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Hi everyone,
My OH has suffered from Sciatica for around 2 years unfortunately over the last 2 weeks the pain has become agonising for him. His GP referred him to physiotherapy who was treating him for a possible herniated disc in his lower back. My OH is not a 'moaner' but for the last 3 days he has been screaming in pain so much so i took him to the local A&E - he was given Morphine for the pain with no effect whatsoever. The doctor told us that they could do no more for him and that he should see his GP for a referral to a specialist - he also said that for a a more accurate diagnosis he really needed an MRI scan- he actually said that to get one my OH would be better off going private!
Well after some badgering from me they admitted him to a ward for pain management. They ( in my opinion) are not taking his pain level seriously and there is no talk of having an MRI scan. Clearly i am not critisising the NHS - i am a nurse myself- but what i am wondering is what i have to do to get him taken seriously and for him to recieve the correct treatment.
My question is what is the correct treatment for sciatica and a herniated disc and is surgery is not the option what pain relief will take his pain away?
Sorry to go on but my OH is really at his wits end - and to add to his woes he has been made redundant!
I would be asking for referral to an orthopaedic consultant and a pain specialist. He needs a proper diagnosis. Has he tried ibuprofen and diazepam for the pain?
Thanks Poppy for your reply.
He is currently taking Dihydracodiene, diclofenac, tramadol, and diazepam - he was also prescribed amytriptaline by his GP. None of the drugs control the pain.
I am hoping for some news from the hospital today regarding referals to the orthapaedic team and the pain management team.
Update
Today the doctors attempted to discharge my OH saying that they could do nothing more for him.
They said that all his tests had come back normal - when pressed on what tests she said ' er the x-rays' - these x-rays were done in A&E 4 days ago - they have not completed any futher tests - no CT scan nor an MRI scan. The doctor said we will give my OH some pain killers - which he has been saying for over 3 weeks that they are not working.So at this point i found a stroppy side of me which i didn't know i had ( lol) and demanded that he be seen by a senior medic and by an orthopedic consultant and that i would not be going anywhere until that happened.
So - he was seen by a senior medic and they are now taking him seriously - they feel that he has been this amount of pain for long enough and are keeping him in hospital until he is sorted out.
I write as a GP with a special interest in back pain, and some experience working in spinal surgery as a junior doctor.
Broadly speaking the acute treatment of back pain with sciatica is: Drugs, Physical treatments, Nerve Stimulation, Nerve Blocks, Psychologiacal therapy, and Surgery, in that order.
Drugs include simple painkillers (paracetamol, codeine, tramadol), antiinflammatory painkillers (Ibuprofen, diclofenac), antispasmodics (like diazepam), and if nerve pain (sciatica, slipped / herniated discs) is involved then you can try some form of "neuromodulator" - like Amitriptyline or Gabapentin - drugs which affect how nerve cells conduct electrical signals and how signals are transmitted from one nerve to another. Neuromodulators work by changing how the celll grows, so they take 1-2 weeks before you see much benefit.
Physical treatments include GRADUATED EXERCISE. This is vital. Lying in bed and keeping still makes pain worse and longer lasting. Walking, swimmming and cycling are all recommended. Exercise should be gradually increased as pain allows. Other phsyical treatments include local heat (eg a hot water bottle) to relive muscle spasm, physiotherapy, and chiropractic or osteopathic manipulation.
Nerves stimulation uses a device called a TENS machine that gives small electrical signals to nerves in the affected leg. The idea is that this painless stimulus overides the painful one - a bit like rubbing near a sore area, or those tight copper bracelets, but more scientific!
Nerve blocks involve injections into the back itself to freeze the affected nerves. You would need a consultant pain specialist or orthopaedic surgeon to do these.
Psychological tratments work on helping people cope with pain as it is not usually possible to eliminate all pain completely. people who dwell on the pain find it much harder to get on with things, and theapists can help people use relaxation and distraction techniques, as well as cognitive behavioural therapies to be more functional and happier despite chronic pain. These are usually available via pain clinics, and some GPs may refer directly if there is an NHS service in the area that allows them to do so.
Surgery is the last resort, and is NEVER used in the first 3 months for simple pain or sciatica alone. Surgery for leg pain may make back pain WORSE, and vice versa. Nearly everyone has 3 months of WORSE pain after surgery, and 90% of people will get better before then so they always wait 6 weeks before scanning and 3 months before operating at the very least. Not all back pain or sciatica will benefit from surgery.
Surgery in the first 3 months is reserved for people with compression of the spinal cord or "cauda equina" (latin for "horses tail" - the bundle of seperate nerve roots at the end of the spinal cord), infection, trauma (ie broken backs), and cancer. These cause less than 2% of all back pain and are rare in people aged 20-55, becoming more common with age. They will have almost certainly been looked for and ruled out in your OH.
He will probably get much better soon, and you should try the above therapies, especially the physical treatments, but A&E is the WORST place to go as they are very limited in what they can do. Other ports of call apart from your GP, are local chiropractic or osteopathic clinics, and possible an acupuncture practice, which is most likely to benefit someone with sciatic pain in one or both legs.
Hope this helps, and that recovery comes before long.
<-- MazzaB, financial warrior! (*with a little help from my [real] flexible friends.......*) Bank --->
Please click on my scales if you find my comments helpful! (or ya think i'm sexy )
Thankyou very much for your detailed and thoughtful reply, it is much appreciated.
