I think my back is dying.

November 20, 2013 1:07 PM

I have been having some really really terrible back pain lately and I need to know roughly what it might be and what kind of doctor person I should see about it and what I can do in the meantime so that I don't end up defenestrating myself in order to escape it.

My family is very much of the suck-it-up-and-deal mindset, so I have zero experience in the world of physical therapy. Do I need a physical therapist?

Here's what's going on: very sharp, achey pain in my upper-mid back between my scapulae, so mid thoracic vertebrae. While I am no stranger to stupid fucking back problems, this is new for me. It came on last week without notice. As far as I'm aware I didn't do anything to tweak it and I haven't been sitting in any weird way. Aleve isn't really helping me much whereas it's usually my go-to.

Here's a difficulty: I have a fairly serious neck issue and so am extremely reluctant to just go and get a massage from a massage-giving person even though I think it would help. I need someone who has had some medical training so they understand and seriously do not fuck with anything near my neck. For that reason I will also not be going to a chiropractor.


My question is: what kind of professional should I be seeing about this? I do not want to take painkillers.


I am in Chicago and have really good insurance if anyone has any local recommendations for people.

posted by phunniemee to Health & Fitness (22 answers total)

Best answer: I'd start with your GP, especially if they're already familiar with your neck issue; they likely refer you to physical therapy or an orthopedist depending on what they find.
posted by ook at 1:13 PM on November 20, 2013 [5 favorites]

I have a massive history with back issues. GP first, then if indicated Orthopedist.

Do NOT mess with a chiropractor or massage or anything like that until a specialist advises you.

You may have nerve issues, or muscle or skeletal issues, but without proper medical intervention, it's all just a guess.
posted by Ruthless Bunny at 1:16 PM on November 20, 2013 [1 favorite]

I would go to an orthopedist. That doc may refer you to physical or occupational therapy.

The way it's worked for me is that the doctor diagnoses and writes a prescription for treatment that the PT fills. No PT has ever wanted to diagnose me, but they're happy to treat me based on my diagnosis.

Back stuff is a little special (some docs specialize in spines), but I'd call an orthopedist to start.

If you have a great GP familiar with your previous diagnosis, start there, but I've had pretty crappy results with GPs when I've needed more than rest and ibuprofen.
posted by purpleclover at 1:19 PM on November 20, 2013 [1 favorite]

Are you willing to try acupuncture?
posted by brujita at 1:22 PM on November 20, 2013

I would go to an orthopedist who will probably recommend a physical therapist.
posted by radioamy at 1:24 PM on November 20, 2013 [1 favorite]

Just popped back into say, while I've been symptom free for most of the past 20 years. I had a recurrance last year. Muscle spasms mostly. Very painful and uncomfortable. Lasted for months.

I learned that pain relivers don't really work. Ibuprophen at night was good, and I got an Rx for a muscle relaxer for when I did flights to and from London. But mostly I just got through it.

You are seeing doctors for referrals to PT, or to rule out serious problems. My back issues were handled with 2 injections of cortisone in my spine. This is NOT a simple thing, I had to be admitted into a hospital. But it did solve my problems.

Some docs will happily prescribe narcotics (mine did) but they don't really work.

Just FYI
posted by Ruthless Bunny at 1:24 PM on November 20, 2013

Best answer: Unfortunately, I have been in similar situations. PT is the thing that made the most difference for me - but usually that requires a prescription from your GP. It's possible your GP might need to refer you to an orthopedist as well. Barring some scary visit to an emergency room or something, that's probably where you need to start. And, as others have said, it's mostly to rule out big, scary things. The hard nitty gritty of getting better, at least for me, was meds and rigorous PT. Still, ruling out the big, scary things was good.
(Muscle relaxers also basically kept me from losing it any more than I did.)
posted by bookgirl18 at 1:29 PM on November 20, 2013 [1 favorite]

I had paralyzing back pain last year. I did painkillers followed by PT and then a lot of core workouts to prevent it from ever happening again.
posted by Sophie1 at 1:37 PM on November 20, 2013

Go see your doctor for a consult. It's not necessarily musculoskeletal. For example, gallbladder problems often show up as pain in the area you're describing.
posted by quince at 1:41 PM on November 20, 2013

I would call whoever you last saw for your neck issue and ask them for a referral to an orthopedist who specializes in back pain.
posted by elizardbits at 1:41 PM on November 20, 2013

Response by poster: Thanks, guys. Glad I asked...I had no idea I'd need to go through my regular doc.

I just called my PCP and got an appointment for tomorrow. He's generally pretty awesome about believing me when I tell him something's fucked up, so I went ahead and did some googling to find a (hopefully) good PT and went ahead and penciled in an appointment with them for next week.

I've been to an orthopedist a few times because I keep doing stupid things like breaking my foot and spraining my ankle and spraining my ankle again and oh my god what is it with this damn ankle but the dude has kind of a douchebro vibe. If I end up needing an orthopedist...anyone know anyone good in Chicago? Who is not a douchebro?


Anyway, thanks.
posted by phunniemee at 1:42 PM on November 20, 2013

I re-injured a very old shoulder problem last year along with a herniated disc in my neck, which pinched the nerve and hurt like a motherfucker.

