Patient: My daughter has been experiencing quite severe lower back pain over the last 3 to 4 months. The pain has caused her to be unable to walk without a cane for support. She describes the pain as constant dull ache with jabbing pain going up and down her spine. She has had periods where she blacks out when the pain hits and the last time she fell and could not feel her legs but they kept twitching and where ice cold, also her toe nails turned black. She recovered with rest but this has been on going and has kept her out of school. She had an xray of her back and an MRI of her neck that and back doctors say showed nothing. They are labelling her as having a mental disorder, or faking it and refuse to give her pain relief medication,but the pain is real enough that sometimes she has to be carried. She gets headaches, dizzyness. What could cause such pain yet not show on xrays.
Doctor: If the source of pain is the back, I agree with the imaging ordered for the back. An x ray would look at the bony struc cture of the spine and is a very good initial test.The MRI looks at the soft tissue of the spine and is also a very good test.The only test not done is a bone scan. The bone scan involves injecting a tracer that is designed to bind to white blood cells and then taking pictures of the spine. If there are any injured areas or areas where there is excessive cell turnover such as in cancer, it will be highlighted by this test.If a physical diagnosis can not be found, the goal should be then to manage the pain. The possibility of a psychological basis of pain should not be excluded. A refferal to a local pain clinic would be appropriate.