My back hurts

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Apollyon

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I have low back pain. Normally I don't. I have to work tonight.

Hmm...what to do? I took 800mg ibuprofen.

Then work in 3 1/2 hours!

I just wish some citizen Googling back pain, with some total BS story about needing 240 Lortab/month (but no pathology on MRI, no neuro findings, and no job), would follow on with a holier-than-thou post about us "loser doctors" and how "we don't know nothin' about medicine or pain (or any other condition that renders him/her unable to contribute to society)". Then some agitas and scorn on top, just for color.
 
About a month ago I hurt my back moving, and took some Ibuprofen, the pain was completely gone, and i finished moving without issues.

I tried explaining that to a patient the other day, she laughed in my face while demanding some Percs.
 
Apollyon said:
I have low back pain. Normally I don't. I have to work tonight.

Hmm...what to do? I took 800mg ibuprofen.

Then work in 3 1/2 hours!

I just wish some citizen Googling back pain, with some total BS story about needing 240 Lortab/month (but no pathology on MRI, no neuro findings, and no job), would follow on with a holier-than-thou post about us "loser doctors" and how "we don't know nothin' about medicine or pain (or any other condition that renders him/her unable to contribute to society)". Then some agitas and scorn on top, just for color.
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Find a DO. Or a DO student. I fixed a nurses foot/limp and the doctor's back one of the shifts I worked last month.

Every once in a while our voodoo and turtle rattles can make you feel better 😉
 
rose351 said:
Find a DO. Or a DO student. I fixed a nurses foot/limp and the doctor's back one of the shifts I worked last month.

Every once in a while our voodoo and turtle rattles can make you feel better 😉
Click to expand...

hmmph...

HH
 
rose351 said:
Find a DO. Or a DO student. I fixed a nurses foot/limp and the doctor's back one of the shifts I worked last month.

Every once in a while our voodoo and turtle rattles can make you feel better 😉
Click to expand...

I think motrin would be just fine.
 
i have chronic back issues including one very rotten disc and often work through pain, sciatica, etc... nsaids kill my stomach so i take other more chronic meds like zanaflex. use a TENS sometimes. still don't get why so many ppl want so many narcs... or jump so quickly to surgery.
 
la gringa said:
still don't get why so many ppl want so many narcs...
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they are addictive like street drugs.....and are legal.

I cant tell you how many times I get cussed out in retail pharm bc they cant get their Xanax, Percocet, Morphine, etc.

Tylenol will even work if you take it on a regular basis...like 500mg q 4-6hrs.....
 
what i'm saying is... i have had to take them but apparently don't have the addict makeup... they make me feel like ****. i take them only w/o any other recourse, sparingly, when i have more than 8 hrs before i have to function. so while i have to attempt to do so, i will never understand.
 
here is what i don't get about many of the low back pain patients: my grandmother had chronic joint pains. she never took anything for it. she just accepted that sometimes pain is part of living. her approach was to go out and do yard work all day, and it got better as the day went on. basically, she just sucked it up and learned to live with it. my grandmother was the kind of person that would rather live her life the way she wants despite pain, rather than sitting around gorked on narcotics doing nothing.

what makes one person decide to keep on with life while a different person becomes completely dependent on drugs to get through the day? i wonder which person i would be?
 
reedman said:
here is what i don't get about many of the low back pain patients: my grandmother had chronic joint pains. she never took anything for it. she just accepted that sometimes pain is part of living. her approach was to go out and do yard work all day, and it got better as the day went on. basically, she just sucked it up and learned to live with it. my grandmother was the kind of person that would rather live her life the way she wants despite pain, rather than sitting around gorked on narcotics doing nothing.

what makes one person decide to keep on with life while a different person becomes completely dependent on drugs to get through the day? i wonder which person i would be?
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I noticed the same (seemingly) extreme intolerance for discomfort on my EM rotation, except with ANYTHING, not just pain. I wonder if this is a more recent phenomenon or if people in general have always been pansies.
 
la gringa said:
i have chronic back issues including one very rotten disc and often work through pain, sciatica, etc... nsaids kill my stomach so i take other more chronic meds like zanaflex. use a TENS sometimes. still don't get why so many ppl want so many narcs... or jump so quickly to surgery.
Click to expand...


