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Diagnosis confusion

christibencchristiben Posts: 119
edited 09/23/2014 - 2:35 PM in Lower Back Pain
I just returned from my first appointment with a pain doctor. He tells me my problem is with arthritis in the lumbar facets and I scheduled an appointment for spinal injections. My ortho doctor told
me that my pain is from a l4-5 compression on a nerve. I'm confused. The ortho is the one who referred me to the pain doctor. Can anyone provide some clarity? They both talk so fast and the appointments are so short and hard to process it in the office.


  • Ugh! It gets so confusing doesn't it?!? You need your docs to take the time to explain your MRI to you so you can learn exactly what's wrong. It's my guess & it's just a guess, that you have both nerve compression & facet joint problems. I have various disc problems & joint problems, & facet joints & SI joint...the list goes on. My problems are degenerative & it's common to have more issues than one.

    For my facet joints (arthritis) I had nerve blocks (injections) as a diagnostic tool. Once they knew that my facet joints were causing pain they went ahead & destroyed the little nerves around there. Is that the procedure your doc was talking about?

    I know docs are often rushed these days & can use language we simply don't understand. So frustrating!! I'm often in so much pain during appointments that I find it hard to concentrate. I make a list of the questions I need answered & go through them with my doc. They know you mean business when you get your note book out! You pay for your appointments don't let them rush you out with more questions than answers.

    I have a variety of different procedures & therapies to chip away at the pain from all the different sources. Are they planning injections (ESI's) to try to help the compression by bringing down the inflammation? Did your Ortho say you weren't a candidate for surgery or has he sent you to pain management to try some conservative treatments first?
    Do you have a copy of your MRI & the summary sheet? I always keep hold of a copy of mine & take it along to appointments so my docs can explain all of the findings.
    Osteoarthritis & DDD.
  • Thanks for the response :). Yes, that is the procedure. I feel like I'm floating in a sea of confusion. And pain!
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  • EnglishGirlEEnglishGirl Posts: 1,801
    edited 09/24/2014 - 11:06 AM
    I've been going through this, constant pain, for over 8 years now. For the first few years I was a very passive patient. It's only the last couple of years that I've been educating myself & advocating for my own care & things have got sooo much better. I know it seems like you've been dropped on an alien planet at the start, at least it was for me. I got a copy of my diagnostic reports, wrote all of my doc wasn't very good at giving me the time & kind of care I knew I needed so I found a new one. He's a kind, compassionate translator!

    Osteoarthritis & DDD.
  • I've had several of those procedures. It's nothing to worry about but it can make the pain flare for a week or so after. I've learnt that if I take those long lasting ice blocks with me & start icing on the way home in the car & then ice regularly for the first days it really helps. I had my SI joint injected the week before last & only had a very, very minor increase in pain after even though it took him a lot of 'jabs' to get the needles positioned.
    Is most of your pain located in your back or do you have a lot of hip & electrical leg pain? Next appointment I'd ask how serious the nerve compression is & what's their plan for that. Severe nerve compression when left too long can cause damage. Have they suggested physical therapy yet or are they trying to get your pain managed first?
    Osteoarthritis & DDD.
  • Hi English Girl! It sounds like were in similar situations. The compression is extreme according to my ortho. Surgery is almost definite, but insurance requires pain management and PT before they will approve payment. I'm in week 3 of PT and am seeing great results in gaining strength of my legs, hips, and abs, but i know that only surgery will fix the uunderlying issue. I too have had this for many years and kept putting off treatment. I'm 51 and need the surgery so I can get back to work. I'm on medical leave and worried if I'll be able to ever work as hard as my career requires.
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  • Dear christiben, I too have had diagnosis confusion, and I agree with the others who say to make them sit down and explain things to you in a language you can understand. You absolutely have to be your own advocate or you will have nothing but trouble maneuvering the pain management game. My doctor is always in a rush, but I make him slow down and answer my questions. Yes, you are paying for his time and you are entitled to answers. I too have a plethora of things I suffer from, as do many of us pain management veterans. I suffer from coccyxdinia, nerve damage of the ganglion impar, degenerative disk disease, arthritis, osteophytes (bone spurs)at nearly every level, severe spinal stenosis and facet syndrome. I could write a medical journal on just my own problems. In 2005 I had a morphine pump implanted to handle the lion's share of my pain. I had to take disability leave from working 3 years ago, but considering the menu of back and leg problems I'very had over the years, I'd say I did pretty well over the last 25 years. Life isn't perfect, but I have survived it and feel glad it wasn't worse. Let me share a bit from back many, many years ago when my chronic pain problem had just begun (it's now been 25 years). I went in search of answers, being referred from specialist to specialist, seeking the magic answer. I first went to an orthopedist who swore my problems were all muscular/skeletal in nature and he could definitely help me; then to a physiatrist, claiming my problems were related to lack of exercise and muscle tone and weakness. He could definitely help me too; then came the neurologist and neuro-surgeon, separate doctors but both believing I had nerve damage or impingement/stenosis of one type or another. I truly wanted to jump from a rooftop. Surely one of them had the right diagnosis! Who do you believe; what direction do you go. I can only say usually you know your body better than anyone out there. You know what you feel, how you feel it, and what seems right or wrong. Once you think you're headed in the right direction, see what that specialist has to say, what he/she would recommend and go from there. You may be wrong and need to change course, but don't be afraid to do just that. I have been told I'morphine not a good surgical candidate, and even if I were, I doubt I would ever go down that road. I know too many friends or people, including my own father who trusted the surgical answer, only to either end back where they started or have far worse trouble post-surgery. I will take my chances with pain management instead.
    I just had a set of 6 facet joint injections (3 on each side), but they had no effect. Today I had number 1 of 2 epidurals to that same area. I've had all these kinds of I injections numerous times over the years (facet, trigger point, SI Joint, and epidurals . Some have helped; some had no effect whatsoever. The injections don't really hurt if done properly and in fact I don't even bother to get sedation because it only takes longer and really isn't necessary. My thought has always been, if I can handle or survive the horrible pain caused by my situation, an injection is a walk in the park. However, if you'really nervous and apprehensive, go ahead and take the sedation, but don't fear the injection. Ice, lots of ice after and you should be fine. Good luck to you.
  • Does someone know what can be a diagnosis if every morning after getting up from the bed I feel such a bad pain in my lower back. I tried to change the mattress few times but nothing helps
  • LizLiz Posts: 9,709
    edited 09/26/2014 - 1:15 AM


    Veritas-Health Forum Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
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