Common problem may not have a common cause
Neck and back pain is one of the most common reasons that Canadians attend for medical treatment. Some studies have shown as far back as 1998 that more than 66% of the adult population were experiencingneck and back pain and more than 80% of adults had experienced back pain during their lifetime.
Pain usually resolves
Most of the time doctors are not able to find any physical condition or illness that is the source of the neck/back pain. Neck/back pain is usally “self limiting”. In other words, most of the time neck/back pain simply resolves on its own.
As a result, many physicians simply prescribe their patients pain medication and tell them to go home and return if the pain gets worse. Most of the time this approach is appropriate and the back pain will eventually resolve.
May not be a common problem
However, the problem with this approach is that neck/back pain can be a symptom of several very serious conditions or illnesses. Failing to properly assess a patient who is suffering from neck/back pain and failing to come up with a proper differential diagnosis can lead to potentially serious consequences.
What is a differential diagnosis?
The differential diagnosis process is a procedure that is taught to all medical students to help them distinguish a particular disease or condition from other diseases or conditions that present with similar symptoms. The purpose of the differential diagnosis is to identify any serious or life threatening conditions so that they can be ruled in or ruled out. Then the physician can go through the differential diagnosis list until all of the possibilities are eliminated and a final diagnosis is reached.
Process of elimination
It is essentially a process of elimination where the doctor obtains as much information as possible and then creates a list of all the possible injuries or conditions that could be causing the signs and symptoms that the patient is suffering from. Each of these possible conditions is tested until, by process of elimination, the doctor comes up with a final diagnosis.
According to a recent article written by the Canadian Medical Protective Association the most common missed diagnosis in patients suffering from back pain was cauda equina syndrome (CES). CES is a potentially debilitating neurological condition that causes paralysis when the nerve roots in the spinal cord are compressed. There are a number of potential causes of CES including a herniated disc, narrowing of the spinal column, and lesions or tumours that compress the spinal cord. Cauda Equina can progress rapidly from tingling or numbness to total and permanent paralysis. The condition is a medical emergency and requires urgent surgery in order to prevent permanent disability.
Potentially serious causes of neck/back pain
Other conditions causing neck/back pain that are frequently missed by doctors included fractured vertebrae, back pain caused by renal (kidney) disease, some forms of bone cancer and lymphoma and infections that effect the spinal cord such as spinal epidural abscess, discitis or osteomyelitis.
Doctors making assumptions
According to the CMPA mistakes leading to missed diagnosis often relate to the doctors failure to realize that certain signs or symptoms were potentially serious indications that the patients neck/back pain was not simply musculoskeletal spasm.
For example, the presence of fever. Fever is typically the body’s response to infection. So a doctor who is presented with a patient who is suffering from neck/back pain and a fever should identify the source of the infection causing the fever and consider that information when coming up with the differential diagnosis. One of the potential causes of fever and neck/back pain is spinal epidural abscess. A condition where an infection causes an abscess on the spinal column that creates pressure causing numbness or neck/back pain.
Another red flag associated with neck/back pain is sudden or rapid weight loss. These two signs in combination can point to the presence of a tumor or lymphoma.
Progressive neurological symptoms like tingling or numbness in combination with neck/back pain can be a sign of a potentially serious spinal compression.
The CMPA also warned physicians to follow up on unusual or abnormal laboratory findings such as elevated white blood cell counts. Increased white blood cell count is a sign of infection (like a fever) so any doctor who is examining a patient who is suffering from neck/back pain, a fever, and has blood tests indicating an increased white blood cell count should consider the possibility of some kind of infection causing spinal cord compression resulting in back pain.
Potentially devastating consequences
Misdiagnosis of neck and back pain can have potentially devastating consequences. In one case our client attended at the emergency department with pain in his neck and tingling in his arm.
He was discharged with pain medication.
He returned to the emergency department on two more occasions with increasing pain and progressive numbness. Over the course of several hours the numbness extended into his legs.
Lab results showed an increased white blood cell count ( indicating the presence of an infection). He developed a fever (also a sign of infection).
The numbness in his legs became more pronounced and after several hours he couldn’t stand because of the loss of function in his legs.
After almost 48 hours our client was diagnosed with a spinal epidural abscess. However, because of the delays in diagnosis there was a delay in treatment of his condition and he became a quadriplegic. We were asked to represent him in a claim against the doctors for negligent misdiagnosis.
So what can you do to protect yourself?
So how can you help your doctor ensure that they don’t miss any serious signs or symptoms when examining you to determine the cause of your neck/back pain?
Don’t simply assume that your neck/back pain is caused by a strain, sprain, or muscle spasm. Make sure you provide your doctor with a complete medical history of all of the signs and symptoms that you are suffering from.
In particular, pay attention to any change in your symptoms and immediately seek medical attention if there is any change.
If you have any tingling or numbness if your arms/legs let your doctor know.
Always ask your doctor to conduct a complete physical and neurological examination when you are being examined for neck/back pain. A full neurological examination takes about 5 to 10 minutes and covers your whole body (rather than simply your head and neck or upper body).
Want more information?
For more information you can read my article: Misdiagnosis can lead to medical malpractice claims or you can contact us for a free copy of my book Health Scare: The Consumers Guide to Medical Malpractice Claims in Canada.
If you or a loved one have suffered injuries that you think may be due to medical malpractice you can buy a copy of my book: Health Scare – The Consumer’s Guide to Medical Malpractice Claims in Canada: Why 98% of Canadian Medical Malpractice Victims Never Receive a Penny in Compensation on Amazon.com. All proceeds from book sales go to charity.
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