To not understand why back pain is so dismissed?

[Saz432]

I posted a few days ago about a recurring issue with my back and worries about being fobbed off by a doctor - my fears were of course completely right. I had a strong suspicion it was going to happen so put it off until this morning hoping it would improve.

I damaged my back a few years ago when I was exclusively pumping. I have had constant upper back pain ever since. I also have a large patch on my back that has altered sensation. This is all in my notes. I’ve had two courses of physio. I’m now just accepting it’s always going to hurt because nothing makes much difference.

In December I seriously messed up my back lifting my son out of his cot. I spent five days in awful pain and barely able to move before seeing a doctor - they gave me a very low dose of diazepam for a few days. They said I could take up to four at a time - I built up to that I was worried about being drowsy but I wasn’t even slightly drowsy even on the maximum dose. It did help me get mobile again so I was very pleased. Haven’t seen a doctor about my back since as I was back to having just the normal level of daily pain.

On Sunday I did it again, putting my son in his cot. I’ve been in so much pain ever since and I am seized up. I can barely lift my children. I can’t sleep because of the pain.

I managed to get a phone consultation with a GP and explained what had happened and that what I was given last year really helped. She said she would prescribe me some naproxen - I didn’t realise until after I got off the phone that this is another anti-inflammatory. I’ve been using diclofenac suppositories that I have left over from a surgery I had and they’ve helped the pain a little but made no difference to my mobility so I know this isn’t going to help much, if at all. Is a few days worth of very low dose muscle relaxants really so bad that they won’t prescribe it 8 months after they were last needed? I’d understand if I were asking every month.

I’ve been a patient at this practice for over 3 years (and actually this doctor I spoke to was my GP throughout my childhood until I went to university) so they know I’m not some random drug seeker.

I am reasonably certain that if the doctor themselves were in this much pain, unable to sleep or work / look after their children, they’d take whatever worked.

It seems like back pain really isn’t taken seriously at all. I don’t bother seeing the doctor when it’s worse than normal because what’s the point? This is different though, I can’t bloody move!

What do I do now? Assuming the medication makes little difference (I’ll be delighted if it does), do I just have to tough it out and hope it improves on its own? I don’t want to be taking strong medications but I need to be able to lift my children and sleep!

When there’s something available that will actually work and they only need to give a few days worth, why won’t they do it?

And good luck with that route Saz. It really sounds as if you need someone to look at your issues as a whole.

I agree. The nhs is just horrific with chronic issues. I’ve got three incredibly rare conditions. I see around 16 different drs. It’s 3 months to have thee tests. Another 3 months to then see your consultant. If you need more tests. It’s then another 6 months. My gp is meant to be the one who talks to all my drs. But that never happens. At my gp today and overheard the lady say the next available routine appointment was October!!! We have 11 drs at my surgery for a small village.

They hate me and I hate them.

I do think you need to see your GP if you are not happy with their management plan. Anti-inflammatories +/- physio is standard treatment for back pain whether it is low back pain or thoracic. The addition of changed sensation/parasthesia suggests nerve impingement (if in arms/hands, probably cervical) and if this comes and goes could be due to muscle spasm. Benzodiazepines can be used in these circumstances, but as Dr’s we are under quite a lot of pressure not to prescribe them and our prescription of them are coming under increasing scrutiny (i’m not a GP). So you aren’t being unreasonable to want something to help the pain, or to get to the bottom of things. As to your point that Dr’s would take them and so are unreasonable able not to prescribe them for you-I think you are being unreasonable. I would not personally use benzo’s as I would not be able to work whilst doing so. Some Dr’s will take them if needed, of course.

If it is an cervical/thoracic MRI you want, please be aware that your GP may not be able to request it directly- they can’t in my area. They can refer to the neurosurgeons who can request cervical/thoracic MRI, and ask them to review you in clinic and/or ask them to consider requesting the MRI before seeing you in clinic. Our pain clinic would be unlikely accept a referral in these circumstances (acute exacerbation).

I have Spina Bifida, have had all the scans and specialists and STILL GPs are absolutely awful at prescribing anything remotely helpful.

Every one also like to make out I have an addiction etc but are soon left bumbling when I ask them to look at how often I fill my prescription. It's literally impossible for me to be addicted and I'm very clear with them this is a conscious decision as I know I have a lifetime of pills ahead.

If I cant get useful help I can imagine the frustration and anger for someone with no actual diagnosis yet etc. Hope you can get some relief soon, OP.

I have back issues and go to a weekly group physio session and the physiotherapist explained about the paths your body can take when you have an acute back injury - basically either getting better or getting worse and ending up with chronic issues, and the key thing to get onto the right path is painkillers. She said that when you have a acute backpain you should be taking as much pain relief/muscle relaxants as you need to be able to keep moving because otherwise you end up being too afraid to move because of the pain and it causes more issues which then get worse and worse until you have chronic pain, which happened with me because I couldn't take any decent painkillers (breastfeeding) and had doctors tell me to move as little as possible which was the worst advice, thankfully I finally got referred to physio.

