Cause vs trigger
 

I was wondering last night in bed (what does a man do on a typical Sunday night eh? ;)) if this is a useful distinction.

I had stumbled on old internet posts of mine (back in 2010) which were from before I was first diagnosed, and the hindsight is much much clearer now.

I was complaining about not finding a good office chair and having sudden back pain making it almost impossible to sit at my desk.

A couple of days later I complained about the pain radiating down my buttocks and legs.

Three weeks later I was diagnosed with PN, the pain in my back was gone; the pain in my feet just started.

Now, there is no doubt that the PN itself was caused by alcohol abuse and B12 deficiency, so that's not what I'm trying to say. The cause is clear. It's just that I think the back pain was the final "trigger". I know glenntaj often talks about co-morbidity, but I wonder if it isn't even more complicated: that a nerve or physical problem (and you often read about things starting with back problems on here, although I don't have stats) can cause the PN that has been building up (from one or more causes), to really break out, even though it is not really related to it.

Could this be one of the reasons why it's sometimes so difficult - if not impossible - to find the real cause of PN? Back then I was 100% convinced the symptoms were caused by my back, and so was the first specialist. I would have sworn by it. I even felt some temporary relief from some back manipulation. And yet in hindsight today I know with complete certainty it wasn't the cause; just the trigger.

Does this sound familiar to anyone? Useful distinction, or does it muddy the waters?

I think what you are personally experiencing is a variant of the "triple" crush syndrome ....damage at more than one place along a nerve, building up to produce symptoms. So, no, the back didn't "create/cause the PN. It was more the "straw" that broke the camel's back sort of thing....

I find in my own experience that one big pain.... can mask lots of other pains so you don't attend to the lesser ones.

Once the big pain resolves for the most part, the background smaller pains become more obvious.

Double or triple crush is also a factor.

And for some I think autoimmune reactions to nerve peptides released into the circulation, may be a factor too. These broken cell membranes or myelin, may cause autoantibodies to be formed which then go on the attack and cause MORE damage. Not everyone gets this, but those patients with genetic tendencies to autoimmune factors, may have far more PN complexity than others.

Both good points, thanks. And yes, the autoimmune version might well be even way more complicated.

Pain masking pain. Now that I can look back without being in agony, I can say I'm pretty sure I didn't have any foot pain (or pain in general) before the back problem started. Stress wise I was a wreck though, especially when the tinnitus started.

I did however have a sort of "restless feet" syndrome, I couldn't keep my toes still, had heavy feeling legs, and very often night cramps in my feet/lower legs like I had as a growing kid/teenager. This became worse & worse over the years until the PN broke out. I can't prove they are related, but they might possibly be.

The back problem cleared up soon afterwards without any intervention, and never came back either. But I do suspect it worked in the way pabb described it.

back and PN
 

Well my experience is I had carpal tunnel for yrs and yrs... I did not know that I really should have gotten this taken care of I had surgery and STILL have it. I found out I have a slipped vertebrae and have had numerous bouts of back pain-radiating down the leg and also with the neck to the arm. I also have nerve pinching at the elbows. So guess that was enough to give this to me. I always thought if I got out of the back pain I was doing good -had lots of PT but now to have PN that is taking over my body it seems... where do you turn?