Q: I am 51 years old. For the last 16-17 years I am having back pain especially in the region of L3-L4. The x-ray does not show any mentionable changes excepting some increase of the bones which during last 16 years remains almost constant. Sometime the pain increases but I have been tolerating it. Three years back I developed severe vertigo and vomiting after lunch and was bed ridden for 7 days for pain in my neck. Recently, I am having constant pain on my neck and back side. There is pain on the gland just behind my right ear. I visited many doctors but nobody has told me about the actual disease. While one advised physical exercises, another advised to undergo some UV therapy and prescribed Sazo-EN 500 and Aminocal and diagnosed it as ankylosing spondylosis. However, HLAB-27 carried out by SRL Ranbaxy is negative. The physical exercise apparently is not having any positive response and also not being carried out regularly owing to paucity of time. I am averse to taking any medicine, but when the pain is unbearable, Valedecoxib is taken and response is good. All other related blood test/eye test carried out were normal. I am having no other ailment except erection disorder.

A:Generally, back pain is classifiable into 3 major categories: 1. More than 90% is non-specific in nature (cause is said to be strain and sprain associated with ageing. Treatment is change in life-style from a sedentary to an active style with regular simple aerobics (like regular 45 minutes of brisk walk), bringing down weight to normal levels (for Indians BMI of 22 or below is ideal) with balanced diet that should include at least 9 servings of fruits and vegetables every day. In addition some qualified physiotherapist is consulted to give details of corrections of postures, and muscle strengthening exercises for the spinal muscles. If I may make a guess, this is the category of the problem that you have. Bed rest, too much x-rays and medications are strongly discouraged. If the pain becomes unbearable, a safe drug like paracetamol is all that is required. As many such individuals have been found to have unusually high level of mental stress, counselling with a clinical psychologist is advisable. A simple muscle relaxant (centrally acting) like amitriptyline 10 mg 2 hours before going to bed taken on a regular basis for prolonged periods works like magic in some such patients. 2. The second category is called Inflammatory low-back pain. It is always a disease of young persons < 40 years of age. It is a serious internal disease that usually starts at the age of 15-20 years. These young people get up in the morning absolutely stiff, with severe low-back and buttock-region pain, then over a period of some minutes-hours, with vigorous physical activities including exercises slowly (over a period of 15 minutes to 2 hours) they recover completely. Then, if they become inactive (like sitting idle for sometime - attending class!) they again experience increasing stiffness and pains. This disease is called inflammatory spinal arthritis (old name ankylosing spondylitis). As you are not in this age group and you have no such symptoms, I would not have even bothered to get any tests done for this disease in your case. 3. The hird category is sinister back pain. Patients within this category can be of any age and gender. They suffer form serious rapidly progressive crippling and severely painful back pain that kills the patient or causes paralysis unless correctly diagnosed and treated within 6 weeks of the onset. Obviously you do not have this category of back pain as it has been going on for quite sometime without causing any such problems!! Thus, in the final analysis, your are likely to have category 1 i.e. the usual variety of non- specific low-back pain. Some of the measures have been mentioned above. You may like to try some of them but, it is strongly recommended that you see a rheumatologist in your city and discuss the problem and let the rheumatologist decide what would be the best mode of managing your problem.