What treatment should I seek next for debilitating pain?

[cellie3155]

I have low back pain radiating down through both buttocks,  hips, thighs and calves.  Sometimes I have numbness, burning and tingling there as well all the way down to the feet.  Muscle weakness and balance probems.  The neurosurgeon ordered a RADCT/CT LUMBAR SPINE W MEELOGRAM.  He said that I am not a candidate for surgery and sent me to a neurologist.  All he has done for me is prescribe neurontin and that only helps with the numbness and tingling. It doesn’t provide any relief for the progressively worsening pain which is now debilitating after a year and a half.

I need help in understanding what the report means.  Also does anyone have any suggestions as to what treatment I might ask for?  The report states the following:

At L3-L4, there is mild disk space narrowing with small marginal osteophytes. There is a mild to moderate diffuse buldge across the posterior margin without a focal protrusion.  There is moderate degenerative facet arthropathy with sclerosis and hypertrophy.  There is vacuum phenomena within the right facet joint and a small synovial cyst containing a tiny focus of air related to this vacuum phenomenon protruding anteromedially approximately 4-5 mm into the central canal moderately steno sing the lateral recess likely impinging the L4 nerve root.  There is a minimal, 2-3 mm, anterolisthesis of L3 on L4 related to this overlying facet degeneration.  The central canal remains patent. Neural formina are mildly narrowed.  

At L4-L5, there is mild disk space narrowing with small marginal osteophytes.  There is a mild diffuse bulge across the posterior margin without a superimposed protrusion.  Moderate to severe facet  degeneration with sclerosis, hypertrophy and vacuum phenomenon is present.  There is bony encroachment on the lateral recesses impinging
the L5 nerve root sheaths somewhat bilaterally, right greater than left, related to this facet degeneration.  There is also associated minimal degenerative spondylolisthesis of 3-4 mm.  Boney neural foramina are mildly narrowed.  Central canal remains patent.

Transitional L5-S1 level with partial socialization of L5 with a rudimentary L5-S1 disk space. Central canal and neural foramina are patent.

[cellie3155]

Hello, I wanted to let you know that I saw the neurologist yesterday and asked to explain the report to me.   He said the anterolisthesis of L3 on L4 and also L4 on L5 is causing instability in the spine and I also have the nerve root compression at L4.  He said to increase the Neurontin to at least 1800 mg a day to break the pain cycle and gradually decrease the dosage to a level that is still controlling the pain. He also gave me a script for Darvocet and told me to take 2 to 3 per day.  He suggested that I go to a pain management doctor for some injections to see if they work for me.  He said he has some patients that get relief with the one injection on a