What is this back pain?

[Latiam]

On August 17th, when I started a new course, I was fine in the morning and limping when I left. All I had done was sit all day. The pain started that night in my hip but the next day radiated into my back's SI region and stayed there.
I got X-rays and they were negative. My physiotherapist worked on it weekly, the only time when I was pain-free. Muscle relaxants didn't help much, and I wasn't comfortable staying on them long term so I stopped. (These were the ones with acetaminophen, because my doctor wouldn't give me anything). I tried cold, heat, stretching, ignoring it...
Finally my physio said if anything it's worse, and a soft tissue injury would have healed by now, so I should get an MRI to figure out what the heck it is.
I got one. It's NEGATIVE.

Later in the week I am going to a physiatrist, a person who handles pain and its source. The last time I went, for another problem, I was told to get on a waiting list to see a rheumatoloigist and see what happened over the next year. I was less than impressed.

So does anyone have any idea what could be negative on an MRI AND Xrays? I'm miserable. And I don't have any faith in this appointment coming up.


TMI TMI TMI TMI
I've been living with this for 3 months, and going to work every day and not taking any pain pills for it. In fact, I had to go off my anti-inflammatories for my arthritis, because I had blood in my stool and the doctor was worried it was a bleeding ulcer. By the time I go to the new rheumatologist November 30 I can go on something else because my stomach will be healed up - Nexium 2x a day.



My resources are almost gone as far as dealing with this without pain meds.
Does anyone have a clue?

[erwins]

I don't see why your physio would say a soft tissue injury would be healed by now. The back is a complicated thing, and once injured, there are knots, scar tissue, "guarding" by other muscles, etc. This can all combine to pull things out of alignment and cause chronic problems.

I'm not any kind of expert, but I'm speaking from experience. I had a soft tissue injury in my mid-back, between my shoulder blade and my spine on my left side during my senior year of college. I had physical therapy and ongoing treatments for a bit over a year. Some of the things that had to be addressed during that time were spasms in my lumbar region and neck, ribs that were torqued, spasms in muscles around the injury ("guarding"), and my pelvis was torqued by the unequal spasms in my lower back.

There was a lingering chronic problem caused by scar tissue that lasted another 5 years or so, but it happened with decreasing frequency over that time. Now, the only remaining effect is that I cannot sit for very long without back support. Sitting on a barstool or a picnic blanket becomes uncomfortable after about 15 minutes, and excruciating after about an hour.

So, just because it involves only soft tissue does not mean that it is either minor or should necessarily be healed in a few weeks. I hope your injury heals faster than mine did, and with fewer parts of your body getting involved, but it is certainly possible for a soft tissue injury to get complicated and difficult to treat.

erwins

[Nana M]

I have had rheumatoid arthritis for many years and it's especially bad in my left hip (to the point that I really need a hip replacement soon). When my hip becomes inflamed, a nerve gets pinched which causes muscle spasms, which then radiate the pain to my lower back. That won't show up on an MRI or x-ray, since the problem is transient inflammation of the tissue around my hip. Once the inflammation is gone, the muscle spasms remain until I can resolve that issue. If this is something similar (it may or may not be), your rheumatologist should be able to tell from testing.

In the meantime, in Canada you can buy Robaxin (methocarbamol) with 1/4 grain codeine. It's a terrific muscle relaxant and pain killer and works well on lower back pain. Even the methacarbamol alone will give you some relief.*

*(disclaimer) It comes in acetominephin formulations which should be safer for your stomach, but you should check with a doctor or pharmacist first.

[noysey]

One thing you might consider is the new course you started where you were sitting all day. If you are still taking it, it could be something about the way you have to sit. In my experience subtle things can bring on pain. I know that as a machinist I found there was one lathe in the shop that I could not work on without ending up with back pain. I'd be careful not to do anything heavy and it wasn't that the lathe was lower than the others so I'd be bending over a lot. I'd end up with back pain no matter what I did.

[Latiam]

Originally Posted by erwins

I don't see why your physio would say a soft tissue injury would be healed by now. The back is a complicated thing, and once injured, there are knots, scar tissue, "guarding" by other muscles, etc. This can all combine to pull things out of alignment and cause chronic problems.

So, just because it involves only soft tissue does not mean that it is either minor or should necessarily be healed in a few weeks. I hope your injury heals faster than mine did, and with fewer parts of your body getting involved, but it is certainly possible for a soft tissue injury to get complicated and difficult to treat.

erwins

It has been 9 weeks now, and at this point, if it is getting worse with regular treatment, I don't think it's your typical soft tissue injury. I had her treating me from day 1, dissipating knots and the "gristle" that turns into scar tissue with digital manipulation.

