Appealing against GP refusal of treatment....Any Advice ?

kingrollo

Bit more of an update.

It would seem that the steriod injections have been dropped by NICE and as such not funded by the NHS.
What is now offered is a medial branch block - which targets certain nerves - if this clears the pain even temporarily - more permanent injection which burs the nerves near the facet joint can be done. this usually gives 1-2 Years relief.

MRI appts are being organised and I have the consultation with the spine specialist on Dec 6. can't get by with much less than 3-4 co codamol daily. Did yoga in the week and my back felt great the day after - but pain has returned a couple of days on.

At least something is getting done !

photonic69

kingrollo wrote:

..............
Did yoga in the week and my back felt great the day after - but pain has returned a couple of days on.

Why don't you do Yoga on a daily basis then? I do a session virtually every lunch hour at work in my office. All I need is a mat. I'm lucky in that I have an office of my own with blinds on the windows. I do spine mobility, core strengthening, and leg and shoulder stretching mostly. Every day. Gets me off my office chair and away from the screens and gives me a wel earned break from it.

Could you not do the same? If not at work then at least at home. 40 mins is all it takes. Do it in front of the TV if you must.

Obviously your condition is different from mine so you'd do what works for you.

yellowv2

PhotoNic69 wrote:

kingrollo wrote:

..............
Did yoga in the week and my back felt great the day after - but pain has returned a couple of days on.

Why don't you do Yoga on a daily basis then? I do a session virtually every lunch hour at work in my office. All I need is a mat. I'm lucky in that I have an office of my own with blinds on the windows. I do spine mobility, core strengthening, and leg and shoulder stretching mostly. Every day. Gets me off my office chair and away from the screens and gives me a wel earned break from it.

Could you not do the same? If not at work then at least at home. 40 mins is all it takes. Do it in front of the TV if you must.

Obviously your condition is different from mine so you'd do what works for you.

Absolutely this!
I would suggest even 15 mins a day would suffice, which is what I do ( Abi Carver yoga15.com)
I’m a believer in chiropractic and alternative therapy and a holostic approach so await the doubters response. It works for me.

drlodge

yellowv2 wrote:

I’m a believer in chiropractic and alternative therapy and a holostic approach so await the doubters response. It works for me.

Echoes my earlier post...my Chiropractor was an oriental guy who took a holistic approach to fixing my back. Didn't just fix the symptoms but looked at the various causes of the prolapsed disc, hopefully it won't happen again. 10 years on and I'm pain free and back to normal, 100%. It did however take a good 2 years or so to sort it to around 90% fixed, then a very slow recovery for the final 10%.

kingrollo

Update:-

Mri date and consultation now agreed - Nov and Dec though.

Had the most useless NHS Physio session ever - he asked me what my back stopped me doing - I said cycling and gym - he said I need to get back to them - if pain flares up take some ibuprofen (oblivious to the fact that I already take much stronger medication Naproxen , and CO Codamal) - He told me to use a cross machine !!!

Have done as he said - did 15 miles on bike which made pain worse, as did the cross trainer !

N0bodyOfTheGoat

I suffered with chronic lower back pain after an injury at work in summer 2008, which I suspect was brought on by carrying heavy items like washing machines with other people up multiple flights of stairs on a daily basis. For the first few weeks I could barely walk as my back was locked leaning forwards and to my left, but longer term I couldn't ride my lovely 2006 Felt F5C through fear of agonising sciatica attacks.

There was a referral to a local NHS physio unit, which kicked in the best part of ~9 months after the injury, but the exercises they gave me to do such as "the bridge" rarely felt like they were improving my back muscles. I must have been taking dichlopenac for ~12 months, but I hated being so reliant on drugs everyday. So instead, I became very reliant on a pc chair-shaped Homedics shiatsu massager when not at work, having to use it at least a handful of times per day.

Curiously, my Saracen Pylon8 hybrid and then later, my Specialized Tricross Singlecross didn't bring on sciatica... But then the Felt has a very aggressively short head tube.

It was only when I started my mission to lose weight in summer 2016 and then begin cycling to improve fitness in 2017 (rather than just commuting at a gentle pace) that out of nowhere, my lower back muscles stopped constantly moaning. It all seemed to happen around the time I randomly started trying to do "the two minute plank challenge" exercises on a fairly regular basis. My lower back would get sore on ~2+ hour rides on the Cube, but as I started regularly riding for a longer duration than this, the soreness became increasingly less of an issue. Touch wood, I think I've felt the need to use the shiatsu massage less than a handful of times this year... And they've only been at times when I've had man flu.

