Back Pain Case Study

Roger's back pain case study is one example of how difficult it is to diagnose and treat back pain.

This back pain case study illustrates the difficulty and challenges that many back pain sufferers experience before they can be correctly diagnosed and treated for their back pain condition.

Roger, aged 23.

At the relatively youthful age of 23, Roger had been in pain for years, despite several different diagnoses for his back condition followed by several different types of treatments. It started after Roger got out of college and started at his accounting job in the city. Roger couldn't recall any particular even that precipitated his pain, and he had no history of injury related to his back. Typically, Roger's work commute would include about an hour sitting on hard benches on the subway, followed by a mile's walk to his building from the subway station. Roger travelled to an from work with a backpack to carry all of his belongings, including his papers, books, and laptop. All totaled, roger probably carried around about 20 pounds of items in his backpack every day.



Once at work, Roger typically worked in an office environment, and spent the majority of his day at a desk, in front of the computer. One, day, while standing on the subway, holding onto one of the metal railings, he suddenly experienced severe pain in both hips that radiated down his legs. The pain seemed to come on for no particular reason, and inexplicably went away just as quickly, about hour later. Upon feeling the pain go away, roger felt both physical and emotional relief, and hoped that he would never experience symptoms like that again. Unfortunately, the symptoms did continue, and they would return with an increasing frequency over the next three months. Over the next few months, Roger became severely limited in how far he could walk, and he was unable to run at all, without significant pain and discomfort. These recent events were particularly disconcerting for Roger, as he was a natural athlete, who always enjoyed sports or athletic activities of some sort.

Eventually, Roger made an appointment with his primary care physician to find out what was wrong, and how to fix it. Based on a detailed report of the symptoms he was having, and a physical examination by his primary care physician, the doctor ordered an X-Ray of the lumbar spine and sacro-iliac joints. The sacro-iliac joints are the joints and ligaments that suspend and hold the sacrum in the middle of the pelvic cavity, at the base of the spine. Typical of a relatively healthy 23 year old male of average size, all the X-rays came back negative.

Next, Roger's orthopedist made an appointment with an orthopedist with an excellent reputation, who was the physician of a major college football team. The orthopedist ordered an read the results of the MRI images that he ordered, also of the lumbar spine and sacrum. Again, the MRI images showed no obvious pathology or signs of arthritis.

Roger was again rerouted to another doctor specialized in orthopedic pain - this time a rheumatologist. The rheumatologist, a specialist in arthritic diseases, did blood tests to look for systemic diseases that cause joint inflammation - such as rheumatoid arthritis and Spondylolysis. There were no positive findings based on the blood tests that were ordered for Roger, but because he had a scaly rash, he was diagnosed with psoriatic arthritis.

Click here to read more about Roger's case study, and how the spine can cause back pain.