Mild Back Pain: There Are No Easy Cases

By | August 22, 2011

Back pain can affect anyone.

An interesting patient came into the office last week, I think as much for reassurance as for the treatment of her chronic pain. She had been referred by two of her co-workers who had been successfully treated for relatively straightforward back problems. Although her pain level was less than her friends her problem was actually more difficult from both a diagnostic and therapeutic standpoint.

The patient; lets call her Susan; was a thin attractive middle-aged woman who had a good job working for one of the studios. She was successful in business, had a good marriage and enjoyed a healthy active life-style. Susan engaged in regular daily exercise, but was troubled by lower back pain, which radiated down the back of her leg, not quite to her knee. The pain was worse in the morning, but improved with her morning exercise and after a warm shower. It was also aggravated by prolonged sitting.

There was no history of either direct or indirect trauma. There was a history of irritable bowel syndrome, but of nothing else. The physical exam was completely within normal limits and review of the MRI showed only minimal straightening of her lumbar spine and a disc protrusion on the right side of L5-S1 that was so small that I had trouble convincing myself that it was real.

Susan had seen many other physicians who had likewise found little to explain her symptoms. When I began the discussion of the differential diagnosis of chronic low back pain and its treatment options, beginning with my standard speech on epistemology and the probabilistic nature of all of my diagnoses, Susan told me that she was a busy woman and really had to get back to work.

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