Severe LBP/sciatica - should I have an MRI? GP said no.

Hello! I am a 48yo female, fit and active (or I used to be active when I didn't hurt), and no stranger to low back pain (always on the right side) and TMS. I have 5 books about TMS which I have read and reread over the last 15-20 years. About 20 years ago I "cured" some severe lower right back pain by simply reading Dr. Sarno's book "Healing Back Pain." I am so incredibly classic "TMS" when it comes to personality, including multiple manifestations of TMS symptoms since a teenager. My LBP has come and gone mildly over the years. When it comes, I know what it is, and it goes away fairly soon after. That's how it's supposed to work for me!

LBP came back in January of 2019 in a mild way and gradually grew in severity until now. Sciatic and right buttock/upper hip pain joined the LBP in March after a couple months of plain LBP. Now the sciatic pain is my worst complaint with pain in the lower right/upper buttock area waking me in the middle of the night and growing until I get out of bed. It is unbearable and takes me about 4 hours to be able to walk on both feet without supporting my weight on furniture. After a few hours, I can finally leave my bedroom and walk downstairs to care for my family. By noon, the pain subsides to about a 4-5 for the day, assuming I don't sit or bend much. Sitting and lying down for more than 20 minutes are horrible. The longer I've been lying down, the worse it is when I arise. The pain doesn't wander, and I don't have other TMS symptoms at this time.

I saw my GP a couple months ago as it was interfering with my life. He knows that I am holistic-minded and don't like bandaid solutions. He asked me if I really wanted to have an MRI because it would probably lead to a recommendation for back surgery. With some surprise, I said no, I just wanted to rule out anything serious and give it more time. He told me he himself had just finished 11 months of awful LBP and sciatica and had chosen NOT to have an MRI because he didn't want surgery. He just gritted his teeth and waited it out. He said that according to my story about how it came on over several months, he doubted I had injured myself. He said that imaging results will likely show age-related damage that does not necessarily correlate with pain. I was quite surprised to hear him acknowledge this and said that was my very concern about having an MRI. He said he felt I could wait. So, yay for that! It wasn't what I expected a conventional medicine doctor to say.

Well, soon after this appointment in August last month, I had to lift something VERY heavy. I had no real pain during the lifting and was in an upright position without having to bend. After that, the pain sky-rocketed beginning the NEXT morning. For the last month and a half, I am fearing that I did something that would require intervention. Of course, this fights my faith that is is TMS only. Truly 2019 was a horrendous year for me stress-wise. I am a month into "Unlearn Your Pain," which I started after rereading "The Divided Mind" during the summer. I was fully convinced I had done NOTHING to injure myself until the lifting in August corresponded with a huge increase in pain the next day and seems to be increasing. I feel that doubt is holding me back.

I NEVER HAD AN MRI. I am plagued (especially in the morning when the pain makes me dizzy for hours after too few hours of sleep) with fears that I should have an MRI. Then I fear what I would be told and how it would hinder me. As it gets a bit better during the second half of the day, I am able to believe it might be just TMS. I remind myself my doctor said he thought I was ok to wait (but that was before lifting the heavy chicken coop). Then I wake up again... And so it goes around and around.

During the day, after about 30 seconds of sitting/bending, my right leg starts to have numbness and tingling. These will go away if I get up and keep moving. The sciatic pain in my leg is really nothing compared to the pain in my lower back, upper hip - just to the right of the tailbone. It is that area which wakes me in the morning. Like a knife in my nerve, and then the pain turns to fire and seems to radiate out a bit and makes it hard to stand on both feet for hours, as I mentioned. I do have some soreness when I press on my lumbar area of my back to the of the spine on the right (several inches above the upper right buttock pain area), although I don't feel pain there as I move around - only when I press it with my fingers.

How urgent is it that I have that MRI to continue my TMS course? I am now an active reader of the TMSwiki page and have been also reading through Alan's course as well as Unlearn Your Pain. I'm not sure there is anything I don't know about neural pain and TMS (well, that's surely an exaggeration lol).

