Is it my arthritis or doctor insanity?

May 23, 2012 6:46 AM

YANAD - On tonight's episode - Back Pain, specialist claims it's osteoarthritis, but I am 37 and have absolutely zero history in my family (even extended) is he wrong? What else could it be? Minor snowstorm inside.

I have had some back pain before, but it always seemed to go away in a couple days to a week. Naturally I assumed it was muscle pain. So maybe a few times a year it hurt, especially if I was hunched over the computer for a bit.

Then my wife got pregnant, and eventually started snoring to the point where I couldn't sleep. I slept on the couch two nights and then ended up sleeping on the in progress nursery floor. Exactly about that time my back really started hurting badly- even when not hunched over. Mostly on one side. I also have some pain in my leg around my calf.

Went to Doctor. They gave me some scrip aleve and told me to wait. Things did not get better so went to specialist. He took x-rays (which I didn't see) and told me I had osteo in my back. The thing is he seemed just a little, well I can't think of any word but off. Normally this wouldn't bother me but just seems weird the whole thing would go from zero to 60 with no history in the family.

The only thing that has helped me feel better is a massage. I felt great for an entire day after that - leads me to think it is muscle or nerve related. He does not agree. He is an orthopeadist.

Should I get another opinion? What else might it be? Any suggestions on how to hurt less?

posted by UMDirector to health & fitness (10 answers total)

Addendum: My father used to have bad back pain (at about the same age) from what he was told was a disintigrating disk. However over the years it seems to have gone away and he is basically fine now.
posted by UMDirector at 6:48 AM on May 23, 2012

Yeah. I had a chiropractor tell me I had osteoarthritis on the basis of an x-ray, when what I really had was a herniated disc (which won't show on an x-ray) that later ruptured, necessitating surgery and almost two years of rehab. I do have a touch of osteoarthritis but it has nothing to do with my back troubles. If you are having pain in your leg, that is a classic sign of a disc issue, and you need an MRI. You should find another doctor.
posted by HotToddy at 6:50 AM on May 23, 2012

(Sorry, I shouldn't have said "you need an MRI" so authoritatively, because after all IANAD. But I bet if you go to another, better doctor, they will end up sending you to physical therapy for four to six weeks, and prescribing anti-inflammatories and muscle relaxants, and if it doesn't get better in that time, then they will order an MRI.)
posted by HotToddy at 6:54 AM on May 23, 2012

Get as many opinions as you'd like, but don't expect anything. I have been down--and am still going down--the same road.

I have had severe back pain since I was 4 years old. I went to chiropractors, but my back kept getting worse. I had x-rays done and "nothing is wrong." I went to physical therapy--nothing. I went to an orthopedist--nothing. I had an MRI--"nothing is wrong." I also have the exact symptoms of sciatica, but the doctors say "no."

Recently, I got a massage. I told her about the sciatica and she worked on those exact areas. It worked! For the first time in over 30 years, I felt like a human--I had no pain for about 20 hours or so! The pain is back, but not nearly as bad. Everyone else I saw said a massage wouldn't do any good as it would only be temporary and not solve the root of the problem. So what--after a massage, my back didn't hurt for the first time in over 30 years, albeit temporarily. Good enough for me.

So, can you keep getting massages? Like once a month? Can you get insurance to pay for them?

Good luck!
posted by TinWhistle at 6:55 AM on May 23, 2012

What kind of doctor was this "specialist"?

Osteoarthritis is what happens after years of wear and tear on your joints. Depending on your genetics and activities, it may show up sooner than it does with other people. You may well have some degenerative changes, but this may not necessarily account for your pain. I had on and off back pain about a decade ago that always cleared up when I got a little physio and corrected my posture. I was told years ago that I should expect early onset osteoarthritis in my spine after getting spinal fusion in my teens, but I had a bone scan a couple of years ago and show no damage there (yet).

See another doctor. A sports medicine specialist associated with a clinic where you could get physio would be ideal. Whether or not you have some skeletal issues, it's likely that bad posture, strain and imbalances are major factors in your soreness, and addressing these will help. And if you do have significant arthritic changes, strengthening the muscle around the affected areas can help.
posted by maudlin at 7:05 AM on May 23, 2012

HotToddy - Who eventually figured out what was wrong? Any idea what type of doctor I might want to see re: might suggest an MRI? Or just another doctor?
posted by UMDirector at 7:24 AM on May 23, 2012

You've already got the right type of doctor (an orthopedist), just not the right one. In my case, it was actually a GP who ordered the MRI, but this falls squarely within the orthopedist's purview. If you have bad insurance like mine, you can save yourself some money by simply calling your GP and requesting a prescription for physical therapy, because in all likelihood that's what you're going to get first. That way you save the cost of one doctor visit. Do the PT, and then if it doesn't help, go to the orthopedist and make sure you mention the magic words "leg pain," because that's what will trigger the MRI. Also, not all physical therapists know what they're doing--a good one is amazing, a bad one is worse than useless. See if there's anyone you can ask for a recommendation. My doctor knew who the best one was in my town, and he was right--after she moved away, I tried several others and they didn't even come close to her level of expertise.
posted by HotToddy at 8:19 AM on May 23, 2012

I've had two kinds of back pain. I've found that identifying the nature of the pain is essential, as the nature of the pain will determine an effective treatment.