I've been getting weekly treatments of massage, ultrasound, and TENS on it, and if it shows no signs of healing after 8-10 weeks, the point at which most are resolved, I don't think it is.

I'll try the Robaxin. Thanks!

[TripleAAA]

Does it radiate down your leg at all?

Do this; next time you lay on your back, relax yourself and look at your feet. Is the foot on the painful side rotated out a bit? It may be Piriformis Syndrome

[RCIAG]

Have you tried acupuncture yet?

It's the only reason I can sit upright again.

I had some mystery pain that was in my right hip & radiated around to my groin. It literally felt like someone was stabbing me in my lower right abdomen if I sat upright or on my right side. Nothing showed on MRIs, CT scans, X-rays, etc.

I sat lopsided to the left for about a year.

At that point I decided to try acupuncture because I'd tried everything else & at least I wasn't putting any more drugs into me or hurting myself all over again (which physical therapy ultimately did).

It took about 2 months of weekly appointments before I could notice the difference, so it's not going to work overnight, & ultimately it took about a year, but at the end of that year I could sit upright even on hard benches, something I couldn't do at all for well over a year.

[NayShel]

Yeah that's like my orthopaedic doc saying my severly sprained ankle should heal in 8 weeks and there was absolutely no improvement.

My saving grace, and something that might help with your back therapy as well, is the Graston Technique. Getting this therapy not only healed my ankle up beautifully but also helped heal a shoulder injury. It's not pleasant but it really works. There are providers in Ontario too...not sure where in Ontario you are so see the website for listings.

[RCIAG]

I knew acupuncture was going to take 3-6 months, the doc was up front about that. And he IS a doctor, he's an anesthesiologist along with being an acupuncturist.

I just knew I wasn't done at the end of 6 months so I kept it up.

[Latiam]

So, this doctor was TOTALLY different from the other doctor. First of all, on the X ray he could see indications on my SI joint. And second of all, the MRI was to look for burst discs, which is stupid. The last shot shows just the very top of my SI joint and then it stops. Useless. But my discs are okay, btw.

He asked me some questions and poked me a little and looked at the Xrays. He ruled out sciatica just in case and then explained that this is SI pain and it has to do with my psoriasis, so basically yeah, it's due to my psoriatic arthritis. And he gave me pills! It's a NSAID that specifically targets that area. I took one 30 minutes ago and it's already starting to work.

Best of all, he made sure that the rheumatologist I was going to was a good one and - this is a biggie - he gave be a preliminary blood test form to speed things up when I go there, and the results will go to him and the rheumatologist. So that when I go there November 30, they will already have the data they need to start helping me.

I am just so tired, but happy. The receptionist was joking with me on my way out and I laughed and I realized it was the first time I had truly laughed in about a month.

[Nana M]

That's wonderful Latiam! It sounds like you will finally get the right help.

Just one thing, psoriatic arthritis doesn't always show up on blood tests, the marker may not be there, so make sure you let the rheumatologist know that you have psoriasis (can you tell I've been there. I have psoraisis too and that's the origin of my arthritis).

[Latiam]

Originally Posted by Nana M

That's wonderful Latiam! It sounds like you will finally get the right help.

Just one thing, psoriatic arthritis doesn't always show up on blood tests, the marker may not be there, so make sure you let the rheumatologist know that you have psoriasis (can you tell I've been there. I have psoraisis too and that's the origin of my arthritis).

I was already diagnosed by the last rheumatologist. Well, then she said I didn't have it because the exercise helped so much (nutbar), but yeah, she diagnosed it. At that time my SI joint wasn't involved. Just knees and fingers. But you know how much PA loves the sacroiliac joint.

I have the RA marker and some other markers. My CRP is up - before I was diagnosed it was 40x the normal level! She said, "This isn't right, it's lab error," (nutbar), but when it was repeated it was still up there.

Have you ever had a point where your hair and nails grew really fast? My hair is growing an inch a month right now. I'm trying to figure out if it's the PA, or because I'm taking omegas and glucosamine and Vitamin D and calcium.

[Nana M]

Gee, I thought that was just me. My hair grows like crazy and I used to just keep it long so I wouldn't go broke at the hairdressers. I never thought to check if was the PA. I must do that.

It's good that the RA marker shows up for you. My daughter doesn't have it but I'd swear she has symptoms. She was told it doesn't always show up, though, so she isn't being blown off completely.