Can anyone who works in an A&E setting tell me if this is correct?

[NotSayingImBatman]

Took my DM to hospital yesterday. Background is, she’s has niggling back pain for 8 weeks, has seen an urgent care GP who has diagnosed sciatica, paid for a private physio who diagnosed issues with her facet joints, and an NHS physio who said the problem is all in her hip. All have told her the best thing to do is keep moving and keep going to work.

She’s a self employed cleaner. On Friday, she was sweeping a customer’s floor, straightened up and heard a loud crack/pop from her spine a was immediately in excruciating pain that radiated from her spine round and over both hips. She ended up on the floor for ten minutes before managing to haul herself upright and get herself home. Since then, she can barely straighten up and can’t move or walk without severe pain in her back. She called her GP who can’t see her any earlier than Friday (an appointment she had to book 6 weeks ago and was told was the first available, hence the private physio).

I took her to A&E last night as she was sobbing in pain. She was examined by the doctor who said her back was completely in spasm and told her she’d need to take diazepam to relax it. She explained she has severe medication anxiety and can’t take anything like that — she’s on the waiting list for a second round of therapy to try to address this anxiety and it’s all over her notes. He said he’d send her for a scan to assess what was causing the spasm and left us in the examination room for 40 minutes before returning and saying actually, he’d spoken to his supervisor and she wouldn’t be getting a scan, after all.

I asked him how we could get her a scan as her symptoms suggested something was wrong. He said only GPs can refer for scans, so it’s up to her doctor to sort next week. If her doctor feels she doesn’t need one, she doesn’t get one, no matter how much pain she’s in. He said this was NHS policy.

Does anyone who works in this setting know if this is correct? I’m so bloody worried about her.

@NotSayingImBatman
I've had what your mother is suffering. The acute pain lasts for 4/5 days and takes about 6 to 8 weeks to resolve.

The first time I took myself to a private physio who worked on the knotted muscles and rang my GP to get a prescription for anti-inflammatories and omeprazole. Heat wraps work brilliantly.

I started personalised, physio led pilates in 2016 due to a crushed disk. No back pain issues due to degeneration lower down since - unless I hoover - so your mum's job is not a great option in my opinion.

But in a large number of cases there is no way of finding a cause - modern medicine is amazing but it really can't always find the why. In other cases, it is possible to find one, but it won't affect treatment at all to know. Of course people always prefer to know the why but there is a genuine argument to be had over whether it's a good use of resource

I'm not really sure what she's wanting here if she won't take medication though. A scan won't take away any pain.

Spasms hurt like a bastard. It would have helped her.

The Emergency Department is there to manage a situation long enough to allow you to survive intact for someone else to look more deeply into the issues.

They're absolutely a stop gap and not set up or resourced to be investigating diagnoses.

I can understand why you went to A&E. With back pain there is a fear there could be an issue that could lead to paralysis or similar. I imagine you are thinking there could be something checked on scan to rule this out and that is why you are worried. I expect the doctors in A&E are confident this is not the case and so for them, the situation is about pain management. Its very difficult when you are worried and I would never discourage a second opinion if you are concerned but it does sound like they have done the necessary things and follow up with the GP is a reasonable plan of action.

Yes, of course I did.

Thanks for all the advice everyone, I’ve never suffered with my back so at least now I can reassure her she’s not alone and give some actual insight from folk that have had the same issue as to how long it might take to resolve. I’ll pick her up some heat packs as well to try.

If she is happy to refuse meds then she needs to accept consequences - pain and no further treatment as she refused the first stage of the plan.

Oof, that sounds spectacularly frustrating.

It sounds like she'd need some kind of MH support to tackle that, albeit I don't know what. Does she have any resources to go private with it, if the NHS don't facilitate it soon?

That’s like contracting a builder for an extension, they advise to build foundations first - you refuse and insist they start building the structure. They won’t do it. Your mother cannot bypass medical protocols.

Via the A&E route if she won’t take any treatment? Yes, unreasonable (unless any red flags of course)

I understand she wants to know what’s wrong and I’m sorry the NHS can’t offer non urgent diagnostics instantly. But this the reality is this is not urgent compared to the conditions of others at A&E who might die if they don’t get full assessments, scans etc. If her pain is bad enough it will override the cognitions that drive the anxiety as she’ll be in survival mode - and benzodiazepines would blunt or even remove the anxiety.

I would honestly not pay it anymore attention if she is refusing care. If it’s not important to her to get better then why is it important to you? She needs to learn that if she goes to a medical setting and doesn’t take their advice then her problems will obviously persist .

Sticking plasters!!? Do you know the cases A and E deal with? Maybe watch a fly on wall prog like 24 hours in A and E and see the ‘sticking plasters’ are actually life saving interventions.

This

Would she try heatpads/cold packs or tens machine etc to try to release the spasm and relieve the pain? Will she take ibruprofen? Can she go back to the physio for advice?

Would your DM consider complementary therapy? Acupuncture worked really well for my Nans back pain - she was bracing herself because of the pain and it relaxed her.

I’m sorry she’s in so much pain and that she’s still working in such a physically demanding job when she’s clearly starting to age.

The anxiety is really worrying if she’s not even able to take basic painkillers or eg blood pressure meds if she needed those, never mind a dose of diazepam. What is she willing to look at to try to improve that? In my area you can self refer for CBT which may be a bit of a sausage machine but it can really make a difference.

It's not sticking plasters, it's evidenced based practice for musculoskeletal non- traumatic back pain, in the absence of red flag symptoms.

Move more, do the exercises, don't stay in one position for any length of time, take pain medication to facilitate this.

In which case if a scan requires a dye for example, will she then turn that down as well?

Book her with an osteopath therapist they are good with these kind of issues. I've tried them for my back and after 1 session I could feel the difference. Hope she gets well soon Xx

The reaction in A&E was according to protocol as no red flags.

BUT - she is left in excruciating pain and unable to take the meds that might relieve this.

The problem lies not in A&E but in the slow speed of treatment/investigation access and in your Mum's phobia.

Of course. And in the meantime she needs to take the prescribed medication to ease the inflammation so that, once she's had the scan, she can have physical therapy. She won't be able to have PT whilst she's inflamed and in spasm

I understand. But what does she think is ultimately going to happen? Medication will be prescribed. What is she intending to do? Remain in pain and blame the NHS?

Backs are a bugger. And once they've gone, they keep going.

If she won't take medication she needs to alternative hot and cold packs and she needs to straighten up ASAP. It'll fucking hurt. But it's necessary.

As much heat as she can stand on her back. Stand up, straighten up and walk around. Then lie down with cold pack. Repeat.

Then look at pilates to help strengthen the back muscles. And therapy so she can take the medication.