Chronic Pain - No Diagnosis

Posted by ttibsen @ttibsen, Jan 31 9:50am

My wife has been plagued by severe pain for the better part of a year now in this area shown – below the knee in the anterior part of the lower leg. In September we visited the ER of our local hospital (a measure of last resort since it’s impossible here to get a timely doctor’s appointment). They were very thorough with their exam including an XR of the affected area but no diagnosis could be arrived at since – the area looked normal clinically – no sensitivity to digital pressure applied to the area – nothing abnormal was seen in the XR. So that was disappointing and the pain has continued unchecked since then. During the day, as with most pain, it’s tolerable but at night it’s bad enough that it interferes with sleep. A combination of Aleve / Tylenol sometimes will help with getting to sleep but not consistently so. As you can imagine, it’s quite depressing to have to endure this chronic pain and not have a diagnosis as to the source. I am wondering whether it is worthwhile to get an MRI of the area. Is it possible that an MRI can pick up abnormalities in this area that an XR wouldn’t? Any insight on the merits (or not) of an MRI (or a CT scan) in this situation would be appreciated.

@ttibsen
Do you have a PCP that you could ask this of? It's really a question for a medical professional. That said, my uneducated opinion is that an MRI could show a physical abnormality in the area (if there is one) more clearly than an x-ray. But if there isn't a physical anomaly the MRI will not show anything either. If the pain is generated from the nerves themselves (i.e. neuropathy) an MRI probably won't help. But again, you should ask your doc or someone in the medical field. Maybe your wife could benefit from myofascial release. There is a discussion here (in the neuropathy group) about that that is very informative. Best, Hank

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@ttibsen Yes, your wife should get an appointment with a Primary Care provider…(PCP Doc).. But whoever read those ER x-rays … the Radiologist… could be asked what an MRI or CT scan of that same area might show… There had to be an x-ray report written and signed… so write or question that Doctor who read the X-ray and have that x-ray report sent to the PCP .. If your ER Hospital medical records are maintained by EPIC… they have an APP available on your Smart Phone called MY Chart… through that My Chart app you can send non-emergency emails to your doctors..

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Thanks very much for the responses. The person reading the XR was the on call doctor who ordered the XR when we went to the ER and she looked at the film during our ER visit. In our small town of 30,000 we don’t have a radiologist. The ER doc never mentioned going beyond an XR so I didn’t feel that I could ask her whether the situation warranted an MRI. I like the possibility presented – that my wife’s situation could be one that might be alleviated by myofascial release so I think we’ll explore that option as it’s a fairly simple one to pursue. Thanks again for your input – it was appreciated.

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Hi Ttibsen, I hope you get some answers which will alleviate your wife’s pain. I just wanted to share that I also had experienced pain in that same area which my PPC and P/T could not account for. I do have chronic hip bursitis which I was receiving physical therapy for but was told no connection. It would bother me mostly in bed but went away after about 6 months. I do exercises for my hips, and back and also had 5 sessions for MFR so don’t know what actually helped, just glad it went away! Helen

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@ttibsen

Thanks very much for the responses. The person reading the XR was the on call doctor who ordered the XR when we went to the ER and she looked at the film during our ER visit. In our small town of 30,000 we don’t have a radiologist. The ER doc never mentioned going beyond an XR so I didn’t feel that I could ask her whether the situation warranted an MRI. I like the possibility presented – that my wife’s situation could be one that might be alleviated by myofascial release so I think we’ll explore that option as it’s a fairly simple one to pursue. Thanks again for your input – it was appreciated.

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I am new to this group, so I hope this input isn't redundant. I have Peripheral neuropathy but it wasn't diagnosed for quite some time. I started with pain/numbness/tingling in my feet and lower legs. I am wondering if you could request an appointment for your wife with a neurologist at the hospital? It may be worth waiting for as a correct diagnosis is so important to the treatment. I hope you both find the answers you need.

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<< I am wondering if you could request an appointment for your wife with a neurologist at the hospital? >>
I guess that I am too timid to speak up when the occasion demands. When we were in the ER it happened to be a particularly slow night so we had a leisurely visit with the attending physician. It's not like our session was a rushed affair. Still, at no time did the physician mention a referral to a neurologist so again – I didn't feel that it was my place to ask for a referral. Perhaps I need to be more assertive!

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It is often part of a plan to see a neurologist. I would want their expertise any way. They deal with things more internally, at the hospital I had a regular doctor that oversaw everything, He made all the necessary referrals and they spoke about combining disciplines in order to help me.

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