Intense Night Pain in Lower Back and Hips

[execmom7]

In the past 8 years I have had intermittent back pain. It began while I was pregnant with my daughter who will be 8 in January. I was diagnosed with a stress fracture in my lower back and said it was caused by the pregnancy. During that pregnancy I also had intense pain in my hips and thighs only at night and it was also explained as pregnancy pains. I have also had neck/shoulder pain and was told from a brief physical exam that I had bursitis, have had intermittent knee pain/swelling in my right knee and frequent eye infections. My eye will get red and be very painful (feels like pressure on it), become weepy and my vision will blur. It usually only lasts a day with antibiotic drops. I have over the past few years gone through periods of time where the pain in my back during the night became excruciating and I have never sought medical help thinking that it was possibly an arthritis type condition caused from my previous "injury". I am not a hypochondriac and rarely see a physician going years between visits. As of late, the pain is terrible during the night, I never sleep past 1-3 am because of the pain, I am exhausted. When I get out of bed I often crawl out and can only raise myself up with the assistance of my arms because I cannot do it on the strength of my back alone. My back does not cause me pain during the day unless I strain it somehow. I have no medical insurance and just moved to begin a new job. I have read much about ankylosing spondylitis and think it may be a possibility and have thought perhaps my father suffered from the same problem as I recall him telling me that he believed he had herniated discs in his lower back. As he had an aneurysm when he was fairly young that caused major brain trauma, it is hard to know. I only know that he suffered from debilitating back pain. None of my previous diagnosis were based on x-ray or MRI - they were assumed. How important is it for me to be seen by a rheumtologist and is it possible to be seen without a referral? Is there diet/exercise that may help? What would be my least expensive course of action to get a diagnosis and assistance?

[Tom Plamondon PA-C]

Regarding ankylosing spondylitis:
Men > women (3:1)
Onset between puberty and 40 y.o.
Worse in the morning and stiffness lasts > 30 mins; worse when lying down or inactive and better with exercise and activity
Duration > 3 months
May have peripheral joint pain (shoulders, hips, knees, etc)
May have associated uveitis (the uvea is the layer of eye tissue just deep to the cornea and continuous with the iris anteriorly)
May involve other systems (heart, lungs, GI-colon, and neurological).

Formal testing includes an xray of the lower spine and sacrum, sed rate and CRP, and perhaps an HLA-B27 blood test.

I present this information more from academia and less from experience.

From experience, I would:
1. Start with a couple simple tests you can do at home to see if the sacroiliac joint is inflamed. These are Gaenslen's Test and Patrick or Faber test (google image these for description)
2. Start a one to two week trial period of NSAIDS (indicated management of ankylosing spondylitis).
3. Use a heating pad on the area followed by painfree active range of motion exercises for the shoulders, hips, and low back. Examples are single knee to chest, trunk rotation, trunk extensions, overhead reaching and hamstring stretching. All of these can be done in recumbant position.

Other considerations:
1. With feeling of increased eye pressure and blurred vision, a trip to the optometrist or ophthalmologist would be prudent especially during "flare-ups"
2. With multiple sexual partners, recurrent eye infections and joint pains/arthritis; gonorrhea infection is part of differential diagnosis.

I would invest in a visit to a competant family physician who either has a background in ortho or rheumatology and/or willing to do some thorough investigating himself - thus saving a trip to a specialist.