Good doctor for back pain?

[Anonymous]

I have lower back issues that no one has really been able to help. My GP is great but this isn't her area. PT was not helpful but I only tried one guy and he was very inexperienced. Chiro wasn't super helpful either. I'm getting an x-ray this week, but I don't expect that to show anything. The only thing that help is ibuprofen - lowest dose possible, around the clock, but I don't want to keep that up. I am trying stretching, but it's not too helpful without good guidance.

Does anyone have a back doctor or PT to recommend that helped with lower back/tailbone/buttocks pain? I am way to young and thin to wake up every single day with pain like this.

[Anonymous]

OP, have you considered that this could be inflammatory and not mechanical back pain?

A few questions:

How long has this been going on? More than three months?

Are you under 40?

Are you stiff for a half hour or so in the morning and feel better as the day goes on (not including night time)?

In general does it feel better with movement?

You mention buttocks pain--does it tend to alternate between the left and right side?

Yes answers to these questions would point to inflammatory back pain caused by spinal arthritis.

Other symptoms that can appear: pain from time to time in your ribs; pain in your heel, shoulder, neck; plantar fascitis; occasional unexplained low fevers.

You would see a rheumatologist for this. But, a note of caution. Some of them haven't kept up in this field and mistakenly believe this is not a women's disorder and that you must test positive on a certain genetic test. Many, many women with this get a wrong diagnosis of fibromyalgia.

[Anonymous]

^^By the way, getting relief with an NSAID like Advil is also a positive indicator for inflammatory back pain.

[Anonymous]

Wow - thank you for your thorough response. It does seem inflammatory because ibuprofen really does take the pain away almost completely, regardless of whether I stretch or not.

Is there anything that causes it? I used to exercise regularly and haven't been good about this. I have a relatively active lifestyle but have been more sedentary than ever the last 2 years or so and that has brought back pain.

[Anonymous]

Anonymous wrote:OP, have you considered that this could be inflammatory and not mechanical back pain?

A few questions:

How long has this been going on? More than three months? Yes.

Are you under 40? Yes

Are you stiff for a half hour or so in the morning and feel better as the day goes on (not including night time)? Painful in am and eases with meds.

In general does it feel better with movement? Sometimes walking for 30 minutes helps.

You mention buttocks pain--does it tend to alternate between the left and right side? Seems even to me. Alternates when sitting.

Yes answers to these questions would point to inflammatory back pain caused by spinal arthritis.

Other symptoms that can appear: pain from time to time in your ribs; pain in your heel, shoulder, neck; plantar fascitis; occasional unexplained low fevers. I have had costcochondritis and shoulder pain. Fevers? I dunno. I run warm.

You would see a rheumatologist for this. But, a note of caution. Some of them haven't kept up in this field and mistakenly believe this is not a women's disorder and that you must test positive on a certain genetic test. Many, many women with this get a wrong diagnosis of fibromyalgia.

To answer your questions, see above. Hmm... Can you recommend a doctor by name?

[Anonymous]

Same boat here ... would be interested in what I can do at home. I have "wasted" a ton of money over the past two years on PT and chiro/PT and still have back pain.

[Anonymous]

Anonymous wrote:OP, have you considered that this could be inflammatory and not mechanical back pain?

A few questions:

How long has this been going on? More than three months?

Are you under 40?

Are you stiff for a half hour or so in the morning and feel better as the day goes on (not including night time)?

In general does it feel better with movement?

You mention buttocks pain--does it tend to alternate between the left and right side?

Yes answers to these questions would point to inflammatory back pain caused by spinal arthritis.

Other symptoms that can appear: pain from time to time in your ribs; pain in your heel, shoulder, neck; plantar fascitis; occasional unexplained low fevers.

You would see a rheumatologist for this. But, a note of caution. Some of them haven't kept up in this field and mistakenly believe this is not a women's disorder and that you must test positive on a certain genetic test. Many, many women with this get a wrong diagnosis of fibromyalgia.

NP here. I hate to say it, but unfortunately even if this offers a more accurate diagnosis, there isn't much to be done about it. I've been to three orthopedists and found myself getting hooked on pain meds (finally off now, thankfully). My options seem to be: live with the pain or have surgery -- which no one who's had it recommends.

[Anonymous]

Anonymous wrote:Wow - thank you for your thorough response. It does seem inflammatory because ibuprofen really does take the pain away almost completely, regardless of whether I stretch or not.

Is there anything that causes it? I used to exercise regularly and haven't been good about this. I have a relatively active lifestyle but have been more sedentary than ever the last 2 years or so and that has brought back pain.

So sorry to tell you that spinal arthritis (spondyloarthritis, axial in your case) is an inherited condition and there is no cure. However, there is treatment. A rheumatologist can put you on prescription NSAIDs that are kinder to your stomach. Some people do fine with that combined with exercise, but others go on to other drugs like methotrexate and anti-TNF inhibitors (treatments somewhat similar to what is done for rheumatoid arthritis).

Exercise is very, very important to managing the condition. Swimming is an especially good exercise. My child has this and manages entirely with exercise for now. I am going broke with personal trainer bills! But before when trying to touch toes, her fingertips a good six inches short of her knees--now she can touch down to her ankles.

It also is essential to get a good rheumatologist. Run, do not walk, from any rheumatologist who tells you that you have fibromyalgia.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Wow - thank you for your thorough response. It does seem inflammatory because ibuprofen really does take the pain away almost completely, regardless of whether I stretch or not.

Is there anything that causes it? I used to exercise regularly and haven't been good about this. I have a relatively active lifestyle but have been more sedentary than ever the last 2 years or so and that has brought back pain.

So sorry to tell you that spinal arthritis (spondyloarthritis, axial in your case) is an inherited condition and there is no cure. However, there is treatment. A rheumatologist can put you on prescription NSAIDs that are kinder to your stomach. Some people do fine with that combined with exercise, but others go on to other drugs like methotrexate and anti-TNF inhibitors (treatments somewhat similar to what is done for rheumatoid arthritis).

Exercise is very, very important to managing the condition. Swimming is an especially good exercise. My child has this and manages entirely with exercise for now. I am going broke with personal trainer bills! But before when trying to touch toes, her fingertips a good six inches short of her knees--now she can touch down to her ankles.

It also is essential to get a good rheumatologist. Run, do not walk, from any rheumatologist who tells you that you have fibromyalgia.

OP here. I can get my hands on the floor to touch my toes pretty easily. So I am not to that point. But I'm seeking an appt with a rheumatologist because that seems like the best route right now. Thanks very much!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

NP here. I hate to say it, but unfortunately even if this offers a more accurate diagnosis, there isn't much to be done about it. I've been to three orthopedists and found myself getting hooked on pain meds (finally off now, thankfully). My options seem to be: live with the pain or have surgery -- which no one who's had it recommends.

If you have what OP is complaining about, one of those orthopedists should have referred you to a rheumatologist.

Pain pills in general are not good for a chronic pain condition, though a very occasional pill to get you through a flare is okay. There are medications that I described earlier. In addition you can take steroids to help through a rough patch or get steroid shots. And if your case is very recalcitrant, there are the anti-TNF inhibitors. There is also exercise. Surgery is not really recommended except in some highly specialized circumstances.

Treatments are improving every year. PP--please do not give up. Please take yourself to a good rheumatologist.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP, have you considered that this could be inflammatory and not mechanical back pain?

A few questions:

How long has this been going on? More than three months? Yes.

Are you under 40? Yes

Are you stiff for a half hour or so in the morning and feel better as the day goes on (not including night time)? Painful in am and eases with meds.

In general does it feel better with movement? Sometimes walking for 30 minutes helps.

You mention buttocks pain--does it tend to alternate between the left and right side? Seems even to me. Alternates when sitting.

Yes answers to these questions would point to inflammatory back pain caused by spinal arthritis.

Other symptoms that can appear: pain from time to time in your ribs; pain in your heel, shoulder, neck; plantar fascitis; occasional unexplained low fevers. I have had costcochondritis and shoulder pain. Fevers? I dunno. I run warm.

You would see a rheumatologist for this. But, a note of caution. Some of them haven't kept up in this field and mistakenly believe this is not a women's disorder and that you must test positive on a certain genetic test. Many, many women with this get a wrong diagnosis of fibromyalgia.

To answer your questions, see above. Hmm... Can you recommend a doctor by name?

OP, the answers to these questions make me suspicious that you have spondyloarthritis. My DD sees Dr. Joseph Laukaitis, who is a first rate diagnostician. He is conservative with treatment. I have also heard good things about his partner, Susan Lack. They do not take insurance, but you can submit if your insurance covers out of network.

I have a friend who pays out of pocket to see Laukaitis because he is out of network for him. He says it is worth every penny even though the doctor offered to work with his in-network provider. My friend's insurance does cover the medication. They are fine with having patients do their labs at a network provider instead of at their office if that isn't covered by insurance.

[Anonymous]

Just don't let anyone prescribe you opioids.

[Anonymous]

Anonymous wrote:Just don't let anyone prescribe you opioids.

Motrin works for me very well!

I have actually taken tramadol and vicodin (spelling?) for dental and surgery recovery before. They don't do much for me, and I'm disinclined to take pain meds.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

NP here. I hate to say it, but unfortunately even if this offers a more accurate diagnosis, there isn't much to be done about it. I've been to three orthopedists and found myself getting hooked on pain meds (finally off now, thankfully). My options seem to be: live with the pain or have surgery -- which no one who's had it recommends.

If you have what OP is complaining about, one of those orthopedists should have referred you to a rheumatologist.

Pain pills in general are not good for a chronic pain condition, though a very occasional pill to get you through a flare is okay. There are medications that I described earlier. In addition you can take steroids to help through a rough patch or get steroid shots. And if your case is very recalcitrant, there are the anti-TNF inhibitors. There is also exercise. Surgery is not really recommended except in some highly specialized circumstances.

Treatments are improving every year. PP--please do not give up. Please take yourself to a good rheumatologist.

Thank you for the advice. I should follow up with a rheumatologist (and I've never been referred to one). Unfortunately, I can't take oral anti-inflammatory drugs because I've had gastric bypass surgery. Ten years later, I discover I have a lot of issues with inflammation -- doh! And when I went down the exercise path, I strained it worse than ever before, so now I'm scared of that too. But I'll explore some of these other meds.

[Anonymous]

Dr Kevin Fitzpatrick...I have chronic lower back pain. They will do blood tests to look for inflammation markers. Plus prob a combination of PT, NSAIDs, and if you're lucky a cortisone injection (life changing!).