The pain is excruciating

ScottM

ScottM

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I know several PoAer who have back problem. I am one of them.

Earlier this week I twisted my back. On Monday and Tuesday it felt like it was muscular and I took it easy. Those symptoms subsided but I then started feeling sciatic pain down both legs. I took a day in bed and then the next two days of working from. Yesterday I was up and moving albeit with a cane to stabilized me as my torso is shifted to the left and the cane helps me to prop myself up.

Last night and tonight I noticed I can only lay in one position. The pain is so sever that I cannot stand it. I have been taking oral anti-inflammatory and there is no signs of cauda equina syndrome.

I don't know if I can wait until Monday to see my doc and I fear all the ER will do is give me a handful of pain meds and muscle relaxors.

I did have some discs diagnosed as herniated last summer and I fear that the physical therapy I had been doing is no longer working and the herniation has shifted.

What would you do? I think I am headed towards surgery. But I do not know what other options I have.
 
I'm no doc, Scott. But last week my mother, who was also headed for back surgery, decided to try acupuncture first. Her doc told her to go ahead, as it wouldn't make matters worse and might actually help. One session and she was a convert. She said the pain was gone.

I think she has a number of sessions remaining, after which she just has to call if and when the pain flares up again.

As an aside, an herb known as Cat's Claw has shown a lot of promise treating bone and joint pain. I use it as part of a one-two punch to treat bursitis and mild arthritis (the other part of the punch is glucosamine/chondroitin/MSM).

If I had to choose one or the other, it would be the Cat's Claw. The two together seem to wipe out the pain, but I've also taken them individually. Either one alone helps me, but the Cat's Claw helps me more. YMMV.

Feel better.

-Rich
 
The literature is pretty clear that over 90% of acute back pain will resolve within a month. Anti inflammatories and muscle relaxants can be useful in the short term. Forty percent of a population with no back pain will have a bulging disk, so having one alone is not an indication for surgery. On the other hand, loss of bowel or bladder function, or numbness in both legs, could represent cauda equina syndrome, which then becomes an urgent surgical issue. Sounds like you need an exam and probably some imaging to start. Good luck.
 
There is more and more pressure on providers to practice evidence based medicine, which sometimes conflicts with the art of medicine. Patients now come in with severe pain- it is difficult to tell them that the vast majority will improve shortly, and that an MRI will not likely be of any benefit in the absence of some specific symptoms. To these patients in pain, it looks like the doctor is doing nothing for them, and ignoring their symptoms, even with the best attempts at explanation. So, the provider will often order an MRI scan, and of course many will show bulging disks (which again are common even in people that have absolutely no back pain). If not, the patient will go away feeling like they are not being treated and their pain is being ignored. Patients in the US are under the impression that technology or pills will solve their problems, rather than a better life style, stopping smoking, and losing weight. They do not want to wait, and expect immediate treatment and resolution of their symptoms, often without any effort on their own part, as if health maintenance was like fast food. This is the major cause of why health care dollars are out of control in the US, yet overall health care is better and less expensive in other countries, as measured by outcomes.
 
Scott go get the surgery as soon as you can and while you can still get a good doc before Obamacare gets into full swing!:D Heh hey just wanted to give you a good chuckle sounds like you need it.

As for the back pain I think your way ahead of your self with the question about headed toward surgery. A lot of back pain is muscular and does resolve. When my back would spasm I used to lie on the floor I've converted somewhat to trying to move and stretch and use of massage. It really seems to work well.

My law partner had horrible back pain and was advised to get surgery but the doc said it was ok for him to try therapy first He went perhaps even to chiropractic which I'm not a huge beliver in but what ever it was it really worked for him. Took a while but it worked and the Doc agreed there was no longer a need for surgery.

Some Sciatica is also caused by periformis syndrome. Basically a muscle in the side of your gluteus that can tighten up and irritate the sciatic nerve. There are great stretchs, massages and exercises you can do that help tremendously some are actually demonstrated on Youtube as are the massage techniques if your sig other is willing to help.

Of course nothing substitues for the advice of your Physcian. I will say that the stretches and massage gave me very prompt relief.

Hope you feel better soon.
 
Thanks for the thoughts everyone.

