Back Pain & Numb Hand

  : Three weeks ago, I slipped and fell at work.  Immediately, I endured significant back pain and a shooting pain going from my shoulder to my LEFT hand.  Within thirty minutes, I received significant relief of the back pain I was enduring.  However, the pain then shifted to my RIGHT leg.  The pain originates at the lower back and continues through my buttock and ends at knee level.  This pain then picks up near mid calf and reaches to the ankle.  I am now unable to stand on my RIGHT heel.  I also have numbness in my left hand (being worst at the pinky and gradually getting better towards the thumb).
  : I went to St. John's Westshore Hospital and the X-rays revealed no vertabral damage.  However, I do have the typical degenerating discs.  I followed up with my doctor and he refferred me to physical therapy on top of prescribing darvocet, daypro, and robaxin.  The therapist told me he was unable to help me.  I called my doctor to ask if he could prescribe something stronger for the pain and I was told, "I must have BWC approval to prescribe you something stronger for the pain".  My wife had stronger pain medicine prescribed for a tooth that was pulled!  I returned to my doctor and was given stronger pain medicine (vicodin es) and was told to return to his office in four weeks.
  : My doctor has indicated he will not order a MRI or a referal to a neuorolgist until my MCO (Corvel) and the BWC approves my claim.  After I called my MCO, I was told they would approve such requests if my doctor submits the proper requests.  To this date he has failed to do so.
  : None of the medicine I was prescribed is helping me cope with the pain.  Honestly, I do not think I am capable of coping with the pain for another month until I see him.  To this date, he has ordered/provided no treatment for my partially numb hand.  I'm 29 years old going on 80!  Being an automotive machinist, it is essential I have feeling restored to my hand.  My job requires I lift up to 75lbs on a daily basis.
  : Is there other pain medicine that is frequently prescribed for this medicine that may help me?  Considering every doctor (even the therapist) believes I have a herniated disc, am I risking permanent nerve damage if this condition goes uncorrected for a period of time (1-3 months)?
  : I am really frustrated with my doctor's treatment plan.  I will have been out of work with this injury for seven weeks without treatment for my problems.  Any suggestions?
  Bill,
  I'm not medically trained in any way, but have personal experience with back pain and the pains and numbness in limbs.  The leg pain sounds like classic Sciatica.  Also, you can experience numbing in the limbs if you are "out of sync" - I would recommend finding a good chiropractor that you have personal referrals for.  I experienced back pain for two years before finally finding a chiropractor that uses the "Pierce" technique (Dr. Richard Cohen, Cincinnati, OH). His phone # is 513-791-7155, and I'm sure he'd be happy to talk to you over the phone and answer any questions.  (Tell him English Elaine referred you) Dr. Cohen had me pain free in 3 weeks, and I have had no back pain for the last five years.  I wish you the best of luck!
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The right leg pain does sound like sciatica, which is just a descriptive term for a symptom of radiating pain. Although the symptom could be caused by irritation of the sciatic nerve per se, it usually is not. Rather, the irritation comes from "pinching" of the nerve roots as they leave the lumbosacral spine (before the point at which they all come together to form the sciatic nerve). This is commonly the result of degenerative spine disease, which includes disc degeneration, drying out, and frank herniation.
The actual amount of damage you have could be documented by an MRI, but it may not be necessary. I would suppose your doctor did a physical exam to determine whether there is any nerve damage (as opposed to nerve irritation and pain, which is commonly out of proportion to the amount of permanent damage).
My personal experience (as a physician and as one who had the same thing happen to me) is that physical therapy is very effective. Also, I advise patients to take nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen (several OTC brand names available). You may find strong pain medications effective, too, but the anti-inflammatory action of the ibuprofen etc is essential to the healing process.
You must talk to your doctor about this prior to making any changes to the treatment plan prescribed. Even if you don't agree with the treatment plan, maybe you should find another doctor, but it is essential that you go through this with appropriate medical guidance.
It is true that many people can do quite well in the hands of an internist or family practitioner without the assistance of a neurologist or other specialist. At the very least, your doctor can monitor you for signs of getting better (hopefully) or worse. In the latter case, you may be referred for further management.
Although some people end up needing surgery for herniated discs, no surgeon should even consider your case until you have gone through appropriate conservative measures.
I hope this helps. As you know, this information is posted for your medical education. Specific comments regarding your diagnosis, treatment options, and prognosis must come from your doctor after appropriate evaluation. CCF MD mdf.