What kind of doctor should I see about my sore neck and back?

January 16, 2012 6:26 AM

What kind of doctor should I see about my neck and back pain? I'm not sure if it's a pinched nerve or muscular.

I'm having a dull stabbing pain on the left side of my neck at the base. Sometimes it radiates up into my head or down my arm (even down into my leg), but mostly it hurts in my neck and shoulder. Sometimes my arm or leg feels a little tingly, so that's why I think it could be a nerve.

I have a probably unrelated soreness on the right side of my back, just below my shoulder blade. I'm pretty sure this is muscular; it's been hurting on and off for a long time (the neck pain is more recent).

Probably relevant: I have Klippel-Feil syndrome, the primary characteristic of which is the fusion of 2 cervical vertebrae (C3 and C4, in my case). It's such a rare thing that most doctors I've encountered have not heard of it. I also have scoliosis.

I'm not looking for a diagnosis here, I just want to know where to start with medical care. My primary doctor is worse than useless, he'll just give me painkillers and tell me to rest. Just assume he doesn't exist, and if I need to start with another primary I'll do so.

I have good insurance (Cigna) and I'm in Milwaukee, so specific recommendations are also welcomed.

posted by desjardins to health & fitness (7 answers total)

Start with your PCP. First, it sounds to me like you aren't seeing an internist, but a "general practitioner" or a "family doctor." The latter are good for annual physicals, colds, strep throat, stuff like that, but for any kind of serious diagnosis, or the maintenance of non-routine conditions, you should definitely be seeing an internist. It's possible that your doctor is an internist and just isn't helping you out, in which case you should switch to a different one, but I have a sneaky suspicion that you're seeing a family doctor, so I'd start by switching that up. Internists are also more likely to be better connected with other practices in the hospital--and internists usually practice in hospitals, not stand-alone clinics--than a GP, which is good for you here, because...

Second, the reason you need to start with your PCP is that your PCP is going to be able to 1) direct you to the appropriate specialist (probably an orthopedist, but ask your doctor), and 2) provide you with the referral that the specialist probably requires, either as a matter of course or as a function of the insurance process. That's just how these things tend to go anymore.
posted by valkyryn at 6:35 AM on January 16, 2012

I agree with valkyryn that an internist would probably be a better PCP match for you than a GP. If this has been a serious, prolonged thing, I would also check with a neurologist, if you can get or don't need a referral -- my wife also has spine and nervous system issues and benefited greatly from neurologist/neurosurgeon consultations.
posted by middleclasstool at 7:07 AM on January 16, 2012

I'm going to vote for seeing a Doctor of Osteopathy (DO), maybe a family practitioner and see where they refer you. DO training is really focused on how all the muscles and anatomy connects and interacts througout the body. So it might end up being that your right side soreness is something that your body has been trying to compensate for in the long term, which has caused a cascade of effects on the left side of your body.

A DO will know what kinds of questions to ask and physical tests to perform. And bonus, may have some manipulations to try that might relieve your symptoms.
posted by bilabial at 7:34 AM on January 16, 2012

I would recommend seeing a DO. DOs, if you are not aware, have the same training as MDs but with additional training in musculoskeletal medicine. The condition to which you are referring sounds to me like "Thoracic Outlet Syndrome" (http://en.wikipedia.org/wiki/Thoracic_outlet_syndrome). DOs have very specific training on how to treat this condition and other such musculoskeletal problems that go far beyond painkillers. Oftentimes, such problems are completely amenable to Manipulative Therapies and painkillers or muscle relaxants aren't always necessary. The manipulations, by the way, are really simple and feel great afterwards.

(In case you can't tell, I should probably write as a disclaimer that I'm a DO student...).
posted by gijoedo at 7:36 AM on January 16, 2012

I don't have Klippel-Feil syndrome, but I am currently being treated for the exact same symptoms by my chiropractor. The primary culprit in my case is that I slouch, especially at the keyboard. The chiropractor did an adjustment and then gave me exercises to help strengthen that area between my shoulder blades. They involve holding a towel and pretending like I am trying to crack a nut between my shoulder blades. I do this in the evenings after I apply moist heat. After I complete the exercises I then apply ice to the area. I also "think tall" and work on pulling my shoulders back and working on my posture. I am very pleased with the progress I am making. I had been suffering for months before I went to the chiropractor (who is in my health care system). When I saw the PCP I was essentially told to take pain relievers and anti-inflammatory agents. I prefer what my chiropractor has done for me.
posted by Hey, Zeus! at 9:15 AM on January 16, 2012

I experience the same symptoms about every 8 to 12 months. Deep, nearly debilitating pain in the base of the neck (typically just on the left side), with the pain radiating down my arm. My fourth finger on my left arm eventually goes numb at the tip.

I self-diagnosed a pinched nerve and went to a massage therapist. Did one hour deep-tissue focusing just on that shoulder and side. It was the most painful experience of my life, but the next day: no pain! And the feeling returned to my finger. I do have to repeat this every year, but it keeps me away from the doctor.

As with Hey, Zeus!, my massage therapist said it was due to poor posture at the keyboard and sitting all day at my desk. Doing neck and shoulder strengthening exercises at the gym (bench press, chest press, pull-ups, push-ups, etc) helped wonders after the initial pain was relieved.
posted by firstcity_thirdcoast at 1:27 PM on January 16, 2012

My PCP is a DO and was awesome when I had mysterious neck pain, so I would like to cast a vote in with the people suggesting DOs.
posted by countess duckula at 9:56 AM on January 23, 2012 [1 favorite]