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Real or Referred Pain

Started by Climber on 04/21/2010 5:43pm

Hi, new to this forum so a little about me, up until a couple of years ago i was a very fit 48 year old male. Had suffered some very minor, more of a nuisance really, hip quad groin and buttock pain for a few years until it all went horribly wrong with a far lateral disc herniation, never quite felt pain like it. Reading the articles by others in this group certainly put my problems into perspective however they worry me what road I might be on. I have a few questions to ask and feel I may learn a thing or two by joining in for a while, so here goes.

How do you distinguishing between real pain and radicular pain. I have long term minor intermittent quad problems that could be due to problems within my lumbar spine. However as a cyclist and hill walker problems with the quads is not unheard of as this is the big muscle that powers you up hill or along the road and does get injured! I have seen a good few Doctors and Physiotherapists and I seem to get a different answer every time.

MRI shows a compromised L4 nerve as it passes through a left foramen narrowed by osteophytosis. This all come to light after a Left Far Lateral herniation at L4-L5 a couple of years back that left me with screaming hip pain and left me very disabled for a good few months. Other problems noted were disc bulging and loss of height at LS-L5 which pretty much explains my right buttock pain. And hypertrophied Facet joints.

Recovery since the herniation has been very very slow, still having problems walking, more than a few miles can leave me in much pain. However cycling is fantastic, providing I take it easy 40 – 50 miles is no problem and leaves my back feeling like new. Problem is quad pain can sometimes spoil my cycling, interestingly my intermittent quad pain goes back may be 10 or 15 years, long long before the herniation, I now tend to think this may have always be down to nerve irritation at the L4 level. And if this was the case it would explain why conventional treatment of the quad muscle has never worked. However saying that, my quad pain feels very real and some doctors and physios think it is my quad muscle. I don’t know what to think, would love to know one way or the other. Any thoughts from this very knowledgeable forum would be very welcome.

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1 Response


Hi Climber,

I would suggest pain is pain! I have had just fusion at L5/S1.

I started seeing a physio about a year ago, because of general hip pain/discomfort. He would alleviate my pain for a week, sometimes too. I lived in the gym at that point...unfortunately thats where a simple hip abductor machine broke me!

I went to the GP, and they gave me drugs and sent me of to my phsio...he reffered me cos he took one look at me and said...nope..not going anywhere near you...but I'll stick some needles in me..which did work short term...

Anyway...he refferred me to the pain Doc, who treated me with epidurals, facet joint injections and drugs...however..I had SEVERE leg and buttock pain, which he could not explain..according to my symptoms, there should have been something on my MRI at L3/4 but according to my MRI the disc was "bulging, herniated and sequeserated"(sp?) at L5/SI..he could offer me NO explanation for my pain...kept on being told that my pathology showed no reason for my pain.

I eventually was referred to a surgeon (not that I am suggestion you need a surgeon!) and about 10 minutes into a half an hour consultation he explained that my completely hideous leg pain was referred pain.

I would ask for a second opinion if I was you, just because your current doctor may not have the relevant expertise that you need.