Pinched Nerve- Some Clarification Please!

There are certain phrases that are used to describe back and neck conditions that I really wish I could eliminate from the English language.  "Pinched Nerve" is one such phrase.  Why would I want to eliminate this seemingly common condition?  One reason- it isn't really common and it almost never applies to the conditions people call a pinched nerve.

"Pinched nerve" came about innocently enough.  It is an easy way to help patients understand what is causing their pain.  It is easily visualized, sounds as extreme as the pain is, and offers a glimpse of how it might be cured, all in one simple phrase.   It is used to describe sharp, moderate to severe pain in the neck or back that originates from the spine and often radiates outward to the traps, buttocks, arms or legs.  Patients visualize simply "freeing" the nerve and feeling better instantly.  As with most things in life, it is not that simple.

While it is possible to pinch or compress a nerve, what is most commonly referred to as pinched is actually inflamed.  The nerve is not trapped anywhere and, therefore, does not need freeing.  To add to the confusion, the condition referred to as "pinched nerve" can be caused by a variety of different things.  This means there is no set cure and no way to know exactly how long it will take.  To give an example, low back pain often referred to as a "pinched nerve" can actually be a disc injury, bulge or herniation (yes, they are all different), a facet joint inflammation, an arthritis flare-up, a muscle spasm or something else entirely.  I have seen "pinched nerves" actually turn out to be kidney stones!

If only it was as simple as one condition with one cure.  It is easy to see why a doctor might resort to using the phrase, especially when the treatment is generally the same for all conditions.  The issue tends to be the length of time required to heal.  A muscle spasm or strain will heal faster than a disc herniation.  A facet syndrome may heal in a day or two and never reoccur.  However, an arthritis flare may feel better in a week and come back in two.  It is important to try to figure out exactly what is causing the pain, not to determine how to treat,  but to know how long healing may take, what type of maintenance (if any) might be needed, and whether or not further testing should be ordered right away or only if treatment isn't successful.

Sometimes I feel like a politician answering the question of what is wrong and how long it will take to heal.  Too many "non-answers" or at least not concrete answers.  However, I feel that it is worth trying to explain, even if it causes confusion or doubt.  If a patient does not truly understand what is wrong, they may not follow through with the treatment necessary to make them feel better.