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.

Heat is the worst thing you can do. It's ice, ice, ice.

My back was eventually stabilised a bit by one of the top physios for one of the top football clubs in the country and because of the inflammation that's at the injury, heat is the worst thing to do. Always ice.

OP I had similar to your mum and it was caused by bending twisting and standing upright.
I am wracking my brains trying to think of the name.

I almost poo’d myself when I did it and I was not able to walk, stand up straight or sit. There was no way I could go to A&E. I managed to shuffle my way upstairs and googled how to lie down with a pillow between my knees.
Google said to go to A&E but i literally could barely move and the pain was too bad (which sounds silly now).

It was the worst thing id ever had and ChatGPT was amazing for it.
I did spend a couple of days lying on my back and only getting up when needed, as this was the only position that I could bare. I took pain killers where 2 hours.

I rang my gp and got an appointment with a (I think) osteopath who said the only thing I can do is take painkillers and gave me exercises.
His advice was to move as much as possible as this reduces the swelling and then reduces the pain.

Get her to lie down with a pillow under her knees and take regular pain killers for a few hours.
Then continue with the pain killers and gently move around as much as her body allows.

Thank goodness she has you. It is very scary and I hope she feels better soon.

It doesn't sound like that would be doable since it's a phobia about side effects of medication. Realistically with any drug there's always going to be something, even if it's like a one in a million chance.

Or hide it in a baby bel, like I do for my dog!

I feel for you OP, I know how tricky it is when a parent has health related anxiety. On a serious note re the meds, diazepam has been a god send to me for these issues, twice in 60 years. I hope she can be persuaded. A and E are there to treat the immediate problem, not diagnose something ongoing.

If i was in agonising pain i would be prepared to take anything that helps

A&E isn’t designed to give people a diagnosis, it’s urgent care/treatment. I think the issue with the expectation of the NHS is that you can get an Amazon prime type of service to find out exactly what’s wrong with you in a same day service. Unfortunately it doesn’t (and can’t) work this way as a GP doesn’t have xray eyes either, so they can do an assessment (same as A&E have) and then refer on, but it is usual that most back pains resolve in 6 weeks with physio, and GP’s can’t send everyone with a back pain for an MRI scan (as they would likely be better by the time they got it). Hence you need to have not got better in 6-8 weeks to be eligible to be referred (radiology would reject it if it was 1-2 weeks of back pain with no physio)

I had severe disc rupture and I was in pain for 4 months before I got a scan, then referred to neurology and had a CT guided steroid injection. This is a last resort step for issues that haven’t resolved, it’s dangerous and risky. They don’t offer this to everyone unless it’s absolutely necessary

Even when I had my MRI scan, the ‘diagnosis’ didn’t change anything about my pain! I was still in pain. I had to get an opinion from a neurosurgeon and that wasn’t an emergency

And again, NO HEAT ON SPASM'D AND INFLAMMED ARWAS and yes I know I'm shouting 😆

This is such bad advice though it's doing my head in!!

If she won't take the drugs (you have my sympathy, my mother also has an irrational fear of medication), can you or her afford private physiotherapy?
Dry needling and massage will help a little, but its very hard to get physiotherapy to work when in significant pain.

I was wondering the same. X-rays expose the body to radiation, would she have one? Is this a new phobia or life long? I feel for you OP- it must be incredibly frustrating. Heat packs or a hot bath if she could get in 1 might help.

As someone else has mentioned upthread, if she presents reporting any red flag symptoms, then they'll arrange a scan on the day. I had a very bad bout of sciatica during pregnancy. Could hardly walk. Only when I started getting sciatica/sharp pains down both legs did I get an MRI (even while pregnant). Back pain is the absolute worse. I hope your DM a speedy recovery.

She needs to pay for a private scan. A&e won’t touch her and rightly so if she’s not complying with them. She needs a private mri and then once she has the results go from there. A&e don’t do emergency scans unless they are emergencies and your mum isn’t one.

I think your Mum may have misunderstood what Diazepam does. It is a powerful muscle relaxant. My friend ended up in hospital for a week with a sudden muscle spasm after changing her grandson's nappy. One dose of Diazepam appeared to release a trapped nerve and she never felt another thing. It is very effective.

I wrote the policy at my trust and that’s what we would do.

