Soft Tissue is a Pain Source?

[Jim M2]

I just got a report from an organization called "Best Doctors." They collect all of your medical records and have a physician write a report and recommendations. They also name local surgeons who they say are best qualified to do the surgery.

In my case they did not recommend a surgeon because they did not recommend surgery. Here are some of their conclusions with my comments.

1. I am pain-focused
Guilty as charged. What I feel is beyond discomfort, it is pain to the tune of 6 to 8 and occasionally 9. It's alway screaming at me. If anyone knows how to ignore please advise.

2. There may not be one specific cause/diagnosis
Most of us here on the forum know this.

3. In many cases the specific cause for pain cannot be discovered
Most of us here on the forum know this.

4. A likely cause of pain is the soft tissue surrounding the lower back
Soft tissue? I wish they were more specific. It seems like some diagnostic would exist to test this.

5. There is no specific abnormal finding at L4-5 on the radiographs
The radiographs show dessication and broadening. In an MRI from 2003 L4-5 was bulged with a small herniation. It was positive during a discogram in 2003, although not highly positive. I have slight loss of strenth in my foot corresponding to L4-5.


Regarding item 4, please tell me if you know what they mean by soft tissue.

[Maria]

Jim,
Soft tissue according to Wikipedia:

In anatomy, soft tissues are the tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes (which are connective tissue), and muscles, nerves and blood vessels (which are not connective tissue).[1]

It is sometimes defined by what it is not. Soft tissue has been defined as "nonepithelial, extraskeletal mesenchyme exclusive of the reticuloendothelial system and glia".[2]

When I think of soft tissue involvement as a response to disc material leaking I think of the muscle spasms that I get that stop me dead in my tracks or nearly so. I think that is why Toradol injectons work so well to help stop this type of pain for me as this is a non steroidal anti-inflammatory medication and it does work well for my severe muscle spasms (or what I consider a soft tissue response). Still the latter part of copied Wiki def makes much sense... "it is sometimes defined by what it is not..." and that reminds me of using "scar tissue" as a definitive diagnosis or explanation of all low back pain for persons that have had spine surgery (and for failed spine surgery).

I still think it's worth further diagnostics to evaluate if there is one or more possible pain generators and if you might be able to address that then would you at least be able to reduce your pain in half? Even that would be acceptable to me I think especially if the reduction in pain was a chronic as the pain sounds like it is.

I like your comments following their findings which do sound reasonably accurate enough but maybe not complete enough to accept especially with the level of pain you're experiencing on a daily basis.

That's my opinion off the top of my head.

[mmglobal]

I had several years of, "your films look way too good for you to be having the kind of pain you are reporting."

In 2002 in Munich, Dr. Zeegers was highly motivated to rule out the second disc. Fortunately for me, both were highly positive and the 2-level ADR surgery SOLVED my LBP. The discs don't have to look horrible to be painful.

I don't know what to say about the report you got. Do they use a divining rod or other such tool that allows them to generate such certain language? (In case anyone is not recognizing... this is a snarky remark!)

Mark (kind of sounds like a hair-lipped dog... mark, mark, mark)

[Maria]

I've just had such a good laugh over Mark's post!!!
Really that report was kind of Ok except maybe what they left out which is what you're feeling and have to deal with on a daily basis!

I too experienced professionals saying "you only have a 2 mm disc bulge" when that fu**er hurt like crazy for years so I believe ME not even the most highly credentialed professional when it comes to "what I feel"~ and I am sure there is an explanation somewhere if someone is willing to look for it and I can afford to have it explored!

[Tim]

Hi Jim

So sorry for your continuing troubles.

How do they know it's anything to do with soft tissue??
This sort of report makes me angry - lazy doctoring!
They don't know and aren't clever enough to find your true pain generators so they right it off as a 'soft tissue' problem.
'Best Doctors', my ass - lazy doctors with no idea more like!

Of course you're "pain focused" - you're in pain! Let them try your pain for a day or two and see how they feel…...

I think Maria hit the nail on the head - there is an explanation if someone is willing to look for it and you can afford to have it explored.

Apologies for rant - If I'd had that sort of report I'd have felt angry, let down and wondering where to go next..

I really hope you can find someone who has the skill, knowledge and perseverance to get to the bottom of your continuing back troubles.

Kind Regards
Tim

[Jim M2]

Mark, Maria, Tim,

The "Best Doctor" doctor came up with "soft tissue" by the process of elimination. Similar to Mark's experience to his way to thinking the imaging did not reveal any serious pathologies. He's on the East coast looking at reports. He never did talk to me.

I'm in a pain psychology group and they got upset when I told them about the report.

At least you all gave me a good laugh. Your feedback is very much appreciated.

[Maria]

Jim,
So glad you're involved in something that sounds like a support group or a group that is supportive!! Hang in here and do what you think is right for you as best you're able. I'm sure Dr. Coufal will be there should you want to schedule that surgery somewhere down the road. I do think he's one of the really good guys though I 100% understand holding off on surgery and wanting to check things out more!

take care and be well~ Maria

[Jim M2]

Hi Maria,

Recently you mentioned that following one of your discograms they injected a numbing drug into your disc. Did it give you much relief? Did you or your doctor consider it to be another diagnostic to verify the provocative pressurization of the disc?

[Maria]

When I went to see the doctor to discuss getting the 2nd discogram (for diagnostic purposes of course) I told him I had to travel the day after the procedure (west coast back to east coast) and that I was afraid of the pain post procedure being a problem so he said he could inject Marcaine right after he pressurized the discs and that would help a lot and it certainly did.

The 3rd time I got a discogram (before it) my PM and I discussed me getting an ESI post discogram and that was even better re relief.

Neither was for diagnostic purposes solely pain relief post procedure.

[Jim M2]

Based on your experience it seems like a Marcaine injection alone is a diagnostic for discogenic pain. Did the doctor inject it into the soft center of the disc through the syringe/catheter that was used to pressurize the disc? They say there isn't very good blood flow in the fiberous portion of the disc. Did it take a while for the Marcaine to kick in and did the pain relief last longer than lidocaine injections elsewhere in the body? Just curious.

[Maria]

The procedure we're talking about was back in 2003 but what I remember was my discs were pressurized and I reacted re which discs were concordant for pain with measurements taken at the time of the discogram. The procedure ended and then the doctor said he was now going to inject the Marcaine for relief. The needle was left in place post procedure and Marcaine given.

The relief I felt was really more post the procedure generally and thru the next day or so. It was more like general relief that I could tell. I don't think it would be considered diagnostic in any way but perhaps you could discuss that with whomever is going to do your discogram to see what that person will tell you. I had noticed way prior to this even being done that I would get relief with Lidocaine injections given orally for dental numbing which would greatly help my back pain.

Even after the 1st discogram the pain of the discogram was there as it should have been during the procedure itself and what I noticed was when I bent over to dress myself post procedure the pain hit just like my back had gone out. I will say that 2-3 days after the discogram my back felt better for about a month at least. I thought it was because the discs had been pressurized maybe...

Since after 2006 when WC stopped authorizing ESIs for my low back I found that a Toradol injection of 60mg IM would just about stop the spasming in my back or my neck that is super severe and if left to my own devices might take up to a month to alleviate with other methods like rest, heat, ice, etc.

I actually wish I had long ago been offered some of these methods of reducing painful spasms and I might not have even had my first back surgery.. probably not my 2nd.

[Jim M2]

Maria,

Very interesting indeed. Thanks for the info. You can bet I'll be talking about it with my PM doctor in a few weeks.