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extreme back pain
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extreme back pain

I have had two mris the first one showed a radial tear in one of my discs L4-5 level and also showed bugling discs.Also showed mild compression upon the anterior and left lateral aspect of the thecal sac,and mild narrowing of the left neural foramen,with contact with traversing left L5 nerve root,as well as mild degenerative facet arthropathy and thickening of ligamentum flavum on the left. The second mri showed twp lipomas one at T3 (smaller lipoma) and the other at T8 where lipoma involves the left lateral aspect of the pedicle in addition to the posterior vertebral body. The spinal canal is dilated from the inferior T7 to the inferior T8 level. I also have disc bulging at T10-11 levels with mild extrinsic mass efffect upon the anterior and left lateral aspect of the thecal sac. I went to to see a neuro dr day before yesterday and he said I had nothing to worry about unless I planned on gaining an extral 300lbs!! I told him how bad I've been hurting and how a lot of times I need help just getting out of bed in the mornings. Please explain this to me about my mris and please tell me there's something more than taking pain meds that will help me. I can't tolerate a lot of pain meds they make me very sick.


                                                                    Thanks,
                                                                     Kymom
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Avatar_n_tn
Hi,
You seem to be suffering from degenerative disc syndrome.
Degenerative disc disease refers to a syndrome in which a compromised disc causes low back pain. Lumbar degenerative disc disease usually starts with a torsional (twisting) injury to the lower back, such as when a person rotates to put something on a shelf or swing a golf club. However, the pain is also frequently caused by simple wear and tear on the spine
Most patients with lumbar degenerative disc disease will experience low-grade continuous but tolerable pain that will occasionally flare (intensify) for a few days or more. Pain symptoms can vary, but generally are:
Centered on the lower back, although it can radiate to the hips and legs
Frequently worse when sitting, when the discs experience a heavier load than when patients are standing, walking or even laying down
Exacerbated by certain movements, particularly bending, twisting or lifting

The low back pain associated with lumbar degenerative disc disease is usually generated from one or both of two sources:

Inflammation, as the proteins in the disc space irritate the surrounding nerves, and/or

Abnormal micro-motion instability, when the outer rings of the disc - the annulus fibrous – are worn down and cannot absorb stress on the spine effectively, resulting in movement along the vertebral segment

Excessive micro-motion, combined with the inflammatory proteins, can produce ongoing low back pain.

Fortunately, over time the pain from lumbar degenerative disc disease usually decreases, rather than becoming progressively worse. This is because a fully degenerated disc no longer has any inflammatory proteins (that can cause pain) and usually collapses into a stable position eliminating the micro-motion that generates the pain.

Lumber degenerative disc disease treatment
For most people, degenerative disc disease can be successfully treated with conservative (meaning non-surgical) care consisting of medication to control inflammation and pain (either oral or injection), and physical therapy and exercise. Surgery is only considered when patients have not achieved relief over six months of conservative care and/or are significantly constrained in performing everyday activities.

Non-surgical treatment for degenerative disc disease
The ongoing pain, as well as the frequency and intensity of the flares, can be mitigated through a number of non-surgical options. Modifying activities to preclude lifting of heavy objects and playing sports that require rotating the back (e.g. golf, basketball or football) can be a good first step. Other options include:

