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15 Year Old Daughter With Chronic Debilitating Back Pain

My 15 year old daughter has been having progressive, chronic back pain since the beginning of the year. She also says the pain radiates up her back at times and around her left hip area. By July, her back pain progressed to being so severe she is unable to participate in almost any activity. Sitting, standing, walking are all painful. By the time school started mid-August, she was only able to make a few days. Doctors didn't take her back pain seriously (said it was because she was overweight) until Sept when they ordered an x-ray. An x-ray showed mild disc herniation and the Orthopedic Pain Mgmt doctor suspected a stress fracture. Weeks later with a back brace and pain worsening, they did an MRI with no significant findings.

The Pain Mgmt Doc performed a pain injection in the L4-L5 area. He noticed on the x-ray that he uses for the pain injection, that she had calcification and arthritis in her SI joints. CT scans were done of the lower lumbar spine with no significant findings...meaning the suspected stress fracture wasn't present. He then did another injection about a week ago in the SI joints with no reduction of pain.

Meanwhile, my daughter is virtually bedridden from pain and even sitting in the car for 10 minutes is excruciating. She wakes up several times a night in pain despite being on hydrocodone (which I'd like to stop) and muscle relaxers and various sleep meds. She cannot pick things up off of the floor and is having difficulty with normal life skills. She desperately wants to be back in school and out with her friends but just can't. When she tries, the pain the next day is even more unbearable.

I'm at a loss and I don't even know where to go from here. Any suggestions would be greatly appreciated. She's too young to be having this kind of chronic pain!
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1

Comments

  • that is young to be having these kinds of issues but if it helps there are some members on this site that are young. First off buy her one of the grabber tools that you can get off Amazon. They are about $15.

    Has she had any kind of back injuries? Is she on any kind of anti-inflamatories? Has she been to a arthritis specialist to see if the pain might be coming from that?

    I would think that being over weight might play into it but I would also think she would have to be way over weight. Does back issues or arthritis run in your family?

    Might be time to go looking to get more opinions to find out what is causing the problems. A lot of us on this site have had to go looking for the right doctor to find out what is going on.
  • wow Sorry to hear your daughters in such pain.
    First off were was the pain doc doing the injection, you said at L4,L5 but he saw issues with her SI joints?.
    I would be going to another doc asap for different opinion, make sure you always get a copy of disc. Most docs won't even read the report.
    I had a mri and took to 2 diff. docs and got 2 diff answers. So I wouldn't keep getting those injections till you know whats wrong and pin point what area it is exactly..
    Who told her to be wearing a back brace?
    I just can't imagine how you must be feeling, seeing her in so much pain.

    It is so frustrating trying to get answers for ourselves, having to get a doc to listen to your daughter must be just hell.

    I would keep banging on docs doors, and I would for sure watch the meds they are giving her, it's hard enough with all the hormonal changes young girls go thru. If she is not getting sleep either, go to er's and keep going.
    I hope someone finally listens to you, and you get some answers.

    Keep us informed.
    Mary
    neck,bone spurs pain started 04, back issues and fusion l4,l5 06~hardware removed.
    good few yrs. 09 pain sharp, numbness feet,legs, diagnosed fibro, neurop. legs.lung issues.
    daily goal do good thing for someone.
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  • There have been 2 diagnostic tests discussed here that have been useful for patients that had MRIs that didn't verify their pain. They then had one of these tests were done and then it showed the cause missed by normal MRI.

    The techniques are called flex x-ray (x-ray taken bending forwards and then backwards) and Dynamic MRI (a special MRI machine that scans when standing). You can use those terms in the search function and read those stories.

    In the meantime, the weight loss suggestion sounds sound and can't hurt. The grabber is essential. Anti-inflammatories is generally prescribed, but you don't mention it?

    Additional suggestion would be to have a physiatrist (a special doctor - google it) work with her, to give her specific exercises so her body can cure itself.

    Your description of the pain she is having is quite vague. Can she be more specific?

    All the best.
  • Thank you for the comments, suggestions and sympathy. I truly appreciate it. I will definitely get the grabber tool.

    To answer some of your questions:
    Injury: She had a bad fall in June but had lower grade back pain before that. Early July is when it started getting really bad. Before that though, she had extreme fatigue since February, weakness, in her arms and legs and overall aches and pains. I'm not sure if and how that plays into the back pain. There were days she couldn't get out of bed due to weakness. Doctors found hypothyroid and anemia then. Once her energy was back up with the thyroid meds, she continued to have progressive pain.

