1309064 tn?1273503022

Constant, now moving pain

I was in a broadside collision at the end and fractured C7 and L2 TP. My L foot began to burn on the plantar surface. Shortly thereafter I began having increased pain in the L hipsocket, buttock and lowback. It's now 16 months later and  I've had a Piriformis injection, steroid dosepak, 3 Lumbar facet injections, 2 Lumbar MRI's and a  EMG and no one can find the source of the pain. My left buttock and hip burn as well as my hamstrings and side of my leg and I often have sharp pain and spasm in my low back. The burning in my foot traveled and now includes my lower leg to just above my left knee and remains constant. Recently my right foot began to tingle and I've had similar pain in the right buttock. Oddly, in the midst of this I had a left knee replacement where the syptoms decreased to a point of toleration long enough to allow me to get through rehab. Now things feel worse than ever.  I've been to a Spine specialist who dismissed my lower body symptoms and focused only on the C7 fracture. I've treated Ortho's, pain management and more recently a DO who referred me to a Neurologist. HE didn't understand why I was there to see him! I'm not sure what type of Dr. to see and have become frustrated and feeling hopeless. At 49, I want my life back. Any thoughts?
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Avatar universal
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. 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.

Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

I am not sure if you sustained injury to your extremities or just to your back. I see that you have had an MRI and an EMG. Thus, when I read your description, there were a few things that came to my mind. One being a condition called complex regional pain syndrome. The others are radiculopathy and fibromyalgia.
Complex regional pain syndrome is a condition that is usually due to a soft tissue injury in many of the patients. Associated symptoms include abnormal skin color or temperature changes, abnormal sweating, and/or swelling of the affected extremity.  The exact pathophysiology is unclear. It is likely due to an abnormal reflex arc from the sympathetic nervous system modulated by cortical pain centers, e.g., brain, causing an increase in catecholamine hypersensitivity. This latter statement is important because the emotional disturbance caused by the injury in many patients may be a precipitating factor in the pain syndrome.  A concept that should be mentioned is that of central and peripheral sensitization.  These concepts explain the lower of the pain threshold and can explain pain to nonpainful stimuli. The treatment is multifactorial and should begin with neuropathic treatment (see below).
The other possibility that comes to mind is what is called a radiculopathy, when there is compression of a nerve as it comes out of the spine. The compression could be due to arthritis of the spine or due to a herniated disc, as may be the case for you. A radiculopathy (what is sometimes referred to as a pinched nerve) often causes shooting pains. The treatment depends on the cause. The evaluation may include an MRI of the lower spine which you already have had. Also an EMG is usually recommended, which you have had.
In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent surgery is if there evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.
Fibromyalagia is another medical condition that leads to whole body pains. Its cause is unknown, but it is characterized by diffuse aches, sometimes GI symptoms similar to irritable bowel, sleep abnormalities, low pain threshold, and other features. It is best treated with medications such as lyrica and neurontin, exercise, and physical therapy.
The pain associated with nerve irritation is called "neuropathic pain", and specific medications are effective in this type of pain. These include neurontin and lyrica, and medications such as elavil (which is an antidepressant but has actually been found to be helpful with neuropathic pain as well). Other treatment includes physical therapy and swimming which are often more helpful than you might think.
In response to the type of doctor you should see, I would recommend a chronic pain specialist.  These specialists can be found in many large academic centers in the pain management departments. They may either be an anesthesiologist, psychiatrist, or neurologist.
Thank you for using the forum, I hope you find this information useful, good luck.
Helpful - 1
Avatar universal
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

After a significant trauma such as the one you've had, often the pain is not localizable, it is due to injury to various musculoskeletal regions (ligaments, tendons, muscles) and possibly nerve compression depending on the nature of your fracture (if it led to compression of nerves or not). Whether or not there is nerve involvement can be assessed by a combination of examination, exact symptoms, MRI, and a study called EMG/NCS which tests how nerves conduct electricity and how muscles respond. If a nerve injury is identified, sometimes medications to help neuropathic pain (such as neurontin, lyrica, elavil, effexor, etc) can help significantly.

It sounds like you've had evaluations with multiple physicians with many procedures. With widespread pain such as that you describe, a focal injection or a surgery seems unlikely to be helpful, though I can not of course comment on whether or not you need surgery as I am not a surgeon and have not seen your imaging or examined you. In cases such as yours, post-traumatic pains that you describe, a multi-disciplinary pain clinic may be most appropriate, a clinic that places high emphasis on physical therapy, cognitive-behavioral therapy to help you deal with the stress of your accident, your injuries, and to help you learn to deal with the pain and the stress it leads to, and non-narcotic pharmacologic management.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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