As to your point that Dr’s would take them and so are unreasonable able not to prescribe them for you-I think you are being unreasonable. I would not personally use benzo’s as I would not be able to work whilst doing so. Some Dr’s will take them if needed, of course.

I take your point, although I’m not sure anyone would be working in this state regardless of medications - the yowling and expletives might concern your patients

I realise that most of the issues I’m dealing with have no quick solution and that diazepam wouldn’t fix my back either, but it would take away the additional horrible stiffness and pain I’m battling with right now.

Natsku makes sense to me. Untreated pain has a massive knock on effect.

I totally understand OP. I’ve suffered on and off with back problems for years, that have worsened since having a baby. I actually picked my toddler up a few weeks ago and couldn’t move. It wore off and I did it again a week later. I’m pregnant so didn’t bother trying to see a doctor because I knew I wouldn’t be helped anyway. However I was at the practise for a midwife appt and saw a sign on the notice board listing a load of drugs including diazepam, stating that no one would receive new prescriptions for those drugs. It seems we’re all to be treated as addicts.

My OH has a shortened leg, uneven hips and corrosion in his bottom disks, all documented and visible if he needs to show them. It occasionally causes major back issues that can see him being signed off of work for months at a time. I’m interested to see how this crackdown on these drugs will affect someone like him who has a long history of issues.

However I was at the practise for a midwife appt and saw a sign on the notice board listing a load of drugs including diazepam, stating that no one would receive new prescriptions for those drugs. It seems we’re all to be treated as addicts.

It’s disgraceful isn’t it? These medications have specific purposes, they’re not simply recreational drugs. I appreciate that some drugs are abused more than others, and they have to be very careful but the whole “no new prescriptions” thing is utterly ridiculous. I hope it’s just an attempt to put people off from asking and not actually true!

God I just want some bloody sleep.

This is going to sound like a really dumb question, but do you have a frozen shoulder? Can you raise your arm up above your head? A sign of mine was when I raised both arms (straight) above my head the right went no where near as high as the left - easily seen in the bathroom mirror, which was where i spotted it. My pain was shoulder blade to spine, not shoulder joint.

Physio said it was caused by isometric use of the muscles - ie keeping them engaged but not moving - so holding a set position. Not good for you. What you're saying about position for pumping causing the pain, just sounds similar to what physio said about maintaining a fixed position with muscles engaged.

I've previously done physical damage to the shoulder - big hole in the muscle on the shoulder blade; tore muscle, ligament and cartilage off my ribs. So I thought the pain was related to those injuries, but no.

I have got knackered shoulders (manual wheelchair user, crutch user), horrific posture (long term slumped in front of a desk or drawing board for the last 20 years).. and a dx of fibromyalgia and Ehlers Danlos..

I see an osteopath once a week or once a fortnight - Osteos typically cost around £40 to £50 outside of London and unless they add extra stuff... I have found them to be the same surprisingly low price all across the country!

Unlike a physio (who will look at you move then give you some exercises and forget about you) or a chiropracter (who will do some dramatic crunching for 5 minutes and little else), an osteo will take a full history and slowly massage and ease out muscles, releasing trapped nerves and putting things back where they should be AND advise you on how to improve posture to ensure things stay where they should be.

6 months seeing my osteopath has done more for me than 5 years nagging my GP or seeing a physio.

I won't be cured, i have irreparable nerve damage now and I can't improve my posture significantly enough to stop doing the damage, (and my osteo has been honest about that) but it IS reducing my pain dramatically and for me thats a big deal.

Btw if you find muscle relaxants help, try asking for Robaxin, there should be no issue letting you have that, its not addictive and isn't a painkiller.

Well I’ve got an appointment this morning as it’s no better - still getting pins and needles up my neck / face and down my arm. It’s the same GP I spoke to the other day so I’m not sure how that’s going to go. I just want to be able to move again. I’m in a bad state, haven’t washed my hair for days as it’s too painful to lift my arm.

I’m sorry so many of you have been dismissed too. It bloody sucks.

I will be sorting out an osteopath and possibly seeing a private GP too as soon as I’m up to it.

Because until people have suffered intense back pain they have no idea how debilitating and all consuming it is. Imagine labour contractions, almost permanently, every day of your life. My husband has suffered for decades. Surgeries, oramorph sometimes, only thing that’s helped in recent years are spinal cortisone injections but there’s currently a 10 month wait at our pain clinic or £1,000 bill to go private. He works but can do little else, sometimes he’s in tears by the end of the day. I don’t know how he carries on a remains as stoic and such a lovely person knowing it’s just going to get worse. As well as the degenerative disc disease he’s developed arthritis in his spine in recent years.m. I couldn’t do what he does and remain vaguely civil. Quietly, he’s something of an hero. In fact I’m going to tell him so this evening.
(Feel free to use your sick buckets )

You should tell him. It means so much when someone acknowledges that you’re coping well. I often feel like such a failure because of the limitations caused by my gynae issues. It does help when people appreciate how hard things can be.

