Naked Science Forum
Life Sciences => Physiology & Medicine => Topic started by: suzy on 08/11/2004 23:49:45
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Hello
I am new to this forum and I write to ask for your support and advice, if possible. I have just returned to work after being off for 10 weeks with an work related injury. When I injured my lower back my whole skelaton structure changed. For the following 10 days I could do nothing. My GP sent me to physio which actually made the condition worse. She has now refered me to the Homeopathic hospital. I still feel discomfort and pain but is at an acceptable level because I take medication. Anyway, I returned to work last week. I work in a nursing hime and I am constantly bending and I am on my feet all day. When I come home I feel worn out because my back is throbbing. I am also taking additional pain killers,although I don`t like doing this. I am starting to become depressed because I cannot approach my employer as they are not at all supportive. I dont know what to do. why has the pain returned so quickly, and so badly. Is it because I am bending alot and on my feet all day. would this cause lower back pain to flair up.
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Suzy...welcome to the forum....and I want to say that in my non professional opinion I would expect your bending and the nature of your work to have aggravated your condition again. Please wait to hear from the experts here though as I am not a qualified medical practictioner, and I'm just sorry that your employers are not supportive, especially as they are in the business of caring. I wouldn't let your GP get away with just sending you to a Homeopathic hospital and I would encourage you to make a fuss and try for a MRI scan....please perservere and find the strength to carry on.....wait and see what others here have to say and I wish you better and hopefully a speedy recovery.
'Men are the same as women...just inside out !'
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suzy, welcome to the forum. I'm sorry that you've found us under such stressful circumstances.
I agree with Neil, you should make a fuss and get the diagnostics and treatment you need. If you are in the US, your employer most likely won't be very supportive because they are liable for your work related injury. I'm not one that advocates litigation, but you might consider consulting an attorney to help clear the way for your treatment. This doesn't necessarily mean a court battle, but maybe just a few well written letters to get things moving.
Good luck, and don't give up! You have lots of options!
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Many thanks for your kind reply. I am based in the UK. My union have passed the information over to their lawyers. I wasn`t aware that they where doing this. I am not sure how I will get on. I sustained the injury while moving furniture in a clients room. Basically my colleague and myself had no options to reposition the furniture because the clients mobility deteriorated and we could not get access into her room with a wheelchair. The only way was to reposition the furniture. This is when I hurt my back. In saying that, my manager was aware that my colleague and myself where moving the furniture. I am in the process of trying to have my sickness re-classified, however, not much luck. They are not answering my letters.
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In the states, it would be a worker's comp injury. I'm not sure how things work in the UK. As Neil suggested, the MRI is the gold standard to diagnose your injury. But even with a herniated or bulging disc, you would try conservative treatment first. Don't know how old you are, or all the symptoms. Would your doc consider sending you back to work with restricted duties until your back is healed. If it's a disc, bending and heavy lifting will definitely aggravate the condition. You can try some of the non-steroidal anti-inflammatory drugs and muscle relaxants even in combination with the pain killers, but it's not good to mask the pain too much. The pain will limit you from doing much more serious injury to your back.
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I am taking non steroidal drugs with co-codamol for breakthrough pain. My GP has diagnosed the injury as mechanical back pain. Not sure what this means. also, my employer sent me for a medical, they advised my employer that I have lighter duties for 6 weeks after returning to work. Maybe its a pain that I will need to live with.
GP also sent me for physio, physio actually aggravated the pain.So I stopped going, hence the reason she is sending me to homeopathic hospital.
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Don't do any more therapy without the MRI. Crucial diagnostic test for you!
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does the MRI show what is wrong?
someone told me that its not always reliable
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It is the first test that should be ordered, maybe other than a rountine Xray, and if it can't locate the problem, it can surely rule out some of the causes of back pain. No test is 100% reliable, but it's right up there near the 100% mark. It's very reliable for diagnosing a herniated disc.
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I asked my GP if I could have an x-ray. She said no, that it would do no good. I thought she would offer MRI scan but she never mentioned it. I find it difficult talking with my doctor, I don`t know why, so I didn`t mention a scan. I left the surgery achieving nothing. Since I have returned to work my leg keeps going away from me. This is something that didn`t happen until I returned to work. I don`t know if its something to do with the fact that I walk all day at work.
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Sure sounds like a disc problem to me. Do you have an option to change doctors?
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yes, I could change to another practice, however, not sure what reason I would give another doctor for transferring.
can you shed any light on the fact that the 10 weeks while off work I had no problem with my leg, and only after one week I was having new symptoms.
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The lifting, bending, pulling, creates different pressures on the spinal column. Whereas you might have been healing during that time, if the healing wasn't complete, you could have aggravated the same condition. Then too, even after your back is healed, it won't be as strong as it was before the injury. You will always have to be careful with how you use your back, and a course in good body mechanics would help. Even with good mechanics, however, you might not be able to do the things you did before.
The reason for changing docs is that you haven't had a proper diagnostic work up and you are still having the same symptoms that brought you to the doc in the first place with no relief. Is there not an orthopedist or neurosurgeon you could see isntead?
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what do you mean by good body mechanics.