Maybe I should be a little clearer. I already have the herniated disc diagnoses, including spinal stenosis and some arthritics. I have previous lower back injury including a crushed vertebra there. I spent most of last winter and this spring in physical therapy and got better. This latest round is worse than I have ever had and is affecting both legs. I cannot even sleep anymore as I am in so much pain and I can barely sit in a chair.

This is really awful.
 
ScottM said:
Thanks for the thoughts everyone.

Maybe I should be a little clearer. I already have the herniated disc diagnoses, including spinal stenosis and some arthritics. I have previous lower back injury including a crushed vertebra there. I spent most of last winter and this spring in physical therapy and got better. This latest round is worse than I have ever had and is affecting both legs. I cannot even sleep anymore as I am in so much pain and I can barely sit in a chair.

This is really awful.
Click to expand...

Sounds to me (but I ain't no expert) like you are due for the surgery - but don't expect it to fix things instantly - it apparently is a long slow recovery. The sooner you get started...
 
Oh Scott, I am so sorry. I don't know what to say that will help but I hope you feel better soon. Can they give you stronger meds for now?
 
Scott, even with the diagnosis it does not mean that surgery is a given. Therapy can still work. Obviously given your pathology you are probably more suseptible to injury and re-injury. I really think you need to get in to your Doc as soon as you can.

Look the pain you are describing sounds horrible. I know you don't want to go to the ER I can certainly understand that but go and get something for the pain. Why go through 20 more hours of hell? At least they can get some X-Rays done to show to your doc tomorrow. I'd hate for you do to anything for fear of nerve injury. See a doc even if its the ER or and Urgey Center. I did not comprehend the serverity of the issue when I posted previously. Send Bruce a PM here and on Red. Pain is what he does.
 
Chiropractors work miracles, it sounds like I had what you had, Yeah im 15 I know but somehow I threw mine out and couldn't walk without excruciating pain down my legs. It took 3 times with our chiropractor to fix mine and his words to me were "You know people will get surgery to fix this!"
 
If you already have a diagnosis of spinal stenosis and have some significant degenerative disk disease, there still are some non surgical options, like PT, epidural injections, a short course of muscle relaxants, etc. Surgery is not always the best option, and particularly in spine surgery, there are no guarantees to the results.(and I am an orthopaedic surgeon and work in an academic center full time)

Multiple level decompressions and fusions are big operations, with associated risks. There are no guarantees of pain relief, and a chance of fairly significant complications- like bleeding (since the surgery is right next to the aorta and vena cava) (assuming they do front back procedures), damage to the sympathetic nerves that can lead to impotence, infection, non-unions, etc. Then, if multiple levels are fused, the adjacent segments take up the load, and then they can become arthritic over time- resulting in more back pain.

If you do see a surgeon, make sure it is a spine surgeon,and in my biased opinion, this would be an orthopaedic surgeon that has done a spine fellowship. Most academic centers have fairly high standards and self policing compared to community hospitals.

Would strongly suggest not relying on the advice of lay friends and relatives- you want someone who is a good surgeon, not necessarily someone who holds your hand or has a fancy looking office. Get multiple opinions from different institutions

Ask physicians that you know, or nurses that work in the hospital where you are potentially going.

You basically get one shot at this, and if you make the wrong decision, it could haunt you for the rest of your life. Just because you're in pain, please don't make a desperate or rash decision.

Good luck.
 
AcroBoy said:
If you already have a diagnosis of spinal stenosis and have some significant degenerative disk disease, there still are some non surgical options, like PT, epidural injections, a short course of muscle relaxants, etc. Surgery is not always the best option, and particularly in spine surgery, there are no guarantees to the results.(and I am an orthopaedic surgeon and work in an academic center full time)

Multiple level decompressions and fusions are big operations, with associated risks. There are no guarantees of pain relief, and a chance of fairly significant complications- like bleeding (since the surgery is right next to the aorta and vena cava) (assuming they do front back procedures), damage to the sympathetic nerves that can lead to impotence, infection, non-unions, etc. Then, if multiple levels are fused, the adjacent segments take up the load, and then they can become arthritic over time- resulting in more back pain.

If you do see a surgeon, make sure it is a spine surgeon,and in my biased opinion, this would be an orthopaedic surgeon that has done a spine fellowship. Most academic centers have fairly high standards and self policing compared to community hospitals.

Would strongly suggest not relying on the advice of lay friends and relatives- you want someone who is a good surgeon, not necessarily someone who holds your hand or has a fancy looking office. Get multiple opinions from different institutions

Ask physicians that you know, or nurses that work in the hospital where you are potentially going.

