I Can’t Live Like This

I Can’t Live Like This

From Chicken Soup for the Soul: Say Goodbye to Back Pain!

I Can’t Live Like This

Brenda’s story about her “teacher bag syndrome” is one I’ve heard many times by patients coming in for neck and mid-back pain. Sometimes a heavy bag will also affect the low back (since your spine and all of the nerves, muscles, tendons, and ligaments connect in some way to each other). There are many variations on this story that I hear from carpenters (who carry tools and wear tool belts), business people (who carry briefcases and/or suitcases when they travel), teenagers (who carry backpacks) and so on. What made Brenda finally seek help for her pain after fifteen years? There were likely multiple factors, including that she was now retired and had more time to focus on herself. But, probably the single most important thing that caused her to seek help was that she thought, “I can’t live like this!”

When I hear a story like Brenda’s, I’m always wondering whether the patient sitting in front of me has an official diagnosis. Then, my next thought is, “Does she have the right diagnosis?” In Brenda’s case, it’s hard to tell the answer to either question. Teacher bag syndrome is not a medical diagnosis. Sure, heavy bags can cause problems, but what is actually her diagnosis? And, is it the right one? (She might have a formal diagnosis for her back pain that she didn’t mention in her story.) Here’s what I’d be thinking if Brenda were in my office:

1. Do you have a diagnosis?

2. Do you have the right diagnosis?

3. Have you seen a doctor?

4. Have you seen the right doctor for your condition?

5. Have you had any tests to diagnose your condition?

6. Have you had the right tests to diagnose your condition?

7. Have you tried any treatment?

8. Have you tried the right treatment for your condition?

Back pain — whether it’s in the upper, mid or lower region — can be difficult to diagnose because there are so many structures that could be injured and causing pain. However, before I recommend any medical treatment, I must first decide what I think the diagnosis is, or at least what I think the most likely diagnosis is.

In a nutshell, here’s why some people have chronic back pain without significant relief of their symptoms: They’ve never been properly diagnosed, and the treatment interventions they’ve tried are not targeted for their particular diagnosis.

Even though this is true, and I want to emphasize how important it is to try and figure out the right diagnosis, it’s not always possible to do so. Our backs have so many complicated structures that may play a role in pain that there are times when it’s challenging to figure out what is causing discomfort. Even with excellent physicians and state-of-the-art testing, it’s not always possible to solve the diagnosis dilemma. Nevertheless, if you are living with back pain, and you want some relief, keep this in mind: Finding the right diagnosis may be the key to getting targeted treatment that really works.

Who Is on Your Team?

Often people see more than one type of practitioner to alleviate back pain, starting with a generalist and then seeking more specific types of help. Here’s a quick guide to the type of clinicians you might encounter.

Physicians

Primary care physician: Trained in general medicine, internal medicine, or family practice; makes referrals to specialists as necessary.

Neurologist: Focuses on treatment of the nerves and nervous system.

Neurosurgeon: Provides surgical care of nerve-related problems.

Orthopedist: Diagnoses and treats problems of the skeletal system and its muscles, joints and ligaments. Some orthopedists also perform spine surgeries.

Osteopath: Has training similar to that of an M.D. Osteopaths utilize some treatment modalities that most M.D.’s are not trained to do such as spinal manipulation.

Physiatrist: Rehabilitation physician that specializes in musculoskeletal medicine, including non-surgical or post-surgical back problems.

Rheumatologist: Specializes in the treatment of rheumatic diseases (those affecting the joints, muscles, bones, skin and other tissues), some of which can affect the back.

Other professionals

Chiropractor: Trained in manipulation of the bones and joints, including those in the spine.

Physical therapist: Focuses on exercises and other rehabilitative techniques to restore function and mobility.

Occupational therapist: Focuses on workstation evaluations, posture, adaptive equipment and upper body strength and range of motion.

Massage Therapist: May help with decreasing muscle stress and tension.

Acupuncturist: Some pain conditions will respond to acupuncture.

Do I Have Sciatica?

Many of my patients tell me, “My doctor sent me to you because I have sciatica.” Sometimes this is true, but more often than not, they don’t actually have sciatica. At least, they don’t have injury to the sciatic nerve.

Medical dictionaries often define “sciatica” as severe pain in the leg along the course of the sciatic nerve, typically felt at the back of the thigh and calf. Of course this implies, and most people believe, that the sciatic nerve is the source of the problem. However, the symptoms associated with this type of pain are not usually due to injury to the sciatic nerve.

The sciatic nerve is the biggest nerve in the body and arises below the level of the spine in a big grouping of nerves called the sacral plexus. Specific injury to the sciatic nerve is actually not all that common. The most common cause of “sciatica” is actually a condition called lumbosacral radiculopathy. Frequently this is due to a herniated disk in the spine (above the level of the sciatic nerve) that is pressing on a nerve that supplies the muscles to the leg (for example, the L5 or S1 nerve root — which is the 5th lumbar or 1st sacral spinal nerve root).

Sciatica is a term that people may use to describe back and leg pain (sometimes associated with burning, numbness and/or tingling), rather than an actual diagnosis. Though the real diagnosis still exists, it’s just not all that common.

So, if you think you have sciatica, ask your doctor whether you really might have a lumbar or sacral (lumbosacral for short) radiculopathy. The treatment for radiculopathy is not the same as it would be for injury to the sciatic nerve. Treating the wrong diagnosis usually means that people don’t get better.

 

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