Ask a doctor on the topic of Internal medicine

Severe pain in the back and flank and front in the area of the lowest two ribs, especially when walking.

February 1, 2017 | 60,00 EUR | answered by Dr. med. Frauke Gehring

Hello,

I have a follow-up question to a question that was already asked here in March. Here is a link to my previous question so that the background is known:
https://frag-einen.com/arzt/orthopaedie/sehr-starke-rueckenschmerzen-vor-allem-beim-laufen-502247.html

This is how it continued:
After my return to Germany, the above-mentioned pain disappeared within about 3-4 days and stayed away for some time or only occurred sporadically. Therefore, I initially did not take any further action.

However, at the end of August, they returned much stronger, especially during longer walks, when standing, and also when sitting. The pain does not usually start massively when sitting, but is only there if it has already occurred from walking or standing. The strongest pain is when walking. However, if I sit slightly tilted so that the left flank is supported by the backrest, this usually brings some relief. Otherwise, the pain is still as described in my previous question, with the slight difference that it is not only coming mainly from the spine into the left flank, but rather I have the impression that it starts more on the left at the level of the two lower ribs and then radiates into the back and chest.

Since the pain returned, I went to an orthopedist at the beginning of September, who took an x-ray that was completely normal. The doctor suspected a rib dysfunction and tensing muscles as a result. He prescribed manual therapy, 10 sessions. After 7 sessions, the problems were almost gone, or at least it seemed so. Shortly thereafter, I was in the USA for a month, where I was once again running a lot (about 12-15km daily) and the pain returned with full force after 2-3 days. In the USA, I initially went to a chiropractor, and the pain initially improved for 2-3 days, but then returned again, sometimes in full, unbearable strength. My wife said I was sometimes as pale as a sheet from the pain. Therefore, I then went to a "regular" doctor in the USA, to a highly rated "Walk-Inn Clinic" in Orlando. The doctor there diagnosed an inflamed nerve and injected me with Dexamethasone as well as a second medication, the name of which I have forgotten, but he described it as being in the same group of active ingredients as Ibuprofen, only several times stronger. He also prescribed me a therapy with Prednisolone tablets, starting with 60mg and then gradually decreasing for 14 days, as well as Diclofenac. In the first three days after the injections, the pain was completely gone, even though in the previous months I had sometimes thought "this is nothing anymore" - I had not felt as good as after the injections in ages. The Prednisolone also seemed to be

Dr. med. Frauke Gehring

Good morning,

1.) Addressing the therapy clearly indicates that the problem lies in the area of the spine. I still suspect a nerve irritation, which cannot be seen in an X-ray.
2.) The pancreas would not have improved on these medications and is therefore ruled out, especially since all other important symptoms are missing.
3.) The general practitioner should be informed in any case, as they need to advise you on the necessary weight loss and perform an ultrasound of the liver (which is not the cause of your complaints, but to see if there is a fatty liver). Then the orthopedist is needed. You need to regularly do active physiotherapy to permanently loosen the structures.