You basically get one shot at this, and if you make the wrong decision, it could haunt you for the rest of your life. Just because you're in pain, please don't make a desperate or rash decision.

Good luck.
Click to expand...
Thanks for the input. I think my next step is probably going to have to be the injections. I was real close to having this done in December when PT finally started to give me some relief. I am hoping that if I get to see my doc tomorrow she gives me some oral steroids (I already am on anti-inflammatory, Naproxen), a script for PT to include some ultrasound and a referral to a pain specialist. I have gotten no relief today at all. I can only stand for a few minutes and I am having a tough time walking even with an assistive device aka cane.
 
ScottM said:
Thanks for the input. I think my next step is probably going to have to be the injections. I was real close to having this done in December when PT finally started to give me some relief. I am hoping that if I get to see my doc tomorrow she gives me some oral steroids (I already am on anti-inflammatory, Naproxen), a script for PT to include some ultrasound and a referral to a pain specialist. I have gotten no relief today at all. I can only stand for a few minutes and I am having a tough time walking even with an assistive device aka cane.
Click to expand...

You should also ping Andrew Stanley as he recently did a bout with back problems (and surgery). IIRC, Agatha might have, too, but I don't remember details.
 
ugh - I've tweaked my back a couple of times over the years, but nothing like this.

First time it was bad enough to see a doc - he told me to take a couple of OTC things (pretty sure it was acetaminophen and ibuprofin), take the max doses, but alternate drugs every other dose. His theory was that since they work on different parts of the pain path, your system can recover from one of the chemicals while the other does its job. That was about 20 yrs ago, I wouldn't try this without checking with your doc first. I used moist heating pads, too. It started when I was on the floor reaching for something - I ended up having to crawl on all fours until I could grab a chair and pull myself up.

Last time I had a similar problem naproxin and heating pads helped a LOT.

--

Good luck with this, I mean it!
 
Thanks Matt.

Saw a doc today and am starting an oral steroid regime and PT again. That worked the last time and I hope it does again. I took a couple of muscle relaxers too. I hate those things as they really make me 'high'. I took them to help me sleep as the pain has been so bad that I cannot fall asleep.

Here's to relief.

Next step is a referral to a pain management specialist. My hope has always been to avoid surgery for this issue.
 
Hope the regimen works, it is always the first thing to try and get you over the acute pain. The philosophies of pain management specialists can vary a lot- some have comprehensive programs that include physical therapy, work hardening, fluoro for injections, etc. And, the good ones know when they have reached their limits, and then refer the patients to appropriate subspecialists in a timely fashion. Others hand out increasingly higher levels of various opiate narcotics, and the patients end up with their underlying problem along with a narcotic dependence.

So, not all pain specialists are created equally, and I have seen this range. At least once a week someone will come in saying "I am between pain doctors, can you prescribe (name your narcotic) until I can find another doctor"?

Some pain docs, with good intentions, will wait too long until referring, and the patient, who might benefit by surgery comes in after a long and frustrating series of treatments, has a new opiate dependence, and gets relief immediately by surgical intervention. They deal effectively with pain as an entity, but sometimes ignore the underlying problem that causes the pain. It can be a fine line, and the best scenarios are when the pain doctors and surgeons have a close working relationship, and understand the strengths and limitations of each other's approach.
 
Scott I'll keep you in my thoughts and hope your recovery is quick and I get to see you in the UP feeling fine!
 
Mrs. Steingar went through a round that wound up with surgery. Fortunately the procedure used (laminectomy) was not very involved, as they used a small probe to remove the material that was causing the neuropathy. Worst she got out of it was a minor addiction to the pain meds (that was fun). The procedure did have a very good outcome.

Of course, every back is different, and back problems are one of the most common injuries in our society. I learned that at a talk in grad school attended by everyone in our lab but my pal Augusto, who was out with a bad back.
 
steingar said:
Fortunately the procedure used (laminectomy) was not very involved, as they used a small probe to remove the material that was causing the neuropathy.
Click to expand...

That brings back some memories. Research "Intervertebral Disc Protrusions in the Dog". Book dates back to the mid 1960s. Dad was the editor and I had the original illustrations for a term paper in high school biology. :D I feel for all of you dealing with this.
 
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