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facet joint pain
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facet joint pain

I am a 45 year old male-6 ft 165lbs. I have a repaired torn rotator cuff of the right shoulder. I have been diagnosed with lumbo-sacral apophseal osteoarthritis primarily in the left part of my lower back. I have no leg pain but occasional cramping in the left lower leg. I take 3-5mg percocet daily for chronic pain and 12.5mg paxil. The pain in my back is getting worse because I am a student and have to sit in poor chairs in college. I am having real difficulty sleeping and cannot sleep for my than 2 hours without experiencing back pain. What can you suggest? Thanks for taking the time to help me. Tom
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Avatar_dr_m_tn
Thanks for using the Forum. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Low back pain is a very common symptom, however is less common in younger patients. There are multiple causes of low back pain, such as radiculopathy, osteoarthrosis and bony pain, pain coming from the ligaments, and muscles.
Radiculopathy is caused by problems in the nerve roots, the pain is very severe, “shooting down” the leg, usually like an “electric sensation”, worse with some positions and maneuvers, and most likely unilateral. The neurologic exam helps to distinguish this problem, as well as the history. It is important to recognize this early. Osteoarthrosis causes pain, and is not common for someone your age to have osteoarthrosis to the point of producing severe pain. Certainly there are risk factors to develop this early, such as family history, obesity, history of activity that may have affected the spine.
Regarding pain caused by problems in the bones, ligaments and/or muscles, they are usually worse with certain positions, heavy work, lifting, obesity, and inadequate posture. Very rarely serious structural problems are the culprit.
The recommendations for the treatment of these kind of problems, include adequate posture, taking care of not lifting heavy objects, or if lifting them, using an adequate posture to do this. Also sleeping on a hard surface as compared to softer surface helps. Analgesics such as Ibuprofen or Naproxen help, however patients should avoid overuse. The chronic use of narcotics is not good and certainly not recommended. Most of the time, physical therapy is very helpful, and this improves many of the factors that perpetuate the pain. PT helps to improve posture, will teach you exercises to strengthen your back, and decrease the pain.
However, before all this is implemented, it is very important to find out the cause of your back pain.
Without a good history and physical examination, I cannot tell you what the cause of your symptoms is. It is very important that you discuss with your physician about the cause of your back pain, and if required, arrange an appointment with a neurologist to make sure there is no neurologic problem, and look for the cause of the back pain.
I hope this information is useful. Good luck.
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Avatar_n_tn
Thank you for your reply. A little more history-I attend physiotherapy (active & passive 3 time a week for years now and it does help. I was told that part of my back problem arises from poor lifting. I was using my back to help lift because of my right shoulder pain. There is no family history of back problems. I have had a problem stomaching anti-inflammatories and there is no competent doctor to give me a cortisone injection. (I live 100km west of Toronto Ontario).Years ago, before I tore my rotator cuff I had other shoulder problems (winged scapulae), tendonitis ect, and I received nerve blocks (with cortisone) in Toronto for 3 years. Thant doctor is retired and I did have a cortisone injection in the shoulder last year before arthroscopic shoulder surgery however it really hurt giving no relief. My physio + family doctor want to find a cortisone injector doctor for my back but they (along with me) am nervous about back injections for fear they could hurt-not help + there are no local  doctors that give them. I do exercises and use ice packs daily with limited success. My family doctor has been trying different anti-depressants to try to block the nerve signal causing pain without much success. I do not suffer from any major depression whatsoever.  If you have any other suggestions-please let me know-Thanks again Tom
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