Munchausen's. And addiction. Both are powerful.
 
Entgegen said:
I noticed the same (seemingly) extreme intolerance for discomfort on my EM rotation, except with ANYTHING, not just pain. I wonder if this is a more recent phenomenon or if people in general have always been pansies.
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What really puzzles (annoys) me is people whining about the treatments they are getting – an IV, drinking contrast, an exam, an NG tube, a local anesthetic, etc., etc., … if you are in enough discomfort to come to the hospital, shouldn’t those relatively minor discomforts be worth enduring to get you to feel better?... Not to mention that if you don’t want anything done – why did you show up in the first place…? 😕
As far as back pain goes – I found that the kind of shoes I am wearing makes a huge difference for how much pain I’m in.
 
alexmtr said:


What really puzzles (annoys) me is people whining about the treatments they are getting – an IV, drinking contrast, an exam, an NG tube, a local anesthetic, etc., etc., … if you are in enough discomfort to come to the hospital, shouldn't those relatively minor discomforts be worth enduring to get you to feel better?... Not to mention that if you don't want anything done – why did you show up in the first place…? 😕
As far as back pain goes – I found that the kind of shoes I am wearing makes a huge difference for how much pain I'm in.
Click to expand...

Please let me in on the type of shoes you wear.
I, too, experience horrendous back and neck issues..
 
rose351 said:
Sure it may, but you're still not fixing the problem just the symptoms.
Click to expand...

Tkim's a DO.

Also, OMM doesn't solve everything. I'm not totally convinced either. At times, it does provide a quick temporary (and I mean VERY temporary) relief, or no relief, for me...
 
Doctor4Life1769 said:
Please let me in on the type of shoes you wear.
Click to expand...
Skechers shape-ups 😍 - I know they are funny-looking, but they REALLY help my back (and my feet for that matter) and I've tried everything, including custom insoles, before.
 
Doctor4Life1769 said:
Tkim's a DO.

Also, OMM doesn't solve everything. I'm not totally convinced either. At times, it does provide a quick temporary (and I mean VERY temporary) relief, or no relief, for me...
Click to expand...

I am always amazed that there is not more objection by DOs when comments about most - maybe not all!?! - OMM are tossed out there (especially in an EM FORUM).

I don't want this to turn into an OMM thread, but come on DOs, chip in to maintaining the equivalence between the MD and DO as physicians.

HH

[[sorry to have offended, but show me the (good) data about spinal manipulation and such, then I'll try to offend less]]
 
People are wusses about pain. I went back to work a week after my lap chole and I didn't take pain meds after the 1st day post-op. I only took the week off because my surgeon insisted (and he works in my hospital so he would catch me out), likewise the pain meds. I was supposed to take them for the week but really didn't need them and didn't like them either.
So, my 1st patient out of the gate on my return was a person who wanted a note for 6 weeks off because she was having her gall bladder out the next week - lap chole, sedentary occupation. Needless to say she didn't get it.
People are wusses.
Cheers,
M
 
Entgegen said:
I noticed the same (seemingly) extreme intolerance for discomfort on my EM rotation, except with ANYTHING, not just pain. I wonder if this is a more recent phenomenon or if people in general have always been pansies.
Click to expand...


Think about what the average (American) person does every day:

Sleep in a comfortable bed in a climate controlled room.
Wake up, eat, use temperature controlled water to get clean.
Ride in a climate controlled vehicle to work, take elevator rather than use stairs.
Sit in ergonomic chair doing non-physical work.
Snack/eat when hungry.
Urinate/defecate when necessary
Climate controlled vehicle home, comfy couch and 152 channels/X Box to suit their entertainment whim
Rinse and repeat until death.

There is absolutely no discomfort AT ALL in most people's day any more. Humans are adaptable as hell, and many patients are totally adapted to being comfortable. If you punched them in the nose, it would be the most horrible, painful thing to happen in the last five years.

Consistently, my favorite patients are people with rheumatoid arthritis, athletes, or infantrymen. If you live constantly with packstraps digging in to your shoulders, grinding, sharp pains in your joints, or muscles burning from training, then the little poke when I start an IV isn't a life-altering trauma. Women who've had multiple children are usually pretty cool too - "I've had four kids, Henry, and this ain't nothing. Go ahead and do what you gotta do!"