I hope you find a solution that works for you, the last ~18 months of being free of lower back pain agony have been a massive game-changer for me.

orraloon

Bit of a mini update on the thread diversion down the chiropractic route.

Mainline NHS process on my dodgy clavicle / shoulder has gone through the x-ray, ultrasound scans, pointing towards clavicle / sternum joint damage with significant arthritis present. Probably have an MRI next to confirm out (hopefully) a soft tissue sarcoma.

Meanwhile have had 2 full treatment sessions after my intial assessment with chiropractor. The holistic approach has been illuminating, and her treatments do seem to be improving flexibility and mobility in the shoulder and more generally. What has been surprising to me is just how out of alignment has become my posture when at rest, spine bent and twisting, pelvis tilted and the like. And how certain muscle groups are much stronger than others, exacerbating the pulls and counteracting strains.

Since I gave up being a desk jockey 14 years ago, I have worked physically. Plus with the cycling, as a result my shoulders, arms, glutes, legs are strong, while back muscles are relatively weak. Just how weak was brought home to me when she asked me to do those cheat press ups, where only the upper half of torso lifts, without using my shoulders, glutes and leg muscles. Really difficult, automatically the strong groups kick in; consciously switching those off meant I really struggled to extent I was thinking wtf is going on here.

Been an eye opener. Trying to take on board her findings, and adapt (a bit, radical changes ain't gonna happen) some exercise regime aspects, and to be more conscious of overall body posture.

I have 2 more sessions booked with her for December and January to complete this course, after which up to me if want to come back say every 6 months for a check on progress, or regression.

So overall, for me this has been a good investment of relatively small amount of money, will be around £250 in total, has got me to think about how my body is working as a whole, compared with focusing on the one specific problem with clavicle.

OP, hope your upcoming sessions get you some progress.

kingrollo

O/P Here

Had the MRI friday - but now face the challenge of getting it reported and over to the hospital where I have the consultation on Dec 6.

Got myself a daily set of core exercises which I do religiously - I do have days where I am almost pain free - not sure if this is the excercises - or the pain meds. Done a few 25 miles rides and today did 36 - I up the meds on these days - the cycling doesn't seem to make it worse - in fact it may make it better.

Hopefully I can get this ablation procedure before long and get back to serious cycling.

kingrollo

Whoop, Whoop, minor victory here.

I wrote to my MP - who contacted the CCG - the CCG have denied there is blanket ban on facet joint injections. In exceptional circumstances they will be funded. and individual funding request has to be made from the GP....

.....And this is the best bit.......

"Your GP practice have been reminded on the IFR process and the circumstances in which and IFR should be made - Your GP practice will I trust be in touch with yourself shortly"

Sounds like they have had a kick up the arse - and believe me I will be requesting a full written apology !

shirley_basso

But why not continue with your exercises so you don't need to have the injections?

kingrollo

Shirley Basso wrote:

But why not continue with your exercises so you don't need to have the injections?

I am continuing the exercises.

But as a regular yoga, pilates attendee , and having had these flare ups every few years for almost 30 years the exercises alone don't cure it. I get good days - but then it returns making regular cycling impossible.

kingrollo

Seen the consultant yesterday - said MRI showed a pretty healthy back for a 55 year old. Said he would do the steroid injections in Jan - Also offered nerve ablation should this fail .

Said to keep on with the exercises\yoga etc.

Good news.

svetty

kingrollo wrote:

believe me I will be requesting a full written apology !

Why when they have followed CCG advice?
Believe me, your GP would have much rather been in a position to agree and write a quick referral letter for facet joint injections if he had been able to.

If your MP is a Tory did you ask why his party is under-funding the NHS so that these sorts of decisions arise?

kingrollo

Svetty wrote:

kingrollo wrote:

believe me I will be requesting a full written apology !

Why when they have followed CCG advice?
Believe me, your GP would have much rather been in a position to agree and write a quick referral letter for facet joint injections if he had been able to.

I disagree - of course now the MP is involved there is a good deal of ass covering going on - but what I since been told is:-

Steroid Injections are not funded - for non specific low back pain. But my history shows over and over that injecting the facet joint relieve the pain - and the relief lasts . Therefore the problem is specifically the facet joint - so it isn't "non specific low back pain"

The GP always had the option of submitting an individual funding request, The GP told me they didn't as it would be rejected. Where as the CCG said it would be considered on merits (Most IFR'S are accepted.)

