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Neurology (Expert Forum)
Re: back pain
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Re: back pain
by CCF NSG MD / gsh, Jan 01, 1995 12:00AM
Posted By CCF NSG MD /gsh on September 15, 1998 at 16:58:15:
In Reply to: back pain posted by Pete on September 15, 1998 at 12:18:12:
Please help!!!
Over the past 5 months I have had severe back pain primarily in
the lower right part of my back. I have spent countless hours
on the internet reading about disc herniation, spondylosis,
sacroiliac joint pain, etc... but do not feel I have a clue what is
wrong with me.
The pain started for no particular reason one morning after I woke up, I
had played 18 holes of golf the previous day. I had also lifted
several very heavy items two days earlier. It atarted as only an
annoying pain with referred pain into the groin when sitting.
One thing to mention is that I do everything on my right side, such as
any strong lifting, raking, shoveling, digging, although I
do not do these things for a living.
Well, to make a long story short the doctors have been unable to find
anything, of significants, wrong with me. Two MRI's showed no major findings,
a bone scan was fine, an EMG was normal, a CT of the abdomen(to rule out
Urologic problems) was fine. My Physiatrist seems to be getting annoyed with
me because I'm so persistent at trying to find the root cause of
my problem.The pain has progressed to a horrible dull pain when sitting
with pain now radiating into the right calf. It is no longer an annoying
pain but a pain that permits me to do NOTHING active whatsoever. Most days
I am unable to even sit therfor I cannot drive or even play with my 2 children.
Also, please note I am only in my 30's, still a young guy
I know you don't like to diagnose without exam but here are the things I have
tried and the success I have had:
Naproxen- initially helped a little
Vicodin- Does help the pain, but how long can I take this
Prednisone- didn't seem to help much
Epidural injection- brought me from 25% to 65%- releived the
horrible pain to a bad pain
PT (traction, ultrasound)- did not help
Walking in the pool seems to really help, as well as flexion/distraction
techniques (Chiropractor). These seem to loosen me up but usually only provide
relief for half a day. Lying down gives me the best relief.
I feel like a paper doll in that every little movement can hurt my back,
especially TWISTING like during a golf swing.
I am very confused and depressed at this point because I see no light at the end
of the tunnel. It appears as though my back is deteriorating very
slowly and unfortunately I have no diagnosis therefor we don't
know what to treat. I am currently in the process of switching
Physiatrists, but it will be several weeks till I can see him.
Any thoughts here would be great????????
They mentioned a possible far lateral herniation??? Also, none
of their findings point to it being surgical, therfor leg raise
test o.k., bowels o.k., no loss of strength, and only very little
change in reflex on the right side with some weakness in
my right toe.
Thank you for reading
Pete
_______
Dear Pete,
This is a tough one. Presumably the MRI would have shown any disc herniation, even if it were far lateral. Your pain syndrome is not typical for a particular nerve root being compressed, as you describe symptoms that may refer anywhere from the L2 or L3 root down to S1. One avenue that may be unexplored is lumbar instability. Plain x-rays in flexion and extension may show instability that has not been diagnosed. Besides that, it sounds like your workup and treatment has been appropriate.
Clearly you are frustrated, but do recall that most back pain is best managed without surgery (about 90%).
Good luck.
In Reply to: back pain posted by Pete on September 15, 1998 at 12:18:12:
Please help!!!
Over the past 5 months I have had severe back pain primarily in
the lower right part of my back. I have spent countless hours
on the internet reading about disc herniation, spondylosis,
sacroiliac joint pain, etc... but do not feel I have a clue what is
wrong with me.
The pain started for no particular reason one morning after I woke up, I
had played 18 holes of golf the previous day. I had also lifted
several very heavy items two days earlier. It atarted as only an
annoying pain with referred pain into the groin when sitting.
One thing to mention is that I do everything on my right side, such as
any strong lifting, raking, shoveling, digging, although I
do not do these things for a living.
Well, to make a long story short the doctors have been unable to find
anything, of significants, wrong with me. Two MRI's showed no major findings,
a bone scan was fine, an EMG was normal, a CT of the abdomen(to rule out
Urologic problems) was fine. My Physiatrist seems to be getting annoyed with
me because I'm so persistent at trying to find the root cause of
my problem.The pain has progressed to a horrible dull pain when sitting
with pain now radiating into the right calf. It is no longer an annoying
pain but a pain that permits me to do NOTHING active whatsoever. Most days
I am unable to even sit therfor I cannot drive or even play with my 2 children.
Also, please note I am only in my 30's, still a young guy
I know you don't like to diagnose without exam but here are the things I have
tried and the success I have had:
Naproxen- initially helped a little
Vicodin- Does help the pain, but how long can I take this
Prednisone- didn't seem to help much
Epidural injection- brought me from 25% to 65%- releived the
horrible pain to a bad pain
PT (traction, ultrasound)- did not help
Walking in the pool seems to really help, as well as flexion/distraction
techniques (Chiropractor). These seem to loosen me up but usually only provide
relief for half a day. Lying down gives me the best relief.
I feel like a paper doll in that every little movement can hurt my back,
especially TWISTING like during a golf swing.
I am very confused and depressed at this point because I see no light at the end
of the tunnel. It appears as though my back is deteriorating very
slowly and unfortunately I have no diagnosis therefor we don't
know what to treat. I am currently in the process of switching
Physiatrists, but it will be several weeks till I can see him.
Any thoughts here would be great????????
They mentioned a possible far lateral herniation??? Also, none
of their findings point to it being surgical, therfor leg raise
test o.k., bowels o.k., no loss of strength, and only very little
change in reflex on the right side with some weakness in
my right toe.
Thank you for reading
Pete
_______
Dear Pete,
This is a tough one. Presumably the MRI would have shown any disc herniation, even if it were far lateral. Your pain syndrome is not typical for a particular nerve root being compressed, as you describe symptoms that may refer anywhere from the L2 or L3 root down to S1. One avenue that may be unexplored is lumbar instability. Plain x-rays in flexion and extension may show instability that has not been diagnosed. Besides that, it sounds like your workup and treatment has been appropriate.
Clearly you are frustrated, but do recall that most back pain is best managed without surgery (about 90%).
Good luck.
