Imaginary back injury after genuine fall

[Broken23]

About 8weeks ago I fell at work. Landing full force on my lumbar spine on the edge of a chair that had tried to roll away from me.

Initially it hurt but not unmanageable with otc pain relief and ice. 5weeks on I noticed reduced sensation in my bladder and the pain in the affected area getting worse and unmanageable. The reduced sensation began to spread downward down the inside of my legs. I still worked up to this point. A moderately physical job with lots of standing and moving about.

Just over a week and a half ago I got so bad I could no longer work. The pain is only manageable if lying down using prescription strength codeine. And short periods shuffling about and regular resting. The altered sensation subsides once lying down. Progressing again the longer I am stood/sat upright. An x-ray a week ago revealed no fractures. MRI today reveals no spinal chord damage. Dr in hospital effectively said it's all in my head/I'm fat.

So. What am I supposed to do now? I'm already on a very low calorie diet trying to control my weight. The painkillers are making me feel horrendous, but should I even be taking them if it's all in my head. Drs exact word were 'all pain is real', meaning she thinks I'm a nutter coming to a&e seeking drugs. I don't want to take them. I want to go back to work.

Whilst most of my interaction with health professionals on this has been great. Today was so dehumanising. At one point I had to call hospital switchboard from my mobile to be put through to my area of a&e as I couldn't move from pain and loss of sensation and had been put in a room on a chair and abandoned with no way of summoning assistance for over 3 hours.

Sorry this is long and maybe nonsensical. It's been a rough couple of days. Any insight appreciated.

I would try physio/hydrotherapy OP.
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Someone had something similar on here called cauda equina could you ask them if it's that??

Don't stop seeking help. Ask to be referred to pain management, or neurology or whatever else seems appropriate.

Re the pain comment, she perhaps phrased it wrongly. Pain is the brain's perception of something, and sometimes the brain gets confused. That doesn't mean imaginary or made up- it's very real and you are experiencing it. It may not have a physical cause. It may be a memory of pain. I've worked with a physio to overcome similar.

That said, you sound like something else is happening- nerve damage, cauda equina etc.

Ask about CE, that's urgent. Otherwise persist in asking for help.

@lovemelovemesaythatyouloveme I have a telephone appointment with occy health physio this morning. I just don't know what I'm supposed to physio since they're saying its all in my head.

@Madamecastafiore the MRI was to check for CES. I am genuinely grateful it's not that. I don't have time to wait for surgery and do the rehab. I need to get back to work.

I'll see what the physio says today.

Just feel completely dismissed as a fat person with a MH health history(I haven't sought NHS help for years, I manage alone quite well) I couldn't possibly have actual pain. I must be attention/drug seeking, and like I am stupid enough to be unaware of my weight and I couldn't possibly be trying to rectify it (I've lost 10lb in the last 2 weeks).

Please don't say 'all in my head' and 'actual pain' etc like that!

People with complex regional pain syndrome, fibromyalgia etc do have actual pain. It's just that the source isn't an injury.

The physio helped me train my body to recognise that the injury was no longer there. Tiny repetitive movements that didn't cause pain, gradually increasing, until I regained full mobility.

I have a bank of techniques now, for tackling pain and injury.

Some good advice from @picklemewalnuts . I was confused by your interpretation of the Drs words (obviously I wasn’t there). It sounded like they were being supportive by stating all pain is real. They have ruled out an injury as the ongoing cause of the loss of sensation (which is a good thing!), but it sounds like the accident was certainly a trigger for what you are experiencing. Hopefully you have a good appointment with the physio. As @picklemewalnuts said, hold on to a holistic view of what you are experiencing- it’s not injury vs your in head. Also try and be compassionate to your self, experiencing pain (and associated worry and probable sleep disturbance) gives most people’s mental health a significant knock.

@picklemewalnuts then where is it if it's not in my head. The scans say it isn't in my back even though I fell and injured it. I don't have fibro- etc.

I've had about 3 hours sleep. Hopefully coming off the painkillers I can stop feeling rubbish.

Pain is very complicated and pain is weird. It's really not about it being "imaginary". All pain is created in the brain, which is why we can use general anaesthetic to do surgeries on people. The body is still being injured, but the pain is not experienced.

Our brain does something called proprieceptive mapping to locate sensation in our body. We have a sort of "map" of where everything is and we assign sensations (electrical signals) to this map. We can trick this quite easily and it can go wrong quite easily. There are lots of fun experiments "hacking" this feature.