About five years ago I experienced a debilitating form of sciatica. I didn't know what it was at first and initially had it treated by a combination of chiropractics and massage. This provided temporary relief only. When it became clear to me that this approach wasn't working, I saw my GP, who ordered an X-Ray and MRI. Upon seeing these, it was clear that I had a bulging disk that was impinging on my sciatic nerve. That eventually led to very successful surgery. I have never had sciatic pain since.

I've also had pain in my lower back just above my waistline. This feels quite a bit different and it occurs two or three times a year. This is an aching pain that leaves me very stiff, and I feel weak, like I would have trouble doing a situp, or I wouldn't be able to lift a heavy piece of furniture without my lower back failing. I've seen a chiropractor for this, and it is incredibly effective. The relief is immediate and lasts for months. It is like I walk into the office partly crippled and walk out healed. Chriopractors have described this as a "sprained joint," and I honestly have no idea whether this is accurate or not. I do know that it is qualitatively different than the nervy sciatic pain, that the relief from manipulation is immediate and long lasting, that it is cheaper and faster than any kind of surgical intervention, and it doesn't involve a doctor cutting in the area of my spinal cord.

(Oh, I also saw a physical therapist, and that did nothing for me).

I've heard anecdotally from friends and acquaintances that yoga and acupuncture have worked in some cases, too.

In any case, based on my experience I would recommend getting x-rayed and having an MRI done because that can provide valuable information about the nature of the pain, especially if it is sciatica, which would likely be caused by a bulging or herniated disk. I would also be very open to trying alternative treatments, especially a chiropractor. When a manipulation makes you feel instantly better, man, it's awesome. I would also be open to yoga and acupuncture, too.

I discovered that medical doctors hold chiroprators in complete disdain, and chiropractors generally feel something similar about MDs. So there is a risk that if you see an MD, they will approach the problem as if it is something that can only be solved with a medical solution, and if you see a chiropractor, they will approach the problem as if it is something that can only be solved chiropractically, like the old adage about having a hammer and treating every problem as if it's a nail. As someone who has experienced different types of pain and has had successful resolution with each method, I think it is worth to try both options.

There were two experiences that made a huge impression on me. The first was seeing the x-ray and MRI and actually seeing where my disk bulged out onto the sciatic nerve. There was no question for me at that point that a medical treatment was appropriate. The second, which has been repeated several times for me, is that moment of sweet relief when a chiropractic manipulation instantly erases a feeling of severe discomfort.

Sorry for the novel. Good luck. This is really something worth being thoughtful and persistent about as it has an enormous effect on your quality of life, as you know.
posted by MoonOrb at 9:24 AM on May 23, 2012 [1 favorite]

Sometimes people are the only ones in their extended families to have osteoarthritis. I would get a second opinion from another orthopedist, because it's always good to have that, but if he or she also diagnoses it as osteo, you can be pretty sure that's what it is. It's a multifactorial issue, not something where heredity can be traced directly; if there's a lot of it in your family, you're certainly at a higher risk for it, but if there's zero of it in your family, you're not at zero risk or anything close to it.
posted by Sidhedevil at 6:51 PM on May 23, 2012

I assume you are in Boston from your profile so luckily you have more doctors than you can shake a stick at. What did the orthopod want to do? You say he said osteoarthritis (OA) but did he mention treatment? Was he a spine specialist or a general orthopaedist? OA in someone your age is unusual but not impossible. Are you overweight? Do you smoke? How's your core strength, do you work out? These things can make you more prone to back pain. Both OA or a disk can lead to radiating pains in the leg and both X-rays and an MRI are usually used to diagnose that. The fact that you didn't see the x-rays bothers me. He or she should have explained why and how OA was the right diagnosis.

You seem uneasy, I would try to get a second opinion. If it were myself, I would seek out a non-operative spine doctor. These folks are usually physiatrists and are very skilled at diagnosis but also very good at managing a lot of back pain non-surgically. They are also very good at letting you know if surgery is the only thing that can help.
posted by karlos at 8:06 PM on May 23, 2012