Patient’s story: I’ve found the reassurance

Nicky, aged 40, primary school teacher (UK), comments her experience with her chronic back pain and second medical opinion:

Nicky H
Nicky, primary school teacher in UK

I have been suffering with chronic lower back pain for over 5 years and was becoming frustrated with the inconclusive reports I’d received from various specialists regarding the causes of my ongoing discomfort.

For the past 6 months, I’ve been seeing a chiropractor for regular massages – as well as carrying out daily, recommended exercises – but due to the conflicting advice I’d been given in the past, I hadn’t felt totally convinced that this was the right course of action for me. I was worried I might even be doing more harm than good.

When a friend recommended Diagnose.me, I was immediately intrigued by the prospect of being able to consult an international expert, without actually having to travel outside of the UK!

I found the site easy to use and within a few “clicks” my X-rays had been sent to the radiologist and musculoskeletal specialist, Dr. Laurence Bellaiche, in Paris (who I later discovered is a consultant to some of France’s top footballers!). As promised, Dr Bellaiche sent me a report within two days and I was relieved that she had made the same diagnosis (almost “word for word”) that had been given to me previously by two UK-based consultants.

Whilst Dr Bellaiche’s second opinion did not go so far as to highlight a new, radical treatment that might have helped my chronic back pain further – it did however provide me with the reassurance I needed. I now feel happy that I am following the right advice based on my existing diagnosis and will therefore continue with my current treatment plan and hope for slow and steady improvement.

Thank you!

Back pain symptoms and diagnosis

Low back pain is the most common cause for medical consultation worldwide. Low back pain may be acute or chronic, with the latter being defined as pain that lasts greater than 3 months. One study[1] has indicated that 85% of adults will experience incapacitating back pain at some point in their lives.

Low back pain is frequently reported as the most frequent cause of disability; it reduces quality of life by hindering work responsibilities and limiting many other life activities. Back pain is most commonly attributed to degenerative disease though many other pathologic states may be the cause. Some of these include trauma, renal stones, pancreatitis, aneurysm, cancer, inflammatory arthritis, scoliosis, infection, metabolic syndromes, and developmental malformations.

Degenerative changes of the spine frequently occur at the disk space between the vertebral bodies or between the posterior elements of the vertebra. The disks are like shock absorbers for the spine; they distribute forces equally and transfer them to the muscles, tendons, and ligaments along the spine. The posterior elements server as anchors for muscles and maintain bilateral joints at each level for movement of the spine.

Patient with both degenerative changes and Paget’s disease.

The spinal cord and spinal nerves protected by the spine can become compressed by degenerative changes leading to pain. Disk tears and inflammatory changes of the bones and surrounding soft tissues are commonly associated with pain.

“There are many treatments for back pain ranging from conservative care to minimally invasive interventions and even open surgery.”

Knowing all the potential causes of back pain is essential to tailoring an effective treatment plan and alleviating pain. Some medical reports only describe glaring abnormalities when in fact those may or may not represent pain generators. If spine imaging has been performed a second opinion from a fellowship trained specialist may be considered prior to any intervention as a second opinion may help identify occult causes of pain.

[1] http://grants.nih.gov/grants/guide/pa-files/PA-97-058.html

MRI without a doctor referral – a good idea?

There is no doubt that magnetic resonance imaging (MRI) is a unique technique to image the human body. The technique has brought a revolution in medicine and the rapid progress is still being made with an unsuspected potential of new developments with the ability to perform not only studies to see all the anatomy of the whole body, but also to analyse the activity of different organs of the body; as for instance detect the brain activity.

The unique advantage of being able to visualize the human body accurately with MRI has conditioned the high demand in recent years.

There is a growing number of MRI requests by doctors, due to the ability to have a proper picture of the human anatomy and detect promptly the disease suspected. Nevertheless, an imaging request and especially an MRI needs to be judicious and scrutinized by the physician who ordered it. It can be as dangerous as it is useful. Many patients view the MRI as a security blanket, and will go as far as requesting it.

There are numerous cases of diagnostic problems that result from misuse of the MRI. It is mandatory to perform a proper clinical correlation (making sure that what’s seen on MRI is in agreement with the patient’s problem) and the fact that any test including an MRI must be ordered to confirm a preliminary diagnosis that is already known from the history, exam, and more simple, inexpensive tests such as an x-ray.

“An MRI examination might show some findings, even pathological, but without any relation with the patient’s complaints. In this case there might be and overtreatment. That means treating an imaging finding but not what is causing the disease.”

Lumbar disk herniation.

At the end requesting an unnecessary test can lead to complications or excessive discomfort that might not have been needed. One of the most common examples is lumbar disk herniation. It can be found a protrusion or herniation on an MRI of the lumbar spine in 60% of the population without any complaints at all. Thereby, the risk is to treat the non-pathological disk disease; and what it could represent the potential consequences of a harmful surgical intervention.

At the end, requesting and MRI without a clear justification and especially without a proper doctor referral might cause more harm than benefit.