The diagnosis of pinched nerves is not always a certain science and many compressive neuropathies turn out to be misdiagnosed conclusions. Of all the many possible back and neck pain diagnoses made by medical and especially complementary medical practitioners, pinched nerves are often some of the most illogically pronounced, given the objective facts of the symptomatic expression. Furthermore, there is rarely any verifiable or logical proof of a pinched nerve existing when the diagnosis is made. In essence, most pinched nerves are said to exist based on medical myth, incorrect diagnostic processing and subjective opinion, rather than through the proper channels of pinpointing the actual reason for symptoms to occur.
This vital essay details many of the common problems inherent to the diagnostic process for suspected compressive neuropathy concerns. We will also provide guidance for patients to improve the accuracy of their diagnostic efforts if they have been labeled with a pinched nerve condition, but have not enjoyed relief despite active treatment.
The majority of pinched nerves are diagnosed by chiropractors, followed by non-neurologist physicians. Chiropractors are spinal experts, but some subscribe to far-fetched and scientifically illogical ideas about nerve impingement being rampant and widespread in the vertebral column. Non-neurologist physicians might simply lack the knowledge and diagnostic experience to separate actual cases of pinched nerves from conditions that might mimic neurological compression in expression, but actually have completely different origins.
We continually receive letters from patients who tell of being diagnosed with a pinched nerve simply because they had pain in the back or neck and some symptomatic expression in one or more limbs. While pain, tingling, weakness or numbness in an arm or leg might indicate a compressive neuropathy, there are many, many other plausible and logical causes for similar symptomatic patterns to exist. Most patients are never told of this fact and are simply labeled as suffering from a spinal pinched nerve without any actual proof of the condition existing.
Neurological conduction testing is rarely performed and virtually none of the diagnosed patients are ever referred to a neurologist for expert symptomatic evaluation and correlation. This is "overlooked" because most doctors and chiropractors know that such efforts would typically discredit their original diagnosis and prevent the patient from entering into highly profitable treatment.
Many patients will receive diagnostic imaging that might show a structural irregularity at or near the level of the spine that might be involved in the neurological expression in the appendage. This "evidence" is typically cited as proof positive that a compressive neuropathy exists and the patient is promptly put into treatment.
The "evidence" we see cited for diagnostic proof usually entails completely normal degenerative changes to the vertebral and intervertebral structures which seem completely innocuous to any objective observer. Furthermore, we see obvious diagnostic blunders in at least 85% of cases, such as symptoms that do not correlate by expected clinical location, symptoms that are far too widespread to possibly come from the diagnosed source and symptoms that change or move regularly, discounting the possibility of a single pinched nerve as the exclusive source.
Some of the diagnostic mistakes we witness would be considered comical, if they did not actually produce horrific consequences for the patient. We routinely see herniated discs imaged towards the right of the spinal canal and theorized to be impinging on the exiting nerve root on the right side. However, the patient has bilateral symptoms or symptoms only on the left. In many cases, the diagnosis of nerve compression is made regardless, showing a fundamental lack of understanding or ethics on the part of the care provider. We also routinely see patients diagnosed with spinal canal concerns, such as impingement by a herniated disc or the accumulation of arthritic growth diagnosed as the source of a pinched nerve. However, the patient has symptoms that exist above the affected spinal levels, yet the diagnosis of a pinched nerve stands firm in spite of the evidence that basically renders the verdict partially or wholly null and void.
With all these errors, it does not surprise us that although the diagnosis of pinched nerves is commonplace, successful treatment for the condition is rarely enjoyed.
In order to optimize your chances of achieving an accurate back pain diagnosis, leading to successful treatment, we recommend the following steps to be considered by all patients who have been diagnosed with a pinched nerve or who suspect that they might suffer from a pinched nerve, but have not yet sought out qualified medical care:
Always seek evaluation of any nerve-related pain syndrome from a spinal neurologist. Be sure to fully describe the location and expression of all symptoms to assist in accurate diagnostic processing. If the doctor suspects spinal nerve compression, request nerve conduction testing to narrow down the possible sources of the problem.
Be sure to rule out other potential causes of symptoms, including localized nerve dysfunction, systemic causation, disease process or mindbody origin. All of these possible situations can create symptoms that perfectly mimic a spinal pinched nerve, but will obviously not respond favorably to treatment that is directed at the spine.
Patients are advised to look for signs of possible nonstructural causation, such as symptoms that change often, move in location or exist in areas that seem unrelated to the diagnosed spinal level of compression. Many of these nonstructural sources of pain are related to the mindbody process and will typically receive no attention from medical practitioners, since they are not trained to identify psychogenic pain issues. Some of these doctors do not even believe that these mindbody conditions exist, despite the overwhelming proof that is now available.
Finally, be sure to question the objective of any treatment directed at a pinched nerve, or any diagnosed causation of pain for that matter. Many therapies are not designed to actually cure the problem, but instead simply to manage the symptoms. It is always best to be sure of the accuracy of the diagnosis and then find an approach to care that will resolve the issue, rather than making you into a slave to ongoing, expensive and possibly dangerous symptom-based care of any variety.