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Like Mr. Goodwrench.
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thanks for all your support and advice. I have an appointment with my GP next week to bring to her attention that my leg is going away from me. don`t know how best to describe it. If this was a disc problem would I not be in alot of pain. I only have alot of discomfort when sitting for long periods and ofcourse when bending to dress the elderly clients in the home that I work in. Also, the pain, discomfort, throbbing is hard to explain. sometimes it feels like my lower back is feeling heavy, other times there is a distinct throbbing and sometimes there is a sudden quick sharp pain.
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Good body mechanics means that there are ways to lift and pull on patients that take the strain off of your back. And physical therapist should be able to teach you these techniques. The sudden quick sharp pain sounds like nerve pain to me. Usually my patients describe nerve pain as something like an electrical shock, or often as a burning pain. Other times they also describe pins and needles. Good luck at the docs. Keep us posted.
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Attended my GP yesterday morning. she has increased my celecoxib and she has given me an anti depressant. Came home from work today and just cryed my eyes out. My supervisor was really hostile towards me today. I forgot to fill out this form, and she asked me why I hadn`t done it, not in a nice way but a really abrupt tone. I told her that I forgot, which I did. I also apologised. She continued to say why did you forget, I said that I didn`t know. she wouldn`t leave it at that, she said again why do you think you forgot. Now, I don`t want to tell her my business that I am on medication. My question is, would this medication make me forget things or have a slower thought pattern. This supervisor has never talked to me in a rude tone before, also the manager last week was hostile towards me and I actually mentioned this to my GP yesterday. I don`t know if this has anything to do with my accident at work and the fact that I have talked with a lawyer which my union put me in touch with, otherwise I wouldn`t have approached a lawyer. I am low in spirit as it is because of having back pain which is controlled with painkillers, without dreading going to work. Thanks for listening
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I'm sorry to hear that you are having problems.
Mechanical back pain is extremely common. Each year in the UK about 5 million people seek treatment for backache at an estimated cost to the NHS of £1.5 billion.
The point prevalence - in others words a snap-shot of the population at any given time - shows that at least 1 person in 10 has a backache, and it's second only to headache as the most common cause of pain.
Fortunately, most cases of back pain resolve relatively quickly without the need for surgical intervention. Indeed, less than 1 person in 10 with backache has a serious condition, and less than 1 person in 100 actually ever requires surgery. Usually anti-inflammatory drugs, avoiding placing excess strain on the back, exercise and gentle muscle-building exercises are sufficient to prevent recurrences.
The most common symptoms include pain, tension and muscle spasm over the lower back which can radiate into the buttocks and legs.
Usually in cases of 'bad back' nothing abnormal is seen on scan. But occasionally there is a structural problem that can trigger the symptoms - such as a prolapsed intervertebral disc (a slipped disc). The soft jelly-like material inside the disc bulges out and can press on the spinal cord or on the nerve 'roots' where they leave the vertebral canal. Under these circumstances there is loss of function in the affected nerves which can be picked up on neurological examination. Cancer is not a common cause of back pain and characteristically causes continuous discomfort that is not related to, or eased by movement. Elderly people may suffer fractures and vertebral collapse due to osteoporosis.
Diagnosis :
Mechanical backpain is usually diagnosed clinically, that is, on the basis of the symptoms alone. The doctor will normally examine the patient's neurological status, including asking about bowel and bladder problems or numbness over the bottom, in order to exclude nerve or cord compression.
Most people expect an x-ray of their back when they visit the doctor, but this is virtually never done. X-rays are not generally helpful in the diagnosis of back pain because the problem is related to soft tissues and nerves which are invisible on an X-ray. Therefore, all an X-ray would achieve is an unnecessary dose of ionising radiation.
Occasionally MRI can be helpful in identifying a structural cause of back pain enabling surgeons to pinpoint a culprit disc that requires attention. But surgery is usually not necessary.
Treatment :
Anti-inflammatory drugs - such as ibuprofen - provide effective relief (but be sure not to take them on an empty stomach and with care if asthmatic).
Do NOT take bed rest, this has been shown to make the problem worse.
Avoid sitting for extended periods of time, and particularly avoid bad posture such as slouching in chairs.
Increase your exercise levels with the aim of gently boosting muscle strength to keep your spine stable.
See the doctor if, despite these measures, the problem gets worse, or if you experience any numbness, leg weakness, or loss of bowel and bladder control.
The problem is likely to be exacerbated by co-existent problems such as depression. Anti-depressants can make you sleepy, but then so can being kept awake all night by thoughts running through your head and worrying about your back.
"I never forget a face, but in your case I'll make an exception"
- Groucho Marx
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would anti inflammatory drugs and anti depressants cause forgetfulness
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No, probably not. Forgetfulness is not a common side effect mentioned by patients on these drugs.
Chris
"I never forget a face, but in your case I'll make an exception"
- Groucho Marx
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If your pain is severe, it can cause a lack of concentration which can lead to forgetfulness. Depression can do the same. But the antidepressant was a good move, because chronic pain causes depression. I am at a loss to explain why no further diagnostic work up has been done for this persistent, severe pain. Don't know how the system works in the UK, though.