As an aside, the swimming pools are getting ready to open in my area. I need to practice my facial control in the mirror again. I find it almost impossible to keep the expression of disgust off my face when a pt presents with the CC of "sunburn". Nothing like tears welling up in a grown-ass adult's eyes because their skin's a little pink and it "HUUUURTS soooo BAAAD!"
 
Savage Henry said:
Consistently, my favorite patients are people with rheumatoid arthritis, athletes, or infantrymen. If you live constantly with packstraps digging in to your shoulders, grinding, sharp pains in your joints, or muscles burning from training, then the little poke when I start an IV isn't a life-altering trauma. Women who've had multiple children are usually pretty cool too - "I've had four kids, Henry, and this ain't nothing. Go ahead and do what you gotta do!"
Click to expand...

What amazes me is when dialysis patients or patients with a port complain about getting an IV/accessed. At some point shouldn't you get used to be poked with needles when it happens every other day?
 
Savage Henry said:
If you punched them in the nose, it would be the most horrible, painful thing to happen in the last five years.
Click to expand...

You know its weird that you said that. I had an ex-military medic that I was training out in triage (where our job is take down name/DOB/cc and flag it if needed, then vital in triage booth). When we were getting vitals and pain scale, of course there was the usual glut of 10s, 12s, 1000s, millions.

He pulled me aside and said incredulously "you know, they say they are a 10 and they are in no apparent distress. What if I shot them in the kneecap - They are already at 10. What if I stabbed them right there - What number would they be then?"

I laughed because I got his point, but I told him I figured he should probably keep that one to himself :laugh:

And to be honest, I understand that sometimes its the worst thing that the patient has experienced in a long time, or even forever. Its still no excuse. I'm a young healthy guy so I really have not been in much pain before. A couple of months back I had food poisoning (I assume) with n/v and myalgias etc etc so bad that I couldn't move, stand up, walk to the bathroom, nothing. I could barely roll over to throw up in a trashcan (and I never did think to ask my wife if she could give me a burger from mcdonalds 😀). HOWEVER, as I lay there in misery with the worst ailment I have had in a long time, I figured that somewhere in my city, someone was getting some chemo and they felt a million times worse than I did. Or whatever. Either way someone somewhere was stoically dealing with something hundreds of times more painful and life threatening. So I laid there for one day and one night until it passed, and I'm not a hero, or tough, nor do I have a "high pain tolerance" because of the illness. I just got sick. I woke up the next morning and ate a banana and had some gatorade, and went on with my life, just in slow motion haha.
 
The Undecider said:
You know its weird that you said that. I had an ex-military medic that I was training out in triage (where our job is take down name/DOB/cc and flag it if needed, then vital in triage booth). When we were getting vitals and pain scale, of course there was the usual glut of 10s, 12s, 1000s, millions.

He pulled me aside and said incredulously "you know, they say they are a 10 and they are in no apparent distress. What if I shot them in the kneecap - They are already at 10. What if I stabbed them right there - What number would they be then?"
Click to expand...

The 1-10 scale is like a clock, not a thermometer. I ask people like this: "On a scale of zero to ten, with zero being nothing, and 10 not being the worst pain you've ever felt, but the worst you can imagine, what do you give this pain?" I, then, if they really look like they're in no distress (go figure), may append "you look rather comfortable, and your vital signs look really good, too". That last sentence, though, might draw out the person that says "I had a 1.5cm kidney stone in the ureter, and my pulse was 58 and my blood pressure was 108/50". Yeah, you're an outlier.
 
Apollyon said:
I ask people like this: "On a scale of zero to ten, with zero being nothing, and 10 not being the worst pain you've ever felt, but the worst you can imagine, what do you give this pain?" I, then, if they really look like they're in no distress (go figure), may append "you look rather comfortable, and your vital signs look really good, too".
Click to expand...

Wow, I haven't met an EM doc yet (of course, I am only a resident), who asks this question. [Is it a Press-Ganey thing in the private world?]

I ask: "Are you in pain?" or "Do you have pain?" and then give 'em pain meds if they do.

I don't see how some arbitrary number helps...but I do see how it hurts.

