Steroids for back pain

[paki44]

I had a back strain over a year ago. I still suffer from lower back pain almost daily. I've tried physical therapy, yoga, light workouts, and medication. I have been taking vicodin and valium for over a year now and I really want to get off of it and for the pain to just go away. My pain is a result of weak hip flexors and a weak core. I have been trying to strengthen these muscles but the pain is still there (I do light workouts 3 to 4 times a week and stretch several times a day). I am considering approaching my doctor about some form of steroids to aid in the muscle growth process. Does anyone have experience or thoughts on my situation?

[caregiver222]

Taking steroids to reduce inflamation is the wrong train, wrong direction, wrong station. Absolutely inappropriate except as short-term relief. Vicodin is also inappropriate, as the pain comes from glial cell stimulation. Do a google search for Dr.Jerome Groopman (author of the book "How Doctor's Think") and the New Yorker Magazine. He wrote an excellent article on overcoming pain from nerve compression that appeared in the New Yorker. Valium reduces muscle tone, so that is not a good idea. Nowadays testosterone is a scheduled drug, tightly controlled, and in the U.S. generally only available through an endochronologist, and I doubt it would be approved for this purpose..

[philnoir]

Sounds like you've been talking with phyiscal therapists, chiropractors, or sports medicine practitioners. They always say that your muscles aren't right and that's why you have pain. Your core is weak. It's almost like saying that your character is weak, that's why you have pain.

But you could very well have other problems that your doctors have ignored. Back pain is the number one reason people go to the doc in America, and it's one of the most poorly understood problems.

Have you seen a spine pain specialist? I'm talking about an interventional pain doctor trained in anesthesiology with advanced training in pain and the spine.

I have severe disc disease -- have had it for over 30 years. One of my pain syndromes was not diagnosed until about 5 years ago. I had facet syndrome, an osteoarthritic condition of the facet joints. When this condition was treated (via nerve destruction), 90% of my neck pain disappeared along with about half of my lower back pain.

The testosterone idea won't work. If the exercises you're doing now haven't helped, "bulking up" your piriformis and psoas muscles aren't going to help either.

Seek new answers. They are there, but it sounds like your current medical team isn't supplying them.

Incidently, opioids and muscle relaxants have worked to help control my chronic pain for over 20 years, in spite of Dr. Groopman's learned opinion.

[caregiver222]

A recommendation against opiates is not "Dr. Groopman's learned opinion". I would suggest locating and reading the article I recommended before commenting. While it is true that opiates may work to relieve chronic pain, pain is often (not always) due to Glial cell inflammation, which have no opiate receptors.  Scientific American ran an excellent article on the issues involving opiates and pain, and the pharmaceutical resolution of pain, which is retrievable on Google. This article explores new avenues of pain control, including the curious discovery that some third-generation antibiotics function effectively to control pain. The issue with muscle relaxants is that they degrade muscle tone, which is essential to maintain vertabral separation, and thus avoid pressure on nerves. That is the same reason it is, in general, a bad idea to wear a cervical collar for a subluxion injury, or spinal stenosis. If there is no bone structure to separate, the situation is different, but this is not the situation in most cases of sciatica. Opiates invariably cause addiction, and the dose required to control pain goes up-and-up over time. Such addiction does not reflect unfavorably on the patient (from a moral standpoint), but is a fact of life. Opiates also cause respiratory depression. A serious problem with opiates is that a patient may start with a small dose, and gradually end up with 100 mg of oxycodone a day. Then the pain may subside (often being episodic). The patients goes off the opiates for a few weeks. The cells then "reset", and if the patient again begins with the same dose they may suffer respiratory arrest. So if you have been off opiates for a while and want to start them again, use only a small dose for starters.

[caregiver222]

One of the significant articles on chronic pain management is in the November 2009 issue of Scientific American, which you will find helpful.

[philnoir]

I'm not going to change a treatment regimen that's worked for over 20 years based on someone's book that's based on incomplete research.

I'm aware of current research in glia and microglia (in rats), even though I've never heard of Dr. Groopman. What I find interesting is that these cells may be involved in development of opioid tolerance and eventually opioid dependence.

By the way, addiction is a psychological disease defined in the DSM and not a physiological response to opioids. Opioid medications do not invariably cause addiction. Most chronic pain patients maintained on these medications are not addicted. Addiction occurs in the treated pain community at levels comparable with those in the non-pain community.

The fact is that we become tolerant to and dependent on opioids but not necessarily addicted.