BackpainredI am constantly looking for topics on pain and pain management to address on this blog for the benefit of my readers. When it comes to pain, numbness and other abnormal sensations, it understandably is a cause for concern, especially for cases where the diagnosis is not clear or certain.

I know that some of you have already seen your doctor, but are not satisfied with the answer you received.  Maybe your doctor unintentionally trivialized your complaint, saying it would work itself out over time.  But in your mind you did give it enough time, and it’s still there.

Or perhaps you are getting physical therapy, chiropractic, massage or acupuncture, but your symptoms remain.  Be aware that pain appearing as musculoskeletal in origin (sprain, strain, arthritis, pinched nerve, fracture, muscle spasm, trigger point and so on) may actually be a sign of something more serious.

For example, I know of a woman who had gradual onset sciatica (nerve pain in the buttock going down the back of the leg). She had massages, chiropractic, acupuncture and physical therapy, but they did not resolve her pain. To make a long story short, she was diagnosed with a brain tumor that was pressing against the motor neurons in her brain that eventually formed the sciatic nerve. Luckily for her, her tumor was operable and her symptoms gradually cleared.

Remember, nerves start from and return to the brain, because that is where the perception of all sensations, not just pain, is processed. If there is a pathology in the brain, it may manifest as symptoms commonly associated with common muscle and nerve conditions.

A second patient I recall complained of a severe headache centered on the right side of her head. The headaches came on rather suddenly, and they were not of the migraine variety. I referred her for an MRI and it turned out that she had a cerebral aneurysm. Although the majority of headaches are not dangerous, it is still important to err on the side of caution if the headache is especially acute, doesn’t respond to medications and if you have a familial history of vascular disease.

Bone pathology/ injury can be a source of pain that may appear muscle/ligament in origin. This can include vertebral compression fractures, bone cysts and bone cancers like osteosarcoma. If you have pain somewhere in your back or believe you have “muscle” pain in an extremity long bone that does not respond at all to physical medicine (chiropractic, physical therapy, massage, stretches, ice/heat, ultrasound etc.) then it is prudent to have diagnostic tests performed to rule out any red flag conditions.

Advanced diagnostic tests for this purpose include:

X-rays, which can show the location, size, and shape of a bone tumor. If x-rays suggest that an abnormal area may be cancer, the doctor is likely to recommend special imaging tests. Even if x-rays suggest that an abnormal area is benign, the doctor may want to do further tests, especially if the patient is experiencing unusual or persistent pain.

A bone scan, which is a test in which a small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it then collects in the bones and is detected by a scanner.

A computed tomography (CT or CAT) scan, which is a series of detailed pictures of areas inside the body, taken from different angles, that are created by a computer linked to an x-ray machine.

A magnetic resonance imaging (MRI) procedure, which uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body without using x-rays.

A positron emission tomography (PET) scan, in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.  ~ National Cancer Institute

If you are seeing a physical medicine provider or alternative practitioner who insists you continue with their treatment despite not experiencing any appreciable results after a few sessions, see your doctor.  If you feel like your primary care doctor’s treatment plan isn’t working, don’t be afraid to ask for a referral to a neurologist or orthopedic specialist.  Express your concerns, and ask if any of these tests should be ordered to rule out potential, serious conditions.


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