles at 2:03 PM on November 8, 2008

In very crude terms, heat makes stuff expand, cold makes it shrink.

For breaks, tears, ruptures shrinking/cold often helps (RICE - Rest Ice Compress Elevate). For hyper-contracted muscles (spasms, charlie-horses etc) heat helps expand the contracted muscle and increases blood flow. Which one should you use? It depends on what is actually wrong. We now have a lovely assortment of possible causes of the back pain in question but a health care professional (MD/Osteopath/NP/PA) can do the differential diagnosis to figure out what is actually causing the pain.
posted by abirae at 2:53 PM on November 8, 2008

Thanks for all the suggestions. Time, ice, massages, pain relievers and occasionally making her walk around and the pain has lessened. She still hurts, but it's more manageable and getting better. Hopefully she'll be right as rain in a day or so. Thanks again!
posted by sepsis at 10:00 PM on November 8, 2008

I'd like to rephrase a couple of things I said.

Obviously, the right answer is to lay flat on your back until the ambulance gets here. You already indicated you weren't planning to do that just yet. It doesn't have to be either/or. If you have a PCP you could call s/he and discuss it; they will ask all the right questions because they know what those are. This is an especially good option if you have no insurance or other issues.

It's good for the healing process to move a little bit, but more importantly it's a way of making sure you still can get around, and checking to see if you are improving between trips. If not, it should change your assessment of the situation. (That was pure sneakiness on my part, and I apologize.)

Conventional Wisdom is cold, not heat, but I've had that fight with many muscle spasm victims, and some of them you just can't convince of that, and I've learned not to try. (Never try to teach a pig to sing; it wastes your time and annoys the pig.)

You mentioned having trouble breathing at the time of the incident, which is not uncommon when you get hit with a pain level of 12 out of nowhere. You did not mention if that problem was still ongoing. I ignored that issue, on the theory you sound like a responsible adult with enough sense to do the right thing if it was. There's also a difference between can't breathe and hurts to breathe. In any case, I certainly have no business comenting on it.

I strive to be polite (and brief) and sometimes end up less than clear as a result; sorry. As I pointed out, my advice is useless and IA still NAD. You have an opinion available from someone with several thousand years training and experience (and in this field, no less). I have the utmost respect for him and had I known for sure he'd stop by, I wouldn't have contributed.

As long as I've sucked up the entire page anyhow, allow me to make two more suggestions.
It's a good idea to log what you're doing, just in case. What pills were taken and when. If you get up and pain levels once in a while maybe. If it goes south, you can at least have the info for the pros. More importantly, it's just a way of keeping an eye on the meds. It's easy to think you'll remember what you took and when, but if you write it down you'll know for sure. I'm talking like a 10 second note here.
If the same thing or something similar happens a second time, heaven forfend, I'd turn myself in right away, before it turns into something onoing.

Sorry for the length. I try not to do that and I usually succeed better than this.
posted by unrepentanthippie at 10:01 AM on November 9, 2008