HH
 
Apollyon said:
The 1-10 scale is like a clock, not a thermometer. I ask people like this: "On a scale of zero to ten, with zero being nothing, and 10 not being the worst pain you've ever felt, but the worst you can imagine, what do you give this pain?" I, then, if they really look like they're in no distress (go figure), may append "you look rather comfortable, and your vital signs look really good, too". That last sentence, though, might draw out the person that says "I had a 1.5cm kidney stone in the ureter, and my pulse was 58 and my blood pressure was 108/50". Yeah, you're an outlier.
Click to expand...

Haha, of course.

Another reason I never complain about my back issues... the 95yo pleasant lady who lives in pain I cannot imagine because of degenerate disease, multiple chronic lumbar fx, blah blah "well dear, today its about a 1 or a 2..."

And then I hang my head and sigh because im a p***y.
 
The Undecider said:
Haha, of course.

Another reason I never complain about my back issues... the 95yo pleasant lady who lives in pain I cannot imagine because of degenerate disease, multiple chronic lumbar fx, blah blah "well dear, today its about a 1 or a 2..."

And then I hang my head and sigh because im a p***y.
Click to expand...

One of the merciful things about being 95 is that all of their pain receptors are just about shot. Whenever I numb up an elderly person, they don't flinch, and rarely complain. Young healthy people are a different story. Getting injected with lidocaine is a very painful experience for them. The same atrophy that makes 95 year old ladies brains about 4/5ths the size it used to be is going on peripherally. That is why old people present atypically. That is why they often respond vaguely when you try to get them to be specific about complaints. They can present with "I just feel weak and dizzy" with every imaginable complaint. Throw in some short-term memory-loss and you enter the realm of vet medicine.
 
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On the subject of back pain - I've started doing yoga - the "cat/cow" stretch does wonders for my lower back.
 
I get in trouble frequently (in general but also due to this specific issue) because I maintain publicly and to administrators that the pain scale is useless. I was recently on a committee that was trying to design a pain protocol for a health system. All of the administrators wanted the pain scale included in the protocol. All of the clinical people wanted other endpoints. I noted many times that the pain scale is useless and that everyone knows it's useless. The administrators never once argued that it wasn't useless but that we need to use it because Joint Commission uses it. So that's pretty typical of healthcare. We do stuff that we know is crap because non-clinical, paper pusher types tell us to.
 
docB said:
I get in trouble frequently (in general but also due to this specific issue) because I maintain publicly and to administrators that the pain scale is useless. I was recently on a committee that was trying to design a pain protocol for a health system. All of the administrators wanted the pain scale included in the protocol. All of the clinical people wanted other endpoints. I noted many times that the pain scale is useless and that everyone knows it's useless. The administrators never once argued that it wasn't useless but that we need to use it because Joint Commission uses it. So that's pretty typical of healthcare. We do stuff that we know is crap because non-clinical, paper pusher types tell us to.
Click to expand...

The pain scale is another example of how we've let our dereliction of duty as the healthcare leaders lead to medicine being driven by nursing protocols. The Joint Commission and management of most hospitals seems driven by nursing people (who are often unscientific), which leads to our ridiculous "fall risk assessment", "home safety", "pneumovax" and other waste of time nonsense that we do in the ED.
 
Apollyon said:
The 1-10 scale is like a clock, not a thermometer. I ask people like this: "On a scale of zero to ten, with zero being nothing, and 10 not being the worst pain you've ever felt, but the worst you can imagine, what do you give this pain?"
Click to expand...

http://xkcd.com/883/
 
Hamhock said:
Wow, I haven't met an EM doc yet (of course, I am only a resident), who asks this question. [Is it a Press-Ganey thing in the private world?]

I ask: "Are you in pain?" or "Do you have pain?" and then give 'em pain meds if they do.

I don't see how some arbitrary number helps...but I do see how it hurts.

HH
Click to expand...

Yea, I tell them I have two numbers on my pain scale-wants more pain meds, doesn't want more pain meds. As long as their state narcotic database is reasonable, I'll give just about anyone pain meds in the ED.
 
