Treatments for painful pinched nerve in upper back?

July 19, 2022 11:46 PM

I think I’ve pinched a nerve in my upper back, and I need to fix it quickly. Can anyone recommend best-practice treatment pathways, please?

I woke up last weekend with a sharp pain radiating across my upper right back. After 2 days and nights of agony and no sleep, I got in to see a physio. She thinks I slept on it wrong, which makes sense since there’s no other obvious cause. (She didn’t use the term ‘pinched nerve’, FWIW, but from extensive googling I feel 90% sure that’s what it is.)

Anyway, she gave me a massage (which hurt like hell but gave some level of immediate relief) and some exercises to do hourly, and I’m going back tomorrow morning for follow-up.

Since then, I’ve been taking the maximum dosage of Voltaren (diclofenac potassium 25mg, 8 tablets per 24 hrs) and using a heat pad, plus doing the exercises, and… it’s barely touching the sides. I can’t sleep as there is literally no bearable position. My right arm is tingling and the grip is weak.

I start a new job in a few days so I’m desperate to expedite this. The physio said if I did the exercises I should probably be ‘a lot better’ within 2 days, but the 2 days are nearly up and…I’m not. I’m considerably worse. Should I see my doctor ASAP and get a referral for an MRI? Just keep seeing the physio? Any other ideas? I’m panicking a little.

Thanks in advance.

posted by Salamander to Health & Fitness (10 answers total)

With this level of pain and no improvement after 2 days, I'd go to the doctor to be on the safe side
posted by crocomancer at 12:56 AM on July 20, 2022 [2 favorites]

My right arm is tingling and the grip is weak.

Get a referral for a neurologist. There are many things that can cause this that would not show up on an MRI. You need a good neurological exam by someone who knows what they are doing.
posted by basalganglia at 3:18 AM on July 20, 2022 [7 favorites]

Also take a COVID test. Current strains can present as something essentially like viral meningitis (next pain, and then tingling/nerve stuff in the arm on the same side).

But yes, time to go to a doctor to rule out anything more serious.
posted by curious nu at 5:22 AM on July 20, 2022 [4 favorites]

When the muscle in my back that gets knotted with stress is bad, I get little relief from flexiril, but valium really helps; take it at night for restful sleep. Long hot baths, too. 2nding the doc recommendations.
posted by theora55 at 9:04 AM on July 20, 2022 [1 favorite]

Get in to a doctor for imaging as soon as you can, but I always check Bob and Brad to see if they've got stretches or postural alignments that might help.
posted by Lyn Never at 9:29 AM on July 20, 2022 [1 favorite]

I would both go to the doctor AND go back to the physio. Stop doing the exercises if they're making things worse. Oftentimes, fixing this sort of thing is a matter of trial and error, unfortunately.

Seconding Bob and Brad.

Can you go for a walk? I find that getting my blood flowing often helps. It loosens things up, shifts your posture around and causes your body to release its own anti-inflammatories.
posted by purple_bird at 9:36 AM on July 20, 2022 [1 favorite]

Best answer: If it's radiating into your limbs, it's likely the nerve, not the muscle. Recovery from nerve-related back pain can be very unpredictable; it all depends on what exactly is putting pressure on the nerve and under what circumstances, which can be really individual. You're getting worse, not better, so yes, go to a doctor asap. ( "Slept on it wrong" is kind of an iffy diagnosis, I'm not sure I'd fully trust that physio.)

In the meantime continue the exercises you've been prescribed, but only if you feel you can do them safely -- DO NOT "push through the pain" or do stretches or 'get the blood flowing' if it's painful; those can be appropriate for muscle pain, but can cause more damage when the nerves are impacted. (My doctors explained to me that the PT exercises were about strengthening the surrounding muscles to hold the damaged area safely, and about learning safer and more effective posture for the long term, not about direct pain relief.)
posted by ook at 10:21 AM on July 20, 2022 [3 favorites]

I had something similar, though not as painful - a dull pain and numbness on the side of my arm/hand. It lasted for...at least two weeks? It gradually went away on its own. I would focus on pain management right now when you call your doctor.
posted by coffeecat at 10:34 AM on July 20, 2022 [1 favorite]

This can take a while, and trying to hurry it may backfire. Do absolutely everything your physio says, because they know best, better than the docs. But I also agree with the suggestion to see a neurologist, based on the arm and hand numbness. Also, you might ask the physio about alternating hot and cold, rather than just heating pads.

And regarding the new job, be frank with them; they need to understand you are in pain with a serious problem — and may need some accommodation such as time off for therapy and medical appointments.
posted by beagle at 5:27 PM on July 20, 2022 [1 favorite]

Response by poster: Update: I had an MRI yesterday and it shows C6 and C7 vertebrae pushing on C7 nerve on right side. Apparently pretty severe (as my pain levels would attest to…). I’m being referred for a ‘CT-guided nerve root injection’ and prescribed Endep to manage the pain. The pain in my right arm has increased quite a lot. I’m a bit freaked out/upset. Thank you for all advice, it is appreciated.
posted by Salamander at 9:54 PM on July 22, 2022 [4 favorites]