So pissed off with Dr i saw today.. don't know what to do about it.

[Skullyton]

ive been in pain with my hip/back for months.

i was initially referred to a physiotherapist after 8wks of pain relief didn't fix it.

Physio diagnosed compressed disks in my lumbar spine because of having a very deep curve in my spine that would never get better and my only hope was strengthening the muscles that support it, and suggested my sciatic nerve was getting pinched. Gave me exercises for my back, saw me another couple of times and sent me on my way.

Last month i had a serious asthma flare and i've had to come off the NSAID pain relief. I have 30/100 co-codamol and while its helping with the now mild back pain, it is NOT touching the excruciating pain in my hip/leg.

This pain starts in my backside and radiates down to my knee, sometimes my toes. Its been so painful some days i can barely walk on it and have ended up CRAWLING to fucking bed.

After 2 weeks of this shit i finally took myself back to the Drs today.

The GP (locum) i saw did the following

1. Declared it wasn't sciatica because the sciatic nerve terminates at the knee so i wouldnt be feeling it in my foot. & also because i 'passed' a straight leg raise test (doesn't make pain worse)
   
2. referred me back to another physio (wtf?)
   
3. referred me for x-ray (only thing i'm happy with)
   
4. refused to offer me any other pain relief, basically because i can't take NSAIDS, i'm stuck with the fucking co-codamol WHICH ISNT HELPING.
   
5. gave me a lecture over my weight, which the previous physio said wasn't a factor in this.. yes losing weight will help because of pressure on my joints, but it wouldnt fix this.
   
   I am SO sick of being in fucking pain, i'm sitting here now and all i can feel is my hip/thigh/knee just throbbing away. I just want some help.

[Gileswithachainsaw]

have you got a really close friend or family you can borrow from to book a private appointment?

how are you supposed to loose weight if you can barely move anyway

you are entitled to a second opinion I'd go back and see a different Dr tomorrow

poor you

[Epilepsyhelp]

Well maybe you were mis-diagnosed the first time, why are you so sure? It sounds like he did an awful lot to try and help and if that's his professional opinion he has to give it.

[Skullyton]

Epilepsy.. the sciatic nerve runs from the lower spine, through the pelvis to the feet. If she doesn't even know where the nerve stops, how can i trust her opinion on it?

en.wikipedia.org/wiki/Sciatic_nerve

[HaloKelly]

To be honest it sounds like he did a decent enough amount.
You've got to remember how hard it is for doctors to ascertain exactly what's wrong from a few symptoms. They're educated in thousands upon thousands of diseases/ailments/problems so what we think is wrong might not be the case...

Anyway it sounds a little like you're more pissed off that you didn't get any strong painkillers. Just ask next time, say you're not coping with the pain and you need something stronger.

[Lostcat2]

So sorry op back pain is excruciating but the GP did seem to be doing things and while annoying and probably tactless to mention your weight it is her responsibility in a way.

Really hope the X-ray helps get you some better treatment.

[FadedRed]

Have you tried a TENS machine? Lloyds Chemists do a short term 'disposable' one for about a fiver, you could try that and if it's helpful, invest in a more expensive long term use one, they cost about thirty quid.

[Tiggeryoubastard]

It doesn't sound like the doctor did anything wrong, but had had a difference of opinion with the Physio. I'm inclined to go with the doctors opinion. Your being overweight WILL have a bearing on this whether they upset you or not they were right to mention it. The Physio that told you it doesn't affect things was, frankly, negligent. Though I do sympathise with how hard it must be to lose weight in that situation. Go see the next Physio, they may be (hopefully will be) better than the last.
Yes, you are entitled to a second opinion, if you want to, go back and see another doctor, but don't go in all guns blazing about todays doctor. I do sympathise and hope you get the help you need.

[ChazsBrilliantAttitude]

The NHS doesn't agree with her on the length of the sciatic nerve.

" Sciatica is the name given to any sort of pain that is caused by irritation or compression of the sciatic nerve.

The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.

Signs and symptoms

When the sciatic nerve is compressed or irritated, it can cause pain, numbness and a tingling sensation that radiates from your lower back and travels down one of your legs to your foot and toes."
www.nhs.uk/conditions/sciatica/Pages/Introduction.aspx

Get a second opinion.

[ILiveAtTheBeach]

Oh dear. As a short term fix, have you tried "doubling up" on pain relief? What I mean by this, is taking pain killers from different drug groups. For eg. you can take 2 paracetamol and 2 iboprufen at the same time. This made a huge difference for me, when I had chronic tooth ache.

[LunchpackOfNotreDame]

Get back to another gp and get on appropriate medication such as amytriptiline or pregabalin or gabapentin

[EldonAve]

Go back and see another GP
they should be able to refer you to a pain clinic who will have many different options for treatment

I passed the straight leg raise test but an mri showed I had ruptured a disc

[ChazsBrilliantAttitude]

I am on amitryptiline for nerve pain caused by bulging disks. In my case in my neck and upper back causing pains in my arm and hand. It really does help. Was that suggested?

[Skullyton]

yes i am mostly pissed off about the pain relief.

it was the whole point of the appt.. i can't take Nsaids and the co-codamol ISNT WORKING, when its bad enough that i'd rather risk an asthma attack than be in this much fucking pain, then something else needs to be done to manage it.

and i'm more inclined to believe a physio who spent an hour doing extensive tests on my spine, hips, movement and asking a lot of questions about the pain, over a gp who gave me barely 5 minutes and made me lift a leg in the air.