My OH has had worsening pain in his lumbar region and spasms and shooting pains in his leg,foot( there is also periods of numbness in his foot - he also complains of his foot feeling'wet'??) and buttock for well over 12 months - so much so he can only relieve the pain by crouching on his knees and resting on his elbows - he has had physio, been seeing a chiropractor and been trying to excersise and work during this episode and he is now totally at the end of his tether - even sneezing or coughing leads to spasm and acute pain for him. I just wonder now if the time has come for surgery.
Thankyou once again - you have given me a lot to think about.
Regards
Sandbag.
Having only experienced overwhelming pain on a couple of occasions in my life, I can only wonder how your OH has managed so long. And thank goodness he has you in his corner.
Keep going, and shouting, until they get something done. It isn't fair or decent to leave anyone in this terrible situation with no sign of it ending.
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My Oh has now had an MRI scan - which shows a slipped disc - the doctors have given him 3 options
Have pain killers and hope the pain goes away
Have an ' epidural' - which he is happy to have!
Go on the waiting list for an operation.
He is much happier now that his pain is being taken seriously.
Thankyou all for your replys - its much appreciated.
Regards
Sandbag.
I do sympathise - my boss and sales director have both had surgery for fusing discs ( aged 50 and 35 respectively) Both had to go through all of the above stages as quoted by the wonderfull reply you got. Just to say both of them are fine and pain free now.
Above post reported - please be aware as this person is trying to advertise on this and many other forums. There is no "friend" just someone trying to sell their wares on the back (no pun intended) of other people's problems.
All help is merely my opinion only - please seek legal advice if you need to as I am only qualified in SEN law.
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you can advise people on legal issues but just becauseone pill is good for one person doesnt mean its good for the other.
Sometimes it is better to be cruel than to be honest or right or even helpful in this case.
jamesrap, some people who have posted here are medically qualified, to speak about drug treatments, and others are sufferers of chronic pain, like i have been for over 20 years now and are more up to date on treatments than some GP's.
What is being talked about are treatments, and the drugs discussed can only be obtained via prescription, and those folk who have added their opinions have undoubtedly done so with that very much in mind.
Nobody is stupid here, we all know that the only person who should prescribe any drug for an individual is their physician, but it helps, especially in these days of post code lottery treatment and NICE to know what others have been offered for various illnesses, and what does or doesn't generally work.
This is the kind of valuable resource most of us would have given our eye teeth for, back in the days when there was no internet and doctors were deemed the founts of all knowledge.
Get a grip and be grateful that people care enough about each other to post in hopes of helping a fellow sufferer.
For the record i suffer from Multiple Sclerosis, Osteo and Rheumatoid Arthritis and Ankylosing Spondylitis, and use web discussion boards to help alleviate my own problems as well as to help others.
According to the current NHS rhetoric patients are no longer patients but customers - customer care training has been made mandatory....
Unfortunately many of those in the heirarchy of the NHS (and govt) seem to think that changing what you refer to patients improves he quality of care. It doesn't; it just allows those who rarely deal with real patients to look as if they are doing something, rather than actually making genuine change.
We are supposed to call patients 'service users'. A couple of years ago some absurd nurse-manager type rebuked me in a meeting for referring to patients as patients, and not 'clients'. I replied that prostitutes and lawyers have clients, and since I belong to neither odious profession, I will continue to call sick people in hospital patients.
I thought this board was about consumer issues not medical issues
So did i, and even if most of the services of the NHS are free at the point of access by patients, or customers as some call them, we still expect a level of quality and efficiency as we would do from any other business or service provider.
And to sandbag and her other half, and the rest of the contributors to the site may i wish a happy and healthier New Year.
Haven't visited this thread for a while! Woah! - some haters out there! Patients are consumers of the NHS - they've paid for it, so they deserve it's best. I've trained for years in what I do, and whilst each patient is different, we learn what to do from experience and scientific studies. What I posted is based on both, but is always tailored to the person in front of you. There are various treatments we know work, and many that we know make no difference when compared to placebo. people selling cures for back pain may believe they work - but I wait until it's put through scientific study before I recommend it to my patients, especially when they are paying for it (I recommend patients consider TENS machines, accupuncture and manipulative therapies funded by themselves if they feel they need extra pain relief - I don't suggest these therapies speed up the cure rate - the evidence is that they don't) This sites about helping people navigate often bureaucratic systems better - whatever service they are consuming! - don't you guys have anything better to do! - you know who I mean.....
<-- MazzaB, financial warrior! (*with a little help from my [real] flexible friends.......*) Bank --->
Please click on my scales if you find my comments helpful! (or ya think i'm sexy )
Shoulder and Back Pain are common because these areas are vulnerable to injury, such as sprains and strains. Other disorders that may cause back pain include herniated disc, degenerative disc disease, pinched nerves, scoliosis and sciatica. There is no way to avoid shoulder pain entirely. There are ways to make it less likely, though, such as regular stretching and taking proper advantage of ergonomically-designed furniture and office equipment.
Chronic Back pain
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<-- MazzaB, financial warrior! (*with a little help from my [real] flexible friends.......*) Bank ---> 
Please click on my scales if you find my comments helpful! (or ya think i'm sexy 
)
Originally Posted by jamesrap