Went to see my GP who gave me narcotics (meh - helped me sleep, did nothing for pain), a short course of oral steroids (helped a bit in terms of getting through the work day) and a scrip for physical therapy. The physical therapy was fantastically helpful.
posted by data hound at 2:12 PM on November 20, 2013

I have a pretty messed up (lower/lumbar) back. I screwed myself up last Saturday just by stretching (really!?). In any case, I have a PPO medical plan, so I don't need a referral from my GP - I can go see any specialist I want. So, I see a sports medicine doctor (I am pretty athletic and active).

In the past I've been to my GP who did nothing (sent me for an x-ray to see if I had a bulging disc, but bulging discs can't be seen on x-ray, only MRI or CT scan). So GP was worthless. I then went to a sports med dr who referred me to physical therapy, which did help to an extent. Then I went to a chiropractor who was helpful to a point, but I was still not 100%. Now I'm at a NEW sports med dr who is sending me for an MRI tomorrow (they also have orthopedic specialists at his office). New sports med dr understands my frustration and is determined to get me back up and running (literally).

My point is: don't give up. If you aren't getting the kind of care you should be or aren't getting relief, go see someone else until you get your issue resolved.
posted by ATX Peanut at 2:36 PM on November 20, 2013

There are things other than back problems that can cause back pain. Go to your GP, too.
posted by theora55 at 2:55 PM on November 20, 2013

Kidney infections show up as back pain too, so....that.
posted by Ruthless Bunny at 4:52 PM on November 20, 2013

Upper back pain need not be musculo-skeletal so it's important to see your GP. Kidney infections, stomach or duodenal ulcers, gall-bladder problems can all cause back pain.
posted by glasseyes at 9:46 PM on November 20, 2013

That spot in your back is exactly where my pain was with my gallstones. I thought it was orthopedic also. Later had a kidney stone and pain was very similar but just a little lower - though it did seem to radiate out further than that - down my side, etc., sometimes. Could also be your heart! See your regular doc first. Yes.
posted by aryma at 11:03 PM on November 20, 2013

Since you've already made your appointment with your PCP, I think you should ask him for a referral to the doctor who is treating your neck problem or another doctor who specializes in Chiari malformation, because I believe there is at least a chance that's causing the back pain.

Specifically, it could be causing the formation or progression of a syrinx

A syrinx results when a watery, protective substance known as cerebrospinal fluid, that normally flows around the spinal cord and brain, transporting nutrients and waste products, collects in a small area of the spinal cord and forms a pseudocyst.
...
In the case of syringomyelia, the syrinx can expand and elongate over time, destroying the spinal cord. Since the spinal cord connects the brain to nerves in the extremities, this damage may result in pain, weakness, and stiffness in the back, shoulders, arms, or legs. Other symptoms may include headaches and a loss of the ability to feel extremes of hot or cold, especially in the hands. Each patient experiences a different combination of symptoms. These symptoms typically vary depending on the extent and, often more critically, to the location of the syrinx within the spinal cord.
...
Syrinxes usually result from lesions that partially obstruct CSF flow. At least ½ of syrinxes occur in patients with congenital abnormalities of the craniocervical junction (e.g. herniation of cerebellar tissue into the spinal canal, called Chiari malformation), ...
[my emphasis]

The difficulty you experience recognizing familiar faces modified by things like sunglasses and beards could also be due to your Chiari malformation, because prosopagnosia (face blindness) results from problems in the fusiform gyrus:

The specific brain area usually associated with prosopagnosia is the fusiform gyrus,[2] which activates specifically in response to faces. Thanks to this specialization, most people recognize faces much more effectively than they do similarly complex inanimate objects. For those with prosopagnosia, the ability to recognize faces depends on the less-sensitive object recognition system.

which is at the very bottom of the cortex where the cortex curves back around toward the cerebellum (see the animation in the linked Wikipedia article), and herniation of the cerebellum into the foramen magnum would certainly make it more likely that that the fusiform gyrus would press on the bottom of the brain case and fail to function properly. I bring this up because I think the fact that you experience some face blindness also raises the probability your Chiari malformation is causing your back pain.
posted by jamjam at 12:49 AM on November 21, 2013 [1 favorite]

Response by poster: Thank you for all your research and concern, jamjam. I don't have a syrinx. I get regular MRIs and there has been zero change in my Chiari since I was first diagnosed well over a decade ago. I generally attribute anything that goes wrong with me to the Chiari since it causes problems with everything, but this is different.

I'm getting an MRI in December to check up on it independent of this back thing anyway.
posted by phunniemee at 4:25 AM on November 21, 2013

Response by poster: Just got out of my doctor's office. He had me move around and poked and prodded me, and he's pretty certain I strained my thoracic paraspinal muscles. He wrote me a referral for PT but said he was pretty sure it would go away on its own. He's going to call on Wednesday and check in.

So. Probably not dying. Still feel like dying.
posted by phunniemee at 4:29 PM on November 21, 2013 [1 favorite]

Excellent, excellent, phunniemee!
posted by jamjam at 5:14 PM on November 21, 2013

Response by poster: I just realized I never updated this. I went to a physical therapist for a couple times a week for about a month and it helped tremendously.

As a bonus, I learned that PT is classed differently than office visits, so your standard co-pay may not be required as long as you have a referral from a physician. (For the insurance I have, this means that my visits were completely free. Awesome.)

If anyone coming back to this thread in the future is in Chicago and needs a recommendation for a physical therapist, hit me up. I like mine a lot.
posted by phunniemee at 9:06 AM on March 19, 2014