[Skullyton]

Chaz, no.

i was told it was nsaids or co-codamol, there were no other options.

i still have my 500mg naproxen, like i said, i'm at the point its more appealing to risk an asthma attack than put up with this any more.

i will lose weight, but only because i'm in so much pain i dont want to eat.

[SomedayMyPrinceWillCome]

An X-ray won't show the discs in your back - is your GP expecting to see a fracture? Ideally you should have an MRI to look at the discs, have you had one of these?

[ChazsBrilliantAttitude]

From the NHS link above
If you have persistent or troublesome sciatic pain, there are a number of painkilling medications that may help. These include:
•paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
•opioid medication, such as codeine or, in severe cases, morphine
•tricyclic antidepressants (TCAs), such as amitriptyline – these medications were originally designed to treat depression, but they have since been found to help relieve nerve pain
•anticonvulsants, such as gabapentin – these medications were originally designed to treat epilepsy but, like TCAs, they can also be useful for treating nerve pain


I had an MRI scan to show up the discs and the problems with my spine.

[Skullyton]

Nope, this x-ray is the first thing.. its all been rest, painkillers and physio to this point.

[LunchpackOfNotreDame]

They will be able to see a narrowing of the disc spaces on an xrays which can indicate a disc issue but will also flag up arthritis or fractures too

[Writtenbyme]

Could it be your sacro-illiac joint? I had years of varying diagnosis and on-off excruciating pain before it was diagnosed correctly.

[LunchpackOfNotreDame]

Si joint can cause piriformis syndrome

[HicDraconis]

1. The sciatic nerve terminates usually just above the knee - it splits into two branches (tibial and common peroneal) which go on to innervate the lower leg and foot. However, sciatic nerve compression pain is usually felt from hip to below the knee. The straight leg raise stretches the nerve and is one of the tests for sciatic nerve irritation - in that stretched nerves hurt more.
   

1. Excellent suggestion, another physio is likely to be able to help with individual muscle groups and exercises (eg for pyriformis syndrome). They're also very good at differentiating between muscular causes of pain and skeletal.
   

1. X-ray - you're happy with. I wouldn't have ordered one personally, it's unlikely to show anything. CT scan generally more useful but probably longer waiting list.
   

1. Pain relief - 60mg codeine is the equivalent in most people to 15-20mg morphine. Codeine is metabolised to morphine, that's how it works. Opioids in general are rubbish for nerve type pain but for some reason everyone starts off on them. Regular paracetamol, NSAIDs if you can tolerate them (which you can't), weak opioid, strong opioid is the pain ladder. You're on a decent dose of codeine. I would probably ask for a trial of gabapentin if you think it's neuropathic pain, it works better than opioids do. Some people can't metabolise codeine at all but you say it's helping your back pain so unlikely you're in this group.
   

1. Weight. Well - they've got a point. Additional load on the spine will add to lumbar compression which will worsen nerve pain. Surgery for spinal decompression is extremely difficult in overweight people due to the positioning you have to put them in while asleep.
   

Other options - epidural or nerve root injections are only really successful for a very few types of pain and only then when done under radiological guidance. TENS as above is worth trying, as is medical acupuncture. Failing that and dependent on a CT of your back there's surgical decompression if indicated.

Don't go back in guns blazing. Do go back in and explain that the pain relief isn't enough and can you try something else or ask for a pain team referral. Good luck.

[Skullyton]

Hic, i'm only assuming the co-codamol is helping with my back, it may well be that improvement is the exercises the physio gave me, which were designed to support the compressed disks. i have had this problem since i was about 15/16 and i was not overweight back then when i had my first round of physio related to this.

Now you mention it, i have been given morphine before during a bout of renal colic, and i don't remember the pain being any less, i was just so high i didn't care about it any more, if that makes sense?

NSAIDs have always been my go-to pain relief, but this long term use has now started having an effect and makes me wheeze.

IT could well be my pelvis as i had severe SPD during my last pregnancy and i have had issues with this right hip on and off since then, but its always settled down after a week or so, this time its just gradually got worse and worse.

The x-ray is apparently to rule out any issue with the hip joint/bone itself.

[TheExMotherInLaw]

Push for an MRI. Once you have been in extreme pain for 6 weeks, they ought to refer you for one. My sciatic pain - bum to foot, has been found to be caused by a massive hernaition near the base of my spine. Surgery to fix it is too dangerous, unless it worsens to make me incapable of walking at all. I do find a tens machine to be extremely helpful to release the muscles that have tensed up because of the pain, so causing MORE pain. (as above) I got the £50 from Boots. That helped me go from howling on the sofa, to crutches, to walking stick. I have gabapentin, and find it very helpful. I have just been referred to a pain clinic, but there is a bit of a waiting list.
Take care.

[HicDraconis]

Renal colic is the pits. Nothing helps with that aside from losing the stones.

However I do wonder if you should have your calcium and parathyroid hormone levels checked (primary hyperparathyroidism causes renal stones and pain along with osteoporosis and anxiety states).

Morphine is unlikely to be any help with sciatica. Tramadol might help. Amitriptyline or gabapentin would be my first line though.

Don't be too surprised if the X-ray shows nothing - it may show some loss of joint space in the back of hip but you can have nerve root compression with a normal X-ray.

[WoodHeaven]

Get another opinion.
As pp have said, there is a lot of other pain killers available. Amitriptiline is one of them but not just that.
I would ask for a referral to the pain clinic ASAP.

Also push for a referral to a back specialist. MRI is one thing they will need to do (XRays are likely to show very little).

This needs to be treated as very severe chronic pain.
Insist that you can't get up and have to crawl to move around etc... Unfortunately, you will have to shout very loud to get heard (incl multiple appointements saying 'It doesn't work').