Saz: have you talked about cortisone injections with your GP and asked for a pain clinic referral? I don’t know if it would be appropriate for your needs but GPs are generally woefully I’ll equipped to assess. My husband is a very clever man who suffered agonies for years before finally being told that there are consultants whose speciality is pain and after the first injection he had 2 almost pain free years. The effectiveness does decrease over time but hopefully new treatments are being developed.
Take someone with you to advocate at your next GP appointment. You’re not an idiot, I know! But when you’re focussing every superhuman effort on trying to walk and breathe through your pain, the last thing you’re capable of is arguing your case.

I am prescribed baclofen as a muscle relaxant. It has some side effects like disturbed sleep and lassitude; but otherwise works fine.

The main muscle relaxant I’m given is Botox. It’s used for cerebral palsy, dystopia, excessive sweating to name but a few!

There are alternatives to diazepam, so rather than ask for that by name (which raises suspicions of addiction), just ask for muscle relaxants as painkillers?

Well you have got further than I have managed!
Ten years ago in work a huge heavy fire door was slammed into my back with force, the handle (normal door handle) went into my spine. Boss sent me hospital (company policy) Dr got me to bend over and gently stroked down my spine, said nothing wrong no better gp in 7 days. Gp did the same (by this time had noticed couldn't feel things in my lower back and had burnt myself on a hot water bottle) gp said fine, just taking its time.
Went back several times, to be met with a shrug and an 'it must be in your head, have you tried homeopathy?'
Have given upp now, can't afford chiropractor or private so I'm stuck. But I have to admit since I was heavily pregnant and gave birth last year I feel its been slightly better

Dystonia not dystopia!

Physiotherapists thought they could treat my neck pain and told me I did not need to see a consultant. It took 7 years to get it diagnosed properly, as cervical dystonia by a consultant neurologist - who said the effective treatment is Botox, not physiotherapy!

My husband is prescribed amiltriptyline (spelling?) at nights too but has found its efficacy diminished over time. He was given diclofenac and naproxen for years but it damaged his kidneys which caused a whole lot of other issues.
Pain affects so many people and loses so many productive hours but is pretty much neglected research wise.

Good grief keep away from physios and worse osteopaths if you’ve an undiagnosed condition! They’ve done far more harm than good to my husband over the decades.
A qualified pain consultant with the latest diagnostic equipment is the only person I’d listen to.

Agh, it makes me so angry! I’m so sorry.

To be fair I didn’t ask for diazepam specifically - I just asked for whatever I was given before as it really helped. I’m more than happy to take something else if it’s as effective, I didn’t get anything else out of it!

Honestly its like I feel like I’ve done something wrong by being in pain, I’m dreading this.

Did I mean chiropractor instead of osteopath? Not sure, get them mixed up. Either way, steer well clear until you’ve a proper diagnosis from a qualified pain consultant.

I hope your appointment goes well today - I was dismissed for over 15 years with back pain .

I was working in a shop when I was 18 and picked up a tray of dog food and my back went 'crack' and I had severe pain. I went to the Dr and got told to 'try and lose weight, that should help'......

...... 15 years of periodic intense pain.... I lost SIX STONE and was within normal BMI range... when my back went again, I went to a different Dr (One at University) 'Yes, You've lost weight, but try and lose a little bit more, that should help'.....

3 years ago I was in B&Q, picked up a can of paint and my back cracked so loudly a couple heard and the woman asked if I was OK, I laughed it off and managed to limp to the car and somehow drive back home - cue 2 months of utter agony, hoping it would sort itself out.

Went to the GP, thinking she'd dismiss it and she just looked at me and said 'It sounds like sciatica, losing weight won't help'.... and referred me to have an MRI scan.

3 L3-L5 disc prolapses / bulges.... caudal epidural under sedation.

I literally cried with relief when I got my MRI scan as it was somehow 'proof' that I wasn't making this pain up and I was so angry I had constantly been dismissed.

Word of warning if you (or anyone else) uses codeine.... I was prescribed Zapain (30mg codeine) for the pain and it was too strong so just went down to the 8mg co-codomol over the counter.

I took them pretty much religiously for 3 months (as directed by GP) when I had my caudal epidural, I had to stop all drugs for 24 hours beforehand and afterwards I felt so sick and shaky... vomiting... diarrhoea.... I realised I was addicted to them and my body was literally going through withdrawal.

I have never felt so, so bad and ill - so either taper off slowly or just be aware, as noone mentioned it to me!

I hope your pain goes soon

I suffered from sciatica, plus other low back pain on and off for 10 years, I realized it was usually connected to stress. G P eventually said it needed to be sorted and referred me to a physio. He was great, and by just looking at my stance and my back, understood the problem, and gave me a series of exercises to practice at home between sessions. He said due to bad sitting and unbalanced carrying habits, some muscles were weak, and when tensed (with stress)they were easily damaged. I have had no real problems since, but if I feel a twinge, I take care not to slouch, and start the exercises again.
He was a sports physio, and much better, imo than the physios I have seen for other problems at the local NHS hospital.

That’s very different to disc, spine and arthritis problems. Physio will often make them worse or cause more damage.