Do we always know what causes neck and back pain?
About 10-15% of the time, spine specialists don’t know why someone is having their neck or back pain. We may look at x-rays or MRI’s of the neck and back, and not see anything especially wrong. That doesn’t mean you don’t have pain, just that we don’t see an obvious reason for your pain. And some patients have unusual symptoms or distributions of pain. In these cases we can try various conservative treatments to see if we can help. Usually, even when we’re not sure why someone is hurting, we can find treatment that helps.
Some people may be surprised to hear that we don’t always know what is causing neck or back pain. Some spinal healthcare providers will always say they know why you’re having pain. I actually don’t recall ever learning in school, when to say, “we don’t know”. But, after decades of practice, eventually, you become so knowledgeable and confident in your diagnostic acumen, that you learn to say, “I’m not sure why you’re having your pain. Your x-rays and MRI scans look reasonably good, and it’s not apparent to me why you’re having your pain. But, fortunately, I can provide you with treatment, not being sure why you’re hurting, and you will probably get better. And if you don’t, I can send you for a second opinion or to another specialist, and we may be able to do more testing that reveals a cause”. It may sound strange to say, but in my experience, most patients are fine with this statement and are often reassured that nothing is obviously very wrong. On the other hand, some chiropractors and physical therapists, who may be lacking in knowledge or experience may not be comfortable seeming to be so ignorant. In my experience, this can lead to some really stupid thinking and explanations that don’t serve patients well.
If you ever come to me for evaluation or treatment, you’ll find me to be very knowledgeable, to explain your problem very well to you, to explain what I do and don’t understand about your problem, whether your clinical presentation is common or atypical, and the “lay of the land” going forward, in terms of what you can expect. That includes the probability that I can help you, how long it will take, how fast it will help, how much it will cost, and what if I can’t help you, etc.
If I can help you, call me at 404-558-4015. I’m Dr. Castanet.