How urgent is it that I have the MRI to confirm that I have only TMS/MBS? I'm not sure if it would help or hinder. Also, I live in Utah, so don't see any TMS specialists nearby??? Thank you for any thoughts anyone might feel to share. <3

 

Hi Jeather,

First, I'm so sorry you are suffering! I'm responding because your pain sounds much like mine did back in 2014 when my "three-year physical breakdown" started. Back then, I didn't know about TMS so I went the MRI, X-ray, Discogram, EMG route. I believe I had a total of 8 MRI's over a one year period. I was so very desperate for answers. ALL of my tests were inconclusive even though I was almost incapacitated with pain. In fact, the neurosurgeon told me my Discogram looked like I was twenty! Please read my story on my profile page.

One of your sentences immediately jumped off the page when you said "Truly 2019 was a horrendous year for me stress-wise." The same could be said for me back in 2014. I think you have your answer. I know it's hard to accept that this is TMS when the pain is all consuming. Of course, you can have an MRI to ease your mind, but that didn't satisfy me and I suspect it won't you either. That's why I wound up with 8 of them. When the MRI didn't show anything but normal wear and tear, I would insist they look somewhere else. Since I had previously been healthy and this happened suddenly, I couldn't fathom that I didn't have a horrible illness that was gobbling up my health one ghastly bite at a time.

If I had it to do over, I wouldn't have gone to the first chiropractor... that lead me to a spine surgeon...that led me to a neurosurgeon... that led me to a rheumatologist....that led me to........well, you get the point. Instead, I would have read the books, worked the program, read success stories, journaled the nastiness, but most importantly - I would done everything I could to balance the rage to soothe ratio by practicing self-care, self-acceptance, and feeling/acknowledging buried emotions.

 

Hi Jeather and welcome. Great response for you from our friend @HattieNC .

Here is my take. You can have the MRI and, if it's inconclusive, as was Hattie's, you can proceed fully with your TMS program and belief. Best case scenario. But if that happens, you need to give yourself the gift of being done with medical consultations. Right? That's the only way you will progress, because it's the fearful brain that keeps making people go back for more tests, more exams, more reassurances (which are never enough).

However, if the MRI does show something, AND if you end up with a surgeon who recommends surgery, please believe that you are fully in control, and you have a choice! I recommend the following two things:

1. Find a copy of Consumer Report's most recent article about back pain (I don't know if that link will work for a non-subscriber). CR has been advocating against back surgery for at least two years, and this article is really like a strong confirmation of that position. (Interestingly, the success and satisfaction rates for hip and knee replacements are significantly higher, but arthroscopic knee surgery also has a very low satisfaction rate). The article quotes Dr. David Hanscom, MD twice, including the following: "Surgery is most likely to help when an underlying structural problem is the cause of the pain, Hanscom says. If the pain is widespread or severe despite only minor damage visible on an X-ray, a sensitized nervous system is more likely to be the problem, he says. “In that case, surgery won’t help.”

2. The two quotes by Dr. Hanscom severely understate his commitment to the mindbody connection, so the second recommendation is to check him out. Dr. Hanscom is (or was) a spine surgeon at Swedish Hospital in Seattle, who had his own struggles with back pain and a failed surgery. After learning about Dr. Sarno and recovering (I can't remember if he actually saw Dr. Sarno) he developed a program called Back In Control, and asked his pre-surgery patients to do the program before committing to surgery. The last time he reported on the results (in his blog posts which we have permission to reprint here on the forum) which was back in late 2017, I think, he said that 40% of patients had decided against surgery, which he found very exciting. He has since left his surgical practice and is devoting his career to mindbody healing using techniques which are based on Dr. Sarno and TMS. His forum profile with a bunch of links is at https://www.tmswiki.org/forum/members/back-in-control-blog.526/ (Back In Control Blog) or you can go straight to his website: https://backincontrol.com/ (Home) where there is a ton of material, including his blogs, sorted by category. One of the menu headings on the website is actually titled "Surgery?"

Good luck!

 

Thank you Hattie! I appreciate your insight. There is something comforting when you know someone else has has a similar symptom array. Lately my struggle has been pain that wakes me up after about 2 hours at night. Deep, burning pain in the upper hip where that nerve is. I find myself thinking that this can't be regular TMS sciatica - that lying down to rest would make it feel better instead of worse. I look forward to reading your profile story after I finish posting here. Thank you again for your insights.

 

Thank you! I look forward to studying your links. I appreciate the time you took for me