    Pain: Sharp and aching constant pain in her lower back, often the pain radiates around her right hip. The pain also radiates down her legs. Worse after walking, sitting up and standing. Not much relief when lying down but some. She also has pain radiating up her spine, sometimes intermittent severe neck pain. Overall pain level 7-10.
    Meds: She is on an anti-inflammatory, ibuprofin initially and then Diclofenac Sodium. She was taking hydrocodone and Tizadine muscle realxer. She is currently taking the anti-inflammatory and Tramadol.
    Docs:
    June/July: Primary care doc prescribed pain meds.
    August: Pain progressing. Changed PC docs because he would not refer her to any specialists. Late August the new Primary Care Doc prescribed more pain meds and PT. PT caused more pain but we continued for a few weeks. PT suggested she get more diagnostics. An x-ray had not even been performed yet.
    Also took her to a Chiropractor who was able to provide mild short term relief.
    Sept: Mid Sept they performed the x-ray showing possible bulging disc, MRI was done about 10 days later. MRI showed a bulging L4 L5 disc and right side spine curvature. She was referred to the Orthopedic Pain Mangement Doc.
    October: Appt with Orthopedic Pain Mangement/Physical Med doc. (I believe he is a physiatrist?) He prescribed the back brace from saying he suspected a stress fracture in addition to the disc bulge but he wasn't too concerned with the disc bulge. If the brace did not relieve the pain, he wanted to do an injection. Lumbar injection was done about 2 weeks later, it increased the pain for the first 3 days but then pain went back to how it was before. While performing this, he was able to see the arthritis in the SI Joints through the flouroscopy. She had another injection in the SI joints last Friday. Pain continues at the level it was before the injections. (Level 7-9) She has not seen any other doctors. She has an appointment with him on Monday.
    The flex x-ray and Dynamic MRI sound great. I will ask him about those. I’m also considering asking to see a neurologist and rheumatologist.

    Sorry this is so lengthy!

  • try to see if you can get a referral from either the pain management doc or your PC to a surgeon (either ortho or neuro) that specializes in the spine. I'm not saying that she needs surgery and I am not a doctor by any means. However they have more expertise in dealing with spine issues and may run some different tests or have different suggestions on what you can do to help her out. Perhaps there is something there that a discogram or CT may show that the MRI and XRay did not. I know that those two tests when I did them showed a lot more than the xray and MRI did. Keep pushing and don't let these docs intmidate you.
    Jodi

    Single level L5/S1 360 fusion with 6 screws and a rod (10/29/12)
    Diagnosis: Grade 1-2 spondylolithesis, Pars Defect, L5/S1 disc tear anterior and posterior, DDD, spinal stenosis
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  • Thank you, brvsfan99. Unfortunately, I try not to let them intimidate me but it's difficult!

    Today we went back to the Pain Management doctor. He said with the MRI, CAT Scan and x-ray all having been done, he can see no physical reason why she should be in this pain. He recommended aggressive PT and exercise.

    He pulled me to a seperate room to discuss his concerns. He asked me if there was any reason she might not be wanting to go to school because he really can't find a reason why she should be in so much pain and she seems "afraid" to do anything. He tried to have her bend forward and she bent forward a little bit but it hurt so she stopped and said, "I can't, it HURTS." I showed him a video of how slowly she walks down stairs and he said it seems to be because she is afraid of hurting herself so she is protecting herself. This is all after he got a call from her "Primary Care Physician" whom she had only seen once since we have always seen her PA's because she was always booked. Her PC doc told him she was really concerned that she was on pain meds at such a young age. Nevermind it was her PA's that put her on the meds in the first place and her PA's who didn't take xrays initially (it took them 4 weeks to order an xray.) I don't know what else she said to him, but his whole demeanor seems to have changed since he talked to her.

    SO, basically he is telling me that her pain may be psychosomatic and that I should send her to counseling. I haven't ruled this out, and am working with counselors to make sure this isn't the case but really, it pisses me off that he dismisses her like that.

    Does a disc bulge in the L4 L5 area cause pain? The MRI report stated she had that.
  • We are all different. Some people have minor bulges with excruciating pain and others have massive extrusions and zero pain. Ultimately, top surgeons treat based on pain with validation from tests. So It is possible and given the consistency and length of time she's had it, quite likely she's in pain. However, she would not bend and show doc the pain, strange.

    Don't give up. Find a spinal board certified and fellowship trained spinal ortho or neurosurgeon (both do spines). Then demand a referral from the PM. He should be happy to do so. If he's not, run away from him fast. The PM is not an expert in the cause. That's the surgeons speciality. Some here may know one near you.

    Surgeon will ask about PT, so probably should be doing in the meantime. Plus do weight loss. Shows initiative and seriousness.

    There are flex X-ray, dynamic MRI, discogram diagnostic tests still not done, so testing is not all been explored yet.

    Keep fighting. Counselling as a parallel strategy is ok too.
  • ssourgirlsssourgirl Posts: 15
    edited 11/19/2012 - 3:04 PM
    Thank you Dave. I should clarify that it wasn't that she wouldn't bend forward, it was that when she bent forward, she only could go a little way without causing pain. He had asked her to tell him when she experienced any pain while having her bend various ways. She had pain bending forward and backward. I said, "she has a hard time picking things up off the floor because it hurts so bad."

    Unfortunately, her insurance only lists the PM doc and another doctor in his practice for Ortho. Her PCP doc is the one who will have to process the referral to anyone else and she is the one who called the PM doc saying she thought it might be psychosomatic. She has absolutely no basis for this as she examined her once and that was because she had to see the doctor (not passed off to her PA who is better IMO) to sign a note for the school to arrange for a home teacher. She barely listened to us and I could see judgement all over her face.

    We have been working on weight loss, very difficult given the fact that she can't exercise much but we're definitely working on that. I also have an appointment with a counselor/hypnotherapist who deals with chronic pain and any underlying emotional issues that might be there. Thank you for the support and information. I will keep fighting :)
  • Sent you a PM
  • Hi, I sent you a PM
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