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Neurology (Expert Forum)
Tired of being in severe pain
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Tired of being in severe pain
by tjs1974, Nov 11, 2006 12:00AM
to who it may concern,
I have had a neck problem now for 10 months and have been in chronic severe pain. This has totally affected my life, as I am on long term disability and am not able to do many things due to my condition. I am 32 years old and was very active and never missed a day of work before this happened.
I had 3 MRI's this year and all three showed a bulging disc at the c5-c6 level. The first MRI was in Janury of 2006. The second one was in April of 2006 and then another one was done in May of 2006. I also had a mylogram in March of 2006, which showed similar results.
I had physical therapy three times this year. The first time was from Jan-Feb of 2006, then March-April of 06 and June-July of 06 and did not help.
I had an EMG in March and September of this year. Both showed possible nerve damage at c7.
I had 2 epidoral injections and 4 nerve blocks this year with nothing helping.
In Sept 2006 of this year, I had a discogram and this is what it said.
areas of a radial tear is shown at c4-c5, c5-c6, and c6-c7.
I went to a neurosurgeon and he told me that surgery would not help my problem.
Are there any surgical procedures or other alternative medicines that would be able to help my radial tears? I just can't go on the rest of my life living like this.
Here is my medicine list
Dilantin for prevention of seizures 130mg 2 times a day
Neurontin 300mg 3 times a day for nerve pain
Vasotec 10 mg once a day for high blood pressure
All help is appreciated.
Thanks,
Todd
I have had a neck problem now for 10 months and have been in chronic severe pain. This has totally affected my life, as I am on long term disability and am not able to do many things due to my condition. I am 32 years old and was very active and never missed a day of work before this happened.
I had 3 MRI's this year and all three showed a bulging disc at the c5-c6 level. The first MRI was in Janury of 2006. The second one was in April of 2006 and then another one was done in May of 2006. I also had a mylogram in March of 2006, which showed similar results.
I had physical therapy three times this year. The first time was from Jan-Feb of 2006, then March-April of 06 and June-July of 06 and did not help.
I had an EMG in March and September of this year. Both showed possible nerve damage at c7.
I had 2 epidoral injections and 4 nerve blocks this year with nothing helping.
In Sept 2006 of this year, I had a discogram and this is what it said.
areas of a radial tear is shown at c4-c5, c5-c6, and c6-c7.
I went to a neurosurgeon and he told me that surgery would not help my problem.
Are there any surgical procedures or other alternative medicines that would be able to help my radial tears? I just can't go on the rest of my life living like this.
Here is my medicine list
Dilantin for prevention of seizures 130mg 2 times a day
Neurontin 300mg 3 times a day for nerve pain
Vasotec 10 mg once a day for high blood pressure
All help is appreciated.
Thanks,
Todd
Doctor's Answer
by CCF-Neuro-M.D.-SH, Nov 22, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
Radial tears can cause pain in 2 different ways. There are 2 layers to intraveterbral discs, the annulus (fiberous ring) and the nucleus pulposus (jello like core of the disc). When there is a tear in the annulus (like a radial tear) then degenerative fluid leaks out of the nucleus pulposus and causes focal inflammation around adjacent nerves causing pain. Second, the nucleus pulposus can herniate out of a large radial tear and cause compression/pain of adjacent nerves and/or spinal cord.
From your description it sounds like you have had an adequate diagnostic workup, but I would suggest that you ask for a second opinion from another neurosurgeon. Many hernitated discs and tears will improve without treatment. However chronic leaking out of a radial tear can lead to granulation tissue formation, edema and chronic pain. You should not give up on the surgical option without a second opinion. Your dose of neurontin is low for preventing pain. Most patients require at least 900mg three times daily (2700mg/day) and many require upwards of 4800mg per day. I do not see anything from the history you provided, that you would need dilantin (pre-existing seizure disorder?). Dilatin can lead to acclerated osteoporosis and vertebral degnerative disease. You should discuss this with the doctor managing your seizure disorder (?). Neurontin is also an anti-epileptic, with no negative effects on your spine.
I hope this has been helpful
Radial tears can cause pain in 2 different ways. There are 2 layers to intraveterbral discs, the annulus (fiberous ring) and the nucleus pulposus (jello like core of the disc). When there is a tear in the annulus (like a radial tear) then degenerative fluid leaks out of the nucleus pulposus and causes focal inflammation around adjacent nerves causing pain. Second, the nucleus pulposus can herniate out of a large radial tear and cause compression/pain of adjacent nerves and/or spinal cord.
From your description it sounds like you have had an adequate diagnostic workup, but I would suggest that you ask for a second opinion from another neurosurgeon. Many hernitated discs and tears will improve without treatment. However chronic leaking out of a radial tear can lead to granulation tissue formation, edema and chronic pain. You should not give up on the surgical option without a second opinion. Your dose of neurontin is low for preventing pain. Most patients require at least 900mg three times daily (2700mg/day) and many require upwards of 4800mg per day. I do not see anything from the history you provided, that you would need dilantin (pre-existing seizure disorder?). Dilatin can lead to acclerated osteoporosis and vertebral degnerative disease. You should discuss this with the doctor managing your seizure disorder (?). Neurontin is also an anti-epileptic, with no negative effects on your spine.
I hope this has been helpful
I was just listing all of my medicines I am on. The Dilantin and Vasotec are being treated for other conditions.
The Neurontin is the medicine I am on for the nerve pain I have in my neck in arm. The pain in my neck is the most severe when it is in spasms, which is usually in the morning and early afternoon. When the spasms occur, I feel like my entire left side of my neck and arm is numb and weak. However, the pain is chronic and at best is moderate. Other medicines I have taken for this as needed were flexiril and advil.
I am going to see a pain specialist on December 4 and an orthopaedic specialist on December 1. The Neurosurgeon thought that the orthopaedic specialist might be able to help me with spinal stimulation.
I haven't tried traction yet, but I will ask the pain specialist about the treatment. If anyone has any other questions, I would be glad to answer.
Thank You,
Todd
I wanted to clarify why I am on dilantin. I am on dilantin as a prevention of seizures due to having AVM surgery in 1994. I did have a recent brain MRI and EEG and everything came back normal.
As far as the surgery goes for my neck, I am seeking a second opinion next week.
If my neurontin is increased, will there be any interaction since I am on dilantin?
All help is appreciated.
Todd