Chronic Back Pain

[jmadzula1]

Hi,

  Thank you for having this forum, I have browsed around, and hopefully my question hasn't already been answered!

I've been having lower back pain for the past 4 months or so.  My primary care gave me a muscle relaxer, that didn't make me feel all that great, so I stopped taking it.  I went back to see him a few days ago, and he completely disregarded my pain symptoms and basically just wanted me to get xrays and bloodwork (which I've already had and they turned up nothing).

My question is, should I just immediately go find a Pain Management Specialist?  Do most of these types of doctors require referrals from Primary Care docs?

Thank you very much for all your help!

[Sumanadevii]

I would see a neurologist.  I had lower back pain that nothing would touch.  It was MS.  You need a doctor that will listen to you, get you a brain and spinal MRI with at least a 3t MRI.  Don't waste even more time with a 1.5MRI.  It just isn't strong enough to see lesions on the spinal cord.  It is a very tight space and it needs a higher resolution.

[atonicat]

I've been where you have many times. I had to go through two PCP, a neuro surgeon, a rheumatologist, and finally a PM doctor to get where I am today. It's taken me about 3 years to get to this point. You need to speak up. You need to keep going back to your PCP or find another one. If you keep going back for back pain, than it will force them to do an xray and an MRI. If you keep going back it will force them to send you to a PM. If you don't want to do that, than you need to find out if your insurance requires a referral for a specialist. If they don't than you need to call a PM and find out if they require a referral.

You're the only one that can make this happen. Doctors work for you. You pay them for a service. If you're not getting the service you want, go to another doctor.

[jmadzula1]

So I went to the Ortho that the Urgent Care guy told me to go too... We talked for 5 min, he did the Ole' let me stretch out your leg and does that hurt, step on the gas pedal, etc...

After that he basically told me nothing was wrong with me and just completely disregarded me and my pain.

I am just so fed up with this... Its like no one is taking me seriously, and I don't know what to do.  I've been crying all day because of how much intense pain I am in, and I don't know what to do.

[jmadzula1]

Thank you both for your very informative and quick responses.  It is certainly nice to know that there are good people on the internet, that are willing to help anyone with what someone is going through.

Last night the pain was unbearable, so my wife and I went to the Urgent Care.  I was a little worried, because I've been to an Urgent Care place before, and it seemed that their only worry was getting patients in and out.  

The doctor we saw last night was just awesome!  He took more time to go over what I've been feeling than my PCP did.  He came to the conclusion that it is most likely a herniated disc.  He wants me to follow up with an Orthopedic Doc in the very near future to get an MRI done.  It felt very good to actually have someone give me their opinion and treat me with a lot of care and compassion, because of how much pain I've been in.  My wife had always thought it was a herniated disc, just because of the symptoms and pains I was explaining to her.

Once again, thank you both for your answers, and hopefully everything will be gravy from here on out!

[Tuckamore]

Hello jmadzula,

Welcome to the Pain Management Forum. I am glad you found us and are always happy to respond to a question or concern even if it has been asked before, so never worry.

Your PCP may have dismissed you because Back Pain is the second leading cause of visits to physicians. The common cold is the first. Back pain statistics are staggering. In my opinion some physicians don't always take this complaint seriously when they have seen 12-15+ patients in a week with similar back pain. Rest, and time will often decrease or resolve the symptoms.....so PCPs tend not to be very aggressive unless the pain is debilitating and acute. The next step is usually conservative treatment. Back pain is also one of the costliest conditions in out country.  

Audrea offered some good suggestions. She is correct when she says the longer a condition goes untreated the more difficult it may be to treat, the more lengthy the treatment process and the less favorable the outcome.... regardless of the diagnosis. I and many others are living testament to that fact.

A log is an excellent suggestion. You must impress upon your PCP how much this pain effects your daily activities as well as any sleep disruptions it may present. I would not wait another four months. Often PCPs may think if it's been four months the pain was not problematic. In my opinion you should return to your PCP often and be assertive. Insist upon answers. An x ray will provide little detail of the spine. if indeed that is the source of your pain. The lab work is probably looking for inflammatory markers to rule out such conditions as arthritis.

Last but not least if your PCP is not performing the service you hired him/her to do... it may be time to look for one that will. They are truly service providers, educated ones yes, but still service providers. There are some great ones that are driven to diagnosis and help their patients. Don't settle for mediocre.

Most PMP require at least a tentative DX and a referral.... and when it comes to spinal issues usually some imaging. Appointment requirements can vary from state to state as does treatments and follow-ups.

Be assertive. In my opinion no one should have to suffer needlessly with pain for months without an earnest attempt at a DX and treatment. I wish you the very best and will look forward to your updates with interest.

Take Care,
~Tuck

[nurseaudrea]

Have you had an MRI yet or any other type of diagnostic test that would be more helpful in a diagnosis? You are still in the early stage where it would be extremely beneficial to find out what is wrong and treat it sooner rather than later to have a better outcome/prognosis. The longer it takes to get the correct diagnosis and treatment the harder it becomes to treat you and to have a good outcome. You have to be your own advocate. Keep pushing your doctor for answers. If your doctor is not as concerned as you are about finding out what is wrong then it is time to find a new doctor. There are many tests out there to help find what is wrong. Try keeping a log from day to day so you know exactly what is going on next time you go in to see your doctor. Also write down any questions you may have before you go in to see him/her. Don't be afraid to take up the doctors time. You pay them for a service. That is what they are there for. If you have a lot of questions you may want to let the receptionist know they need to put you in a time slot with extra time so your questions can be answered without the doctor being afraid he/she will get behind.

Hopefully this helps a little. Good luck.
Audrea