Applying heat to stiff muscles or joints to increase flexibility and range of motion, or using ice packs to cool down sore muscles or numb the area where painful flares are concentrated.
Medications such as non-steroidal anti-inflammatories (e.g., ibuprofen, naproxen, COX-2 inhibitors) and pain relievers like acetaminophen (such as Tylenol) help many patients feel good enough to engage in regular activities. Stronger prescription medications such as oral steroids, muscle relaxants or narcotic pain medications may also be used to manage intense pain episodes on a short-term basis, and some patients may benefit from an epidural steroid injection. Not all medications are right for all patients, and patients will need to discuss side effects and possible factors that would preclude taking them with their physician.
An exercise program is essential to relieving the pain of lumbar degenerative disc disease and should have several components, including:
Hamstring stretching, since tightness in these muscles can increase the stress on the back and the pain caused by a degenerative disc
A strengthening exercise program, such as Dynamic Lumbar Stabilization exercises, where patients are taught to find their ‘natural spine’, the position in which they feel most comfortable, and to maintain that position
Low-impact aerobic conditioning (such as walking, swimming, biking) to ensure adequate flow of nutrients and blood to spine structures, and relieve pressure on the discs
Chiropractic manipulation can relieve low back pain by taking pressure off sensitive nerves or tissue, increasing range of motion, restoring blood flow, reducing muscle tension, and, like more active exercise, promoting the release of endorphins within the body to act as natural painkillers,But take care not to over strain during chiropractice.
Epidural steroid injections can provide low back pain relief by delivering medication directly to the painful area to decrease inflammation
Surgery for degenerative disc disease
Patients unable to function because of the pain, or who are frustrated with their activity limitations, may consider lumbar spinal fusion surgery. Fusion surgery works because it stops the motion at a painful motion segment. A one-level fusion at the L5-S1 segment does not significantly change the mechanics in the back and is the most common form of fusion, as this is the most likely level to break down for degenerative disc disease. Fusion of the L4-L5 level does remove some of the normal motion of the spine as this is a major motion segment (as opposed to L5-S1 which has really limited motion) Multi-level fusions are more problematic. A two-level fusion may be considered for patients with severe, disabling pain, but three-level fusions are not recommended because back movement is too diminished and altering the muscle composition can in and of itself cause pain (this has been termed fusion disease).

While it is a major surgery, fusion surgery can be an effective option for patients to enhance their activity level and overall quality of life. This is particularly true now that minimally invasive techniques are available to decrease post-operative discomfort, preserve more of the normal anatomy of the low back, and result in higher rates of fusion than previous techniques.

A newer surgery to treat pain and disability from lumbar degenerative disc disease is artificial disc replacement. The theory is that replacing the disc, instead of fusing the disc space together, maintains more of the normal motion in the lumbar spine, thereby reducing the chance that adjacent levels of the spine will break down due to increased stress. This procedure is still a new procedure in the US, so long-term efficacy, and potential risks and complications are still relatively unknown.

Goodluck.
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Avatar_n_tn
It is indeed very likely that your symptoms are related to your abnormal MRI findings.  Consult your neurologist about a physical therapy plan to decrease your reliance on pain medication.  Surgery may only be indicated as a last resort for this type of condition.

If you are unhappy with the way your current neurologist is managing your condition, you could always opt for a second opinion from another neurologist.
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Avatar_n_tn
I have tried physical therapy twice now and have had to benefits from it. I have also tried the steriod injections in my back again with no help. The last time I went for an injection was going to be in the hole of my disc and the dr wouldn't do it due to the new findings of my second mri showing two tumors in the middle part of my back. I hurt everyday of my life and I am only 38 yrs old. I was a cna for 10 plus years which I'm sure did most of the damage I'm currently facing now. Then I went back to school for my cmt thinking no more heave lifting wrong. When the aids are busy and need an extra hand you have to lock up your med cart and go help them. I'm not for surgery at all it scares me to death but if they could guarentee me at least a 50% chance of relieving a lot of my pain I'd have it done. I do plan on going to Uk for a second opinion because the neuro dr here told me to walk and swim knowing how hard it is for me to even get out of bed to get my youngest off to school thank god I have my mom to help with cleaning or whatever else needs to be done around the house. My husband does all he can but he works a whole lot and works swing shifts. I didn't tell the dr but a lot of times we aren't even able to be intimate due to the pain I'm having. I feel very guilty for this but cannot help it. My husband has been awesome about it and does not try to initiate anything because he knows how bad I hurt.

                                          
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