ActiveDutyMD said:
Yea, I tell them I have two numbers on my pain scale-wants more pain meds, doesn't want more pain meds. As long as their state narcotic database is reasonable, I'll give just about anyone pain meds in the ED.
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That's actually the clinical endpoint I was pushing in my pain protocol. You quit medicating them when they said they didn't want any more or were asleep. I was soundly defeated by nurses who demanded we tie it to the pain scale. So in their schema a totally happy, NAD patient with a misunderstanding of the damn scale who rates their pain >5 (Hey! It's an arbitrary number that someone had to use an anoscope to find!) will be medicated again whether they want it or not. Awesome!
 
And here I thought that the pain from a paper cut was alleviated by one good curse word.
 
tkim said:
That's if you believe that OMM fixes the problem. I remain unconvinced that it does. Thanks.
Click to expand...

I have anecdotal evidence from the 30-40 people I've worked on/treated with OMT in the past year in the clinics. Yes, I'm not an experienced physician with years of experience and an N=30,000. But I know that it helps some people. There is a time and place for it, and it doesn't always help. But if there is something I can do in a few minutes to help a patient, why not try?

OMM is not a cure all, it's not the holy grail. I know this and I understand it well. It can't cure cancer, it won't fix diabetes, if you have a slipped disc or if you have other disc issues, it probably won't help. But if you have a musculoskeletal problem it may be fixable.

Originally Posted by Doctor4Life1769
Tkim's a DO.

Also, OMM doesn't solve everything. I'm not totally convinced either. At times, it does provide a quick temporary (and I mean VERY temporary) relief, or no relief, for me...
I am always amazed that there is not more objection by DOs when comments about most - maybe not all!?! - OMM are tossed out there (especially in an EM FORUM).

I don't want this to turn into an OMM thread, but come on DOs, chip in to maintaining the equivalence between the MD and DO as physicians.

HH

[[sorry to have offended, but show me the (good) data about spinal manipulation and such, then I'll try to offend less]]
Click to expand...

There isnt much "good" data about spinal manipulation because there haven't been a lot of studies done. That's our fault as a profession. But then again, we are trying to quantify and put numbers to something that may not be quantifiable.

If it helps some of our patients and we don't quite understand how it works should we just not use it? There are numerous cases of procedures and medicines that we use that work around this logic. We do things in medicine sometimes because we know it has worked in the past and we're told thats just how it is.

No offense taken, I'm just still green and optimistic I suppose and I can see the utility of OMT because it works on me and makes me feel better. It helps me heal faster when I hurt myself running or working out, and I've seen it work on patients first hand. I feel like OMT gets a bad rap because there aren't tons of studies to support it and this is a problem in our profession as a whole and poor support from the joke of our professional organization, the AOA. I realize that in our society today we practice EBM, but it seems sometimes that we are trying to make everything so scientific and black and white that we lose the art behind what we do. It may not completely 'fix' someone to do OMT on them, but if the humanistic portion of what I do during OMT of putting my hands on the patient and talking to them and really listening helps their mental health and if I can help turn a 7 day illness into only 5 or 6 days, why is that bad?
 
rose351 said:
I have anecdotal evidence from the 30-40 people I've worked on/treated with OMT in the past year in the clinics. Yes, I'm not an experienced physician with years of experience and an N=30,000. But I know that it helps some people. There is a time and place for it, and it doesn't always help. But if there is something I can do in a few minutes to help a patient, why not try?

...

It may not completely 'fix' someone to do OMT on them, but if the humanistic portion of what I do during OMT of putting my hands on the patient and talking to them and really listening helps their mental health and if I can help turn a 7 day illness into only 5 or 6 days, why is that bad?
Click to expand...

I will refer you back to your own post about Western medicine merely fixing the symptom and not the problem and have you reread this quoted part of your post. Now it's putting hands on and listening to the patient for their mental problems that's the fix? Sounds like placebo and sham medicine.

I see a one year OMM 'fellowship' with a large helping of cranial in your future. Godspeed.