Pretty much the GP practice just hoped I would go away take co codamol for the rest of my life with all the problems that causes. Sadly if you don't push you don't get the treatment.

Yes my MP is a tory - and I told him the CCG policy is borderline barbaric. But he and his party have sort of 'got out of jail' on this one - because the CCG left a small window open for treatment and the GP didn't take it.

kingrollo

They had a cancellation so got called in for the jab Today - all done - few days rest - then gradually build up - will be as good as it going to get in two weeks - fingers crossed.

kingrollo

Bugger was going great guns after the inject. Did a couple of hour long turbo session - fine at the time and immediately after - but the pain has returned now - under control with naproxen - but gutted - out of options now. I guess my only option now is nerve ablation assuming gp will fund it - which the probably won't

Any ideas folks ? before I become an ex cyclist...

pilot_pete

I’ve been suffering lower back pain since my twenties when in the infantry. Carrying too much weight over too many mountains! I’m now 52 and the pain got too bad about ten years ago so I started looking a getting treatment. Went on a similar journey to yourself.

Luckily I have private medical insurance through work and ended up going down that route. MRI revealed lowest disk collapsed (degenerative disk disease) and tears in the one above.

Over the years my body had adjusted to compensate for the pain. My pelvis had rotated either side in opposite directions to try to alleviate the pain. Mine spine had a bit of an S in the Thorasic region and my head wasn’t on straight! All compensation trying to get into a pain free position over the years.

I had three sets of facet joint injections, the first worked for six months, the second for 6 weeks and the third virtually no time. I was offered a spinal fusion, but have really, really shied away from that.

For a number of years I had also visited a chiropractor and he would manipulate my spine and pelvis, getting all the joints back to where they should be sitting which would relieve the pain for weeks if not months at a time. Some call it snake oil, but the fact is all they are doing is hyper extending a joint through manipulation to free off a restriction and get the joint back to the correct position. Physios do similar, just over a longer time using less ‘persuasion’.

The majority of my pain is coming from the sacro illiac joints where the spine sits in the pelvis. The two pelvis halves rotate slightly in opposite directions and this puts pressure on the nerves causing the pain. It flared up over the last few weeks to the point that sleep was becoming difficult so 8nbooked an appointment last Friday. 30 mins of manipulation and I could immediately feel the relief. That evening I sat pain free watching the telly.

So, it’s not as snake oil as some say - if your spine isn’t properly aligned due to pain compensation by your body adjusting your gait then it’s not a mystery why realigning everything helps alleviate the pain. The manipulations a chiropractor uses do not hurt, they are akin to cracking a knuckle - you can feel it and at most it’s slightly uncomfortable, but I must admit I actually enjoy it as I can literally feel the relief as soon as the joint is manipulated. I especially like the head tilt ‘crack’ which sounds really loud as it is close to your ears! As soon as this one is done either side I can rotate my head fully left and right again where as immediately before the movement was restricted, more on the left than the right.

The sacro illiac joint manipulation is quite aggressive - it’s a big joint and he uses my bent leg as a lever to twist the pelvis against my spine (lying on my side on the edge of the couch). Once again, the relief is almost instant. I am now back to almost pain free, certainly to very manageable levels with no drugs, which is fine by me.

Flexibility, core strength exercises and physical activity are key. I have done yoga in the past which helped, do core exercises and obviously cycle lots, which all help. I find a hunched bike position opens up my lower vertebrae which helps, but my lower back does start to ache a bit (due fatigue I think) on 6hr+ rides.

So, I would recommend going to see a chiropractor as a bit of preventative maintenance might offset further more invasive treatment. Mine charges £40 for a session or you can book 3 for £110, which I do and then save the extras for later use.

Interestingly my chiropractor is an ex rugby player and that’s how he got into it, going on to treat rugby back injuries at his club. He has branched out and been on training courses to treat bovine and equine cases using the same techniques! He can manipulate a horses spine to get rid of lameness and increase the milk yield in a heard of dairy cows by sorting out their backs and getting them pain free! Crazy eh? Well worth a visit every now and again and keeps me away from my consultant surgeon whose parting words to me after I refused further injections were “you’ll be back”. I haven’t been in three years yet...

PP