Dear Dr. Archer,

I've always had health insurance, but due to finances and job, I could no longer afford to work. I quit, causing me to lose my medical insurance in 2011. I'm a recent graduate as a massage therapist, so I have a bit of medical training.

I'm stuck using county medical help which, unfortunately, is not giving me proper health care. I'm currently 130 percent below the poverty level with my income and I live with a friend who helps me, but can't pay any medical coverage for me. I've had lower back pain for the last 20 years, and am now in my 40s. 

The pain has gotten so bad that it is not relieved at all by muscle relaxants, massage, ice, heat, Jacuzzi, pool or even chiropractic adjustments. I've been diagnosed with four different issues as to the cause of my back pain, but am swaying toward a sacroiliac joint problem which was diagnosed by one chiropractor I saw. He suggested a sacroiliac joint injection.

Based on the location and type of pain I feel this to be the problem. I presented this to the county doctors and they refuse to listen to me and tell me there is no such procedure. I've researched it and found there to be information supporting this all over the place! I keep asking to be referred to a specialist and they refuse, sending me away with anti-inflammatories and muscle relaxants for a month that don't work.

Do you have any suggestions who I might turn to for help. My pain is affecting every bit of my life and making it near impossible for me to perform massage and even basic housework. I'm in tears at points, but doctors through the county refuse to listen and refer me to a specialist to rule the problem out.

All the hospitals in the Los Angeles county where I can go give me the same story. I can barely walk or stand for more than a few minutes. Thank you for your time.

Lanay

Dear Lanay,

This is not my area of expertise, so I don’t know anything about the injections you speak of. However, I will give my thoughts because the brain can react negatively to chronic pain, causing a viscious cycle. Chronic pain causes changes in brain chemistry and this causes depression. It can also cause trouble with sleep, appetite and the ability to exercise, all of which can worsen depression. So in addition to all the things that are done to physically relieve the pain, treating any depression is crucial.

My advice: Tell your county doctor you are depressed and want a referral to a psychiatrist. This will help in its own right, but then you can tell the psychiatrist that you also want to see a chronic pain specialist. Pain doctors and psychiatrists work hand in hand and I think that this round about method will get you to where you need to be.

You can learn more by reading Can Physical Pain Cause Depression, Disability Is Only One Of My Problems and My Doctor Cannot Control My Pain, and be sure to follow the links.

The most important thing you can do for yourself and your health is to never give up hope. Life is always throwing curve balls and making us face challenges we'd rather not face. I realize chronic pain is a terrible thing to contend with, but stay focused and do what you have to do to get the right doctors on your side. Take care.

Dr. Archer