Some parts of your map are more detailed than others. Most people, for example, cannot actually tell if you are touching their third or fourth toes without seeing it, though they are completely unaware of this gap in their perception, just like you can't see your blind spot in your vision.

It's a big, but resolvable problem, but it is a specialised one and often not well-understood by HCAP who are not neurologists or pain consultants . You may need to get a referral to a specialist pain clinic, but they can usually only do this after ~12 weeks and they have exhausted all other obvious avenues.

Physio is usually tried first because physio directly targets the proprieceptive map (introducing and reinforcing non-pain signals into the area). It's a very good intervention when it's done rigorously and it's also usually part of pain clinic strategies. People with highly intractable chronic pain, like incomplete and complex spinal cord injury patients, often end up only treating with neurophysio and no medications at all, in the end (as painkillers stop working after a few months).

Hello, sorry to hear about your treatment, I have seen negative attitudes towards people who have pain with no visible cause. Can you request a copy of your MRI report? It will detail whether there is any ligament damage or degenerative changes. I can't remember if MRI is 100% accurate for detecting spondylolisthesis (I'm not a radiologist, clearly. I'm a student radiographer). What I'm saying is keep on at them, especially if they're pushing back, it's not a normal amount of pain to be in, and the fact that it's happening when you weight-bear is suggestive of an issue. I hope the physio is able to help.

What gloov has written above is also worth having a good read of, I agree that pain is weird and sometimes there is no "cause" for it. Worth exhausting the possible physical causes first though. Hope it improves soon for you.

If it helps at all, I’m not sure this is to do with your weight or your mental health history. I have neither of those issues and was still treated like there was no possible way I was in pain; when I had been for years.

Back pain is quite functional, really. If they can’t see the cause, they tend to believe that there’s nothing they can do directly.

@Broken23 I didn't have Fibro, either. Until the day I got a diagnosis. I had pain and injuries, but they couldn't see where or why. They checked my bloods and treated any deficiencies. I was still no better. Then I was diagnosed with fibromyalgia. Could I have something else no one has found yet? Yes, of course. However my condition responds to treatment for Fibro so that's what I'll do.

You don't know the cause of your pain, yet. There may be an injury that has been missed, or there may be something more complicated going on.

The key thing is that it needs addressing- you can't be left as you are. Don't dismiss treatment that isn't aimed at a specific physical injury.
Treatment is anything that helps.

Listen to @picklemewalnuts she is wise.

I'm not dismissing any treatment. I haven't received any treatment to dismiss. I was told it was all in my head and go home. Which I did.

Occy health physio are due to call in half an hour. My first contact. But if my injury isn't real I don't think it will help.

I hope Occy health helped you. They can be really helpful. It doesn't matter what the underlying cause of it is, from their point of view. They just need to find ways of helping.

I was thinking about you this morning. I went to a class for people with chronic pain.

We did tai chi and Qigong, breathing exercises, and NICE treatment guidelines for various conditions. Really interesting stuff about pain management.

Second opinion.
my family member was told it was all in their head. It wasn’t.

Occy health have a different point of view to A&E. She's looked at the scans, x-rays and accompanying reports (the benefit of working and being treated in the same hospital, no waiting for things to be sent). She suspects some kind of nerve irritation and thinks the doc insinuating I'm a drug seeker is out of line considering it's still relatively early days post-trauma. I need to speak to my GP tomorrow about a different type of pain relief (instead of keeping giving me opiates) better suited to nerve pain.

I have a face to face appointment with her next week.

That's good!
I missed the insinuation about being a drug seeker, sorry.

I hope it all settles down, and that you get back to full recovery!

So it sounds like what you are suffering is actually very common “scan negative cauda equina”. Around 70% of people attending A and E with cauda equina symptoms do not have disc prolapse. Unfortunately, many medics take the view that if there is nothing on a scan or blood test there is nothing wrong - which is not true.

All pain is “in the head”. Even if you have a giant nail in your foot it’s the messages from your brain causing pain. It’s very unhelpful to think of mind and body separate.

There is a lot not known about pain (lots of reasons, including that disorders like fibro impact women more then men so it’s not researched as much). However we know in some people that the messages from the brain get badly mixed up. It starts sending out pain messages (or continues to do so) when the physical cause has gone. There appears to be genetic, environmental and social reasons for this, but no definite answers

Your focus needs to be getting a plan to move forward. Some people do just get better over a few weeks. Other people need more involvement. If in the latter group
you probably need to be referred to neurology and then hopefully a neuro rehab unit/pain management team.