Saddle anaesthesia, loss of bladder and bowel etc - scan through A&E or surgical inpatients for urgent surgical management. Should be scanned within 4hours - reported within 1 hour of scanning and operated on within 24 hours (if necessary - few are)

Pain - even excruciating - GP referral

It’s not because we are unsympathetic arseholes - it’s because an a&e referral takes up a slot on an inpatient list that could be used for someone who is poorly enough to be in a hospital bed, or bumps an outpatient who may be sicker or need imaging before an mdt who will have their care kicked down the road if it’s missed. We can run very efficient booked outpatient lists if we don’t have to leave gaps in it for a&e. There is also a cost factor for out of hours (both scanning and reporting) with no benefit in outcomes for someone who isn’t going to need or want urgent surgery.

People with spasm often struggle to be still enough for scans and really need to take the drugs they are offered.

I think people are very harsh here. This site had become very aggressive.

She actually heard a crack and felt something go. How can anyone exclude this being unstable and close to the spinal cord without, at least, X rays?

And, of course A&E is there for basic diagnosis of acute conditions that need urgent treatment or admission.

Just because she doesn’t have cauda equina red flag symptoms doesn’t mean that it isn’t serious.

In the absence of the NHS doing their job, I would seek an urgent private scan. If she goes via her GP, this probably won’t happen until sometime in 2026.

It is sad that so many accept our two tier medical system without even questioning it.

This is one of the reasons the NHS is struggling... turns up in A&E with a chronic problem- offered advice and medication- refuses it and leaves 🤷‍♀️ Ridiculous. What was she expecting? A magic wand to be waved over to fix everything?

Why?

Literally speaking from experience, heat is the only thing that relaxes my muscles so I can move. (Barring medication)

And moving is the only thing that works to stop the spasms.

Then cold once I've moved.

I'm not a medical professional but that works for me.

Her mental health issues actually sound like a more serious problem than her back issues - at least in an "emergency" context (i.e. they're more likely to cause a risk to her life).

I do wonder how many of those who criticise people using A&E when they are seriously worried about their health have private alternatives for themselves!

I mean, the OP’s mother had an accident and believed it was an emergency!

A scan is unlikely to be any actual use while the spasms are ongoing. She needs to take the medication she has been given or live with the pain until it stops, what else can they do? They have tried to treat her and she has refused.

Even if something is wrong with her spine and she needs surgery, she wouldn't be able to have it without taking medication. So there isn't any point, its just time wasting.

Not taking medication may end up killing her. I had a friend who was a nurse but had a medicine phobia. She had significant vaginal itching but refused treatment. She ended up jumping out of her bedroom window as she couldn’t cope with it anymore. She broke her back and is now paralysed. All because she refused to take some tablets🤷‍♂️

They do.

After all, what would've happened if A and E had performed the scan that day and found something urgent for which surgery or medication was required? She'd still be unable to do anything about it.

The nhs did do their job. It was the patient that refused their suggestions. She probably couldn’t have a scan without the diazepam and she refused it. That’s her fault so she cannot blame the nhs. She wasn’t an emergency. She can walk, sit, go to the bathroom normally so it’s not a red flag. She needs to pay for a private scan or therapy because whatever the scan comes back with she will need painkillers and probably diazepam and she’s wasting everyone’s time and money in not having it.

I’ve been there, I have sympathy as it’s agonising but you do need to help yourself when this happens. Take the muscle relaxant, alternating ice and heat packs, try and keep gently moving. The acute episode lasts about 4-5 days and then as the muscles slowly relax off you just go gently, keep up with the anti inflammatory meds.
Unless there is loss of feeling in legs or saddle there is no more that can be done. Scans aren’t helpful really, if it keeps happening she may be referred for MRI

She was perfectly reasonable to go to an and e it could have been serious.

a and e have followed their protocol. I have had diazepam (before a smear) and it really does work.

i’m sorry your mum is in pain. For what it is worth, I have a severe ankle injury following an accident and these have worked for me:

dry needling (some physios will do this)
ice
hot baths
cold water swimming

(yes I know the two Above seem to contradict but they both work for me)

if she’s prepared to tolerate creams and the like there are deep heat/deep freeze sprays and you can get ibuprofen gels to go on the skin. These are surprisingly effective if somewhat smelly.

Is it only taking medicine that worries her? I was thinking of something like a Voltarol (diclofenac) patch; which is absorbed through the skin.