Sorry dude, it'll take a while for you before the Kool-Aid wears off.
 
hh said:
I don't want this to turn into an OMM thread, but come on DOs, chip in to maintaining the equivalence between the MD and DO as physicians.
Click to expand...
See and this is where I'm sure I go against the grain with the majority of DOs out there. In my short clinical experience there are noticeable differences between DOs and MDs in patient interaction and the fact that the end point is the same for both, but the roads taken to get there will vary. There ARE differences in an MD and a DO that's why the profession was created. Today those differences aren't appreciated as much because the DO curriculum have been augmented to mimic the MD side of things because the AOA thinks that unless we conform we will never be accepted in the medical field. Many of my clinical rotations are with MDs, we have allopathic physicians who teach at our school and while I'm getting an excellent education and learning the medicine, I'm missing out on the DO mindset of treatment.

There are a number of students in my class (and I'm sure at osteopathic schools across the country) who completely despise OMT. The only reason they are my peers is because they want to be a physician and it was the only opportunity that presented itself for them. So in essence, while they are training at an osteopathic facility, they want nothing more than to practice 'allopathic medicine', and that is what they will do as soon as they graduate and finish residency. I don't think there is really a difference in the actual medicine and the science behind what we do because we take the same classes and learn the same pathophysiology. If you do the same thing over and over again, anyone can learn how to diagnose and do procedures. But there is a definite difference in my eyes in the delivery of care and I feel like DOs are simply better in general at practicing the art of medicine. I think in our effort to cut costs and to see more patients in the same amount of time we forget that our patients are more than a number and an illness, they are still people too.
 
tkim said:
I will refer you back to your own post about Western medicine merely fixing the symptom and not the problem and have you reread this quoted part of your post. Now it's putting hands on and listening to the patient for their mental problems that's the fix? Sounds like placebo and sham medicine.
Click to expand...

I don't mean actual psychiatric problems. But if you put your hands on a patient they feel like you are listening to them and that you spent more time in with them than you actually did. If something as simple as sitting down makes patients happier and they feel you care, directly addressing their complaints with OMT should work in a similar fashion, no?

http://healthomg.com/2011/04/11/sitting-docs-have-happier-patients/

I see a one year OMM 'fellowship' with a large helping of cranial in your future. Godspeed.

Sorry dude, it'll take a while for you before the Kool-Aid wears off.
Click to expand...
I'm headed for an one of the combined EM programs I hope. If not I'll do EM first, pediatrics second and then go practice. I'd rather not spend an extra year doing OMT and FP clinic crap. I know OMT has its limitations, I've already commented on those.

On the other hand, I've been sitting at the side of the table with one of our faculty at school and witnessed a migraine that had been going on for over 24 hours in one of my friends resolve. I've personally treated friends for nausea, headaches and congestion with cranial, cervical balanced ligamentous and FPR techniques and had excellent results. And I'm pretty awful at cranial because I don't use it often enough.

There is no need to mock and slam something that you don't understand and can't or don't want to appreciate. I'll sit over here and finish my kool-aid and help who I can. Sorry for rocking the boat...
 
Apollyon said:
My back feels a lot better! I'm on my 3rd of 3 night shifts, and I am now pain free! I think I had a spasm - I had pain before I went to sleep today, and woke up well.

Go me!
Click to expand...
👍
 
rose351 said:
See and this is where I'm sure I go against the grain with the majority of DOs out there. In my short clinical experience there are noticeable differences between DOs and MDs in patient interaction and the fact that the end point is the same for both

.....

I think in our effort to cut costs and to see more patients in the same amount of time we forget that our patients are more than a number and an illness, they are still people too.
Click to expand...

I'm not positive this is what you mean, because you seem to be afraid to come out and say it, but - are you implying that your DO education teaches you to be nicer to your patients? To treat them more like people?

That's laughable. It has nothing to do with your education. Maybe you are implying that there is a selection bias because nicer people are more likely to choose a DO school? That's even sillier.
 
rose351 said:
On the other hand, I've been sitting at the side of the table with one of our faculty at school and witnessed a migraine that had been going on for over 24 hours in one of my friends resolve.
Click to expand...

😕

I don't understand your point. What does someone's headache resolving have to do with anything?

HH
 
rose351 said:
I've personally treated friends for nausea, headaches and congestion with cranial, cervical balanced ligamentous and FPR techniques and had excellent results. And I'm pretty awful at cranial because I don't use it often enough.
Click to expand...

I've personally treated friends for nausea, headaches, and congestion with the essence of testicle, the nectar of yak urine, and manipulation of spiritual axis and had excellent results.

HH
 
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