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.

I said “The NHS”, not A&E. My point being that even if OP’s mother goes to her GP, they probably won’t send her for a scan (unless she’s been going back repeatedly for years).

I agree that A&E isn’t the place for chronic pain, I never said it was.

What on earth is medication anxiety? She can't expect the NHS to help her if she won't even take pain relief.

The reality is that most people over a certain age who have scan will probably show some bulging of discs. The point is that some people this presents as symptoms and others it won't. Which is why for the most part the scans are not that helpful because it's the symptoms that matter.
If shes not going to take meds to help then she basically doesn't need a GP. She needs a physio who is specifically qualified in backs. These folks are amazing and can do work to relieve the pain and then give her exercises to help too. They were fab for me. GPs basically can only give meds and pretty much little else. As I said the scans just are not that helpful.

Yes but their job is to treat the emergency - the pain and check you aren’t in mortal danger. It’s not to treat the long term condition and investigate it like ‘one stop shop’. They do not have an empty MRI scanner sitting in the back of A&E. MRI scanners cost hundreds of thousands, if not a million pounds and due to the radiation, you have to meet a very strict criteria to get in one (risk of cauda equine). A basic MRI takes about 20-30 mins and very specialist!

If something hurts, A&E will usually just give you something to stop it hurting as much and check you are not in mortal danger and let you go

Yep. They’ really aren’t much use at times. 🤷‍♀️

MRI scanners don't use radiation; they use magnets and radio waves. X rays use radiation.

They made a diagnosis of severe muscle spasm - and recommended diazepam. But unfortunately she won’t take it. I honestly don’t see the point of her going to A&E if she had decided in advance she wouldn’t take the treatment advised regardless of what that was . and yes - I know she has anxiety but it’s up to her whether she allows it to control her. It’s not that she can’t take the medication- it’s that she won’t. And I say this as someone who has had severe anxiety and know the discomfort and distress of doing something when anxiety tells you not to.

Very sorry for your mum, OP - this is excruciating 😥

i see heat packs have been recommended.
just a caution from me that ice packs may be better.

when I had back spasms it was as a result of a ruptured disc, heat made it much worse.

probably trial and error, but just to bear in mind.

i hope she improves very quickly.

are injections part of your mum’s phobia? Maybe that’s an option next time?
or medical CBD oil?

Ironically the diazepam would have made her relaxed.
They followed protocol

Is she feeling any better, @NotSayingImBatman ?

Heat is the very worst thing for me when my back has "gone out" (makes the pain far worse) but I hope it worked well for your mum.

If she won't take medication,what would she imagine the doctors would do for her/ Does she think surgery is better?

Back problems are almost never A&E worthy, aside from cauda equina which involves wetting yourself and losing sensation in your limbs, which it doesn't sound like she had.

It's most likely that the supervisor declined the scan because she refused the medication. Sad but true. They cannot afford to have time wasted by patients who are uncooperative and were there for issues that are not acutely life-threatening.

I said this and got told to cop on

My DH started chemo recently and he had to be read the full list of side effects before signing that he understood all the risks and their potential complications, which included loss of life. On balance though, he would not have been given these medications had it not been medically necessary to fix a far worse problem.

Side effects are what they are. If medication is needed to fix a genuine medical issue then it is a risk that needs taking. Just as not taking the medication has a risk of side effects.

Right now not taking diazepam is having the side effect of back spasms and severe pain.

How is your mum doing OP?