Presentations for back pain vary greatly. They range from the calm and cool, chronic back pain that is "worse than usual and I can't get into my doctor" to the person who the relative states "needs help getting out of the car, probably a stetcher". Oh, there is drama, lots of drama with back pain.
Hey I know back pain hurts. I once did something to my back at work and had to go home. By the time I got home, I couldn't stand up. Here's the thing: I took NSAIDS, used heat and ice, rested it. It went away on its own. Never went to the doctor.
My point? I know there are a lot of people who have serious injuries, but most are a simple muscle strain that people don't treat the right way. Then it gets worse and becomes a chronic problem. Many, many people, probably including many nurses have "bulging discs". They cause occasional pain but they live with it.
Why so much back pain in this country? Obesity. Out of shape. Stress.
Back pain is probably a billion dollar industry. Lots of back surgeries that don't work. Thousands and thousands of narcotic prescriptions written. Chiropractors making milllions. What I always think about all these people coming in for back pain is how do you know if someone is really having pain? Is there some physical exam you can do to tell? You could easily lie, carry on and walk out with a script for Percocet.
7 comments:
I used to have serious back pain. I went to a great physiotherapist and had several traction treatments. That helped a lot, as did losing 85 lbs.
oh ya, that 'lose weight' admonition.. my very favourite.
I totally agree it helps to reduce the strain, but why is this advice
invariably delivered in a tone
suggesting that ~
1 - I never thought of that,
and
2 - it's easy, just do it!
.. the result is a compound of
guilt AND pain.
Well being fat makes your back, knees, hips, everything hurt in addition to the 509609405 other problems it causes. Start losing weight now to reduce the number of times the doctor tells you to lose weight (ie. each time you get a new problem from being overweight/obese).
I think malingering is reasonably detectable from a basic exam, but you can do the straight leg raise test (read about it on the Internet) to take the BS detection to a whole new level if you're bored.
Speaking of a whole new level, how about brain surgery for morbid obesity?
http://metronews.ca/health/293844/video-using-brain-surgery-to-slim-down-the-waist/
I'm sort of glad I have some frank neurological deficits from my 'back injury' that make it pretty apparent that I'm not faking it. That said, I've never actually gone to the ED for pain, thankfully I've had a GP / emergency GPs who believed me & have had emergency medication to avoid clogging up an ED bed.
I hear everyone on the back pain = drug seeking, and I've seen it in hospitals [I'm a med student], it's incredibly hard / can be impossible to tell when someone is faking or if they are actually in acute or chronic/exaccerbated pain.
From the other side, before I was taken on by a pain team I was constantly terrified a doctor would tell me I was lying and send me on my merry way. Pain that never leaves, 24/7 is enough to bring anyone to screaming tears
[on a side note, i'm 24 - in great physical shape, bmi 21, no previous back injuries and now waiting a spinal nerve stimulator in an effort to avoid a 3 level fusion].
it's a tricky topic - and for those with legitimate chronic back pain the guilt & shame are well reinforced by a lot of health care staff [not at jab at anyone, just a product of a health system with lots of drug seekers & no way to weed out the lies from the truth]
Amen there med student!! I also have chronic back pain from osteoarthritis, fail back shndrome, spinal cord damage from a simple surgery gone bad because of a hot dog surgeon too busy talking about what a pain in the ass I was as a patient instead of focusing on surgery at hand.! I avoid talking about the chronic pain or why after being on my feet for 11 hours I walk with a limp:-)
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