Question
I am currently in a lot of pain.  I don't know what kind of doctor to see.  In June of 06 I had been diagnosed with a herniated/ruptured disc at the C5 level by electric testing and a CT scan (I could not lay down for the MRI).  The arm/shoulder pain was intense and I was in bed for one month.  I am allergic to ibuprofen and had a bad reaction to epidural cortisone shot and did not have the full series as it did nothing for the pain either.  I did have a course of PT with ultrasound and ice but I'm not sure that really helped either. The pain went away as suddenly as it began 3mos to the day.  I had a similar thing happen this past June 07 but it was no where near as severe and the pain went away after about 3 wks. It was not disabling at all. I was able to have a MRI and it showed a bulging C5.  Now I am injured again.  Almost as bad as the first time.  The pain is down my left arm to my pointer finger. It is most intense on the scapular and upper arm area.  But here is the complicating factor, previous to all of this I had been seeing a DC for SI joint problems (pain on rising from seated position and one leg a little shorter)and also have been said to have fibromyalgia.  I also have occasional sciatic pain down my leg (and possibly now onto the top of my foot but not sure if the SI is where this is originating from).  Is all of this connected and what kind of doctor do I see?  A DC, neurologist, DO, Orthopaedist.  I'm so confused and in much pain.  Please help!  I live in Brockton.  Thanks for any insight you can provide.

Answer
Ilene,

I'm sorry you're in such pain.  You're not alone.  What you describe is quite common and there are so many different types of doctors that treat it.   Let's see if I can help you make some choices on treatment.  First, your chiropractor should be examining you to determine if you have any positive neurologic signs, or signs of nerve compression.  This would be the case if you have a diminished muscle-stretch reflex in your arm, or if you have lost the strength to grip, pinch, or resist with an arm muscle.  If you have these neurologic signs, and have a bulging disc that is displacing and compromising the nerve in your spine that goes down your arm, then you should have a discussion with a spine surgeon.   I'd highly recommend David Kim, MD, out of the N.E. Babtist.   If you do not have any obvious neurologic signs, but have a lot of pain, then you should work with your chiropractor and also an interventioanal pain management specialist (IPMS).  The IMPS doctor is usually an MD, sometimes DO.   They may have specialty training in anesthesiology or physiatry.   I'd highly recommend that you see Aneesh Singla, MD.  He is an anesthesiologist and IMPS and he has an office in Dedham, MA.  781-326-8888 is the main number.  Dr.'s Kim and Singla are excellent physicians and real nice guys.   As for your chiropractor, he/she should try to find ways to reduce your pain.   Ultrasound is likely a waste of your time.  Electric stimulation does not fix anything, but a TENS unit (a portable electric stimulator that you can use at home) can provide short-term, temporary relief of pain.   Manual methods must be carefully chosen by the DC.  He/she can try hands-on neck traction.  If you find that alleviating at all, then consider a home neck traction unit.  Many are sold (even in the pharmacy) that hook over a door, but your DC should set you up to do home traction laying on the floor so your neck muscles can relax.   Traction should be done no more than 10 minutes at a time and you must wear a football mouthpiece so as to protect your jaw (TMJ/jaw joints) from the head harness pulling on your jaw.  Hands-on high-velocity manipulation can be safe and effective if carefully performed.   If your DC is only using a percussion instrument, then you are not getting the same thing as hands-on treatment.   So, see the DC 1st and check neurologic signs and treatment options.   If you are a surgical candidate, then contact Dr. Kim.  If you are not a surgical candidate then contact Dr. Singla.  With severe pain from a disc, you can discuss with your PCP taking oral prednisone ("Medrol Dose Pack") - while not a first line of defence for spine pain, it surely can bring bodily pain down when nothing else is working - but this is something your MD can discuss with you.  

I hope this was helpful.  Good luck with it all.  

Dr. G