Back and Neck Injury/Chronic Back Pain
QUESTION: Dr. Ornstein,
I have been dealing with Chronic Back Pain for over 2 1/2 years now and have been receiving treatment with chiropractor care, acupuncture, electric stimulation and massage therapy. I have also gotten x-rays, MRI's and CT-Scan's and everything has showed fine other than a fractured rib on my T6 right in between my shoulder blade and spine.
My employer has asked my doctors whether my injury is temporary or permanent at this point and I wanted to know....what makes a back injury permanent? I know all my exams have come out good, but I am still in pretty bad pain.
ANSWER: Hi Mark,
The answer depends on what source is making the inquiry. Sounds odd, however, there are different requirements depending on the type of injury, like workers compensation, and that depends on the state requirements. Generally, there are medical guidelines that can determine the percentage of disability based on a number of findings. It is always difficult when no pain generator can be specifically identified. Usually it will be up to the opinion of the doctor and/or a second opinion; sometimes the company doctor or one chosen by the state, and additional testing may be required, like functional capacity evaluation.
Basically, consistent findings both subjective and objective are considered, along with response to therapies. It can get complicated and sometimes is left to a Judge to decide. However, just because there is no pain generator identified on radiographic evaluations, does not mean there is nothing there. For example, Modic Type 1 changes on MRI studies were long thought to be an incidental finding related to disc degeneration. We are now finding that it indicates a painful condition with specific subjective findings. New methods of treatment are proving to enable those who have been disabled to get back on their feet and back to work. Previously, it was basically relegated to "be all in your head". It is true that chronic pain can have an effect on the brain and the pain can remain even if a previously known pain generator is gone. Similar to a phantom limb, where there is no limb, but one still perceives pain or sensation.
So, it is not an easy answer, nor is it an easy topic to deal with. But, never give up trying to get better and finding the best ways to deal with it.
All the best!
---------- FOLLOW-UP ----------
QUESTION: Dr. Steve,
I was referred to another doctor and he was reviewing my x-rays of my back and my rib that I fractured and he says that he might have the answer to my problems.
He showed me a picture of my 6th rib where it was fractured and he was able to show me where the fracture did not heal correctly and it almost seems like it shows a small curve where my rib and my spine connect. He is actually sending me for more testing, but said that this is probably what the problem is and the possibility of my rib rolling over my nerve to the rib.
What do you think?
Yes, this is a distinct possibility and nerves do run along the ribs. A fracture can heal with a callus and there is a good deal of mobility between the ribs, sternum and vertebrae. So, not only can the nerve be affected, but this can have an effect on upper body mechanics. I am glad to hear about this new finding and it sounds like this doctor is doing a great job. I hope the doctor will provide some answers and hopefully, some solutions.