Are online back pain / sciatica consultations good value? The obvious answer is “it depends”. Here are a few questions I think you should be asking in making your judgment.
Specialist or not?
Are you getting someone who can say that they specialise in lower back pain and sciatica? There are a number of online doctor services, but these are probably worse than seeing a general practitioner face-to-face about your problem, and for many people that’s a poor experience. In fact a study which asked family doctors to classify the problems that caused them “heart-sink” (i.e. the ones they hate) included lower back pain in the top three answers (the other two were lack of energy and headaches). So online doctor consultations for lower back pain don’t seem a great solution to me. I’d be looking for someone from the physical therapy field – a physiotherapist, chiropractor, or osteopath. Of course if the outcome you’re seeking is simply a prescription for painkillers and anti-inflammatories, perhaps an online doctor is all you need.
Does the online service answer this question first… Can lower back pain / sciatica be a sign of something more serious?
Read the linked-to article if you want more detail, but in brief, below are the questions you should be asked. We call them Red Flag questions, and a “yes” to any of them MAY indicate you have an underlying problem that needs further investigation.
- Compared with during your waking day, is your background pain worse when trying to sleep? (Not the sharper pain you get when you’re turning over, just the constant type of ache).
- Have you lost any great amount of weight without meaning to over the last year?
- Have you been diagnosed with Cancer at any time?
- Have you had lower back surgery in the last 2 years?
- Do you have any weakness (rather than pain) in any of the following?
When standing, lifting either big toe up
When standing, pushing up onto the toes of one foot (compared with the other, or compared with what you would expect is your normal)
- Do you have any numbness (lack of sensation) or pins and needles in your pelvic floor area (up between your upper thighs, the area you would sit on if on a saddle)?
- Have you had any recent change in sexual function? Loss of feeling, erection or ability to orgasm?
- Do you have any difficulty urinating or defecating (using the toilet)? e.g. trouble starting or stopping, or not aware of your bladder filling
- Have you suffered any significant trauma recently, which in any way could impact on your lower back?
- Have you been on a prolonged course of oral corticosteroids in the past or now?
- Have you had a persistent high temperature recently?
Follow on resources?
Explaining what’s likely to be wrong with your back can be extremely helpful, but the real benefit is if it leads to a plan of action that you can execute. This should include guidance on all sorts of things: how to sit, how to get into and out of chairs, how to stand, how to get comfortable in bed, which exercises may relieve your pain, which will prevent a recurrence, how to best use medication, etc. etc… Given that you’re looking for an online consultation, it would be sensible to follow that up with an online course for lower back pain / sciatica.
What’s the price versus the benefit (what’s the Return on Investment)?
First consider that if you are a lower back pain / sciatica sufferer, it’s likely to cause you more disability in your life than heart disease and cancer combined. That’s because in most cases it becomes a recurrent or constant problem that continues over decades, whereas these other illnesses only tend to last a few years. Now admittedly, these other things can kill you, whereas your lower back pain /sciatica won’t. But the recurrent and long-term nature of LBP/sciatica is surely worth sorting out once and for all, isn’t it? The benefits are obvious – less pain, better movement, more time doing things you enjoy doing, less fear your back is going to go wrong again.
What about the price? Given the above benefits, you may think it’s worth paying thousands for this outcome, yet most online consultations can be had for less than £100 ($130)! I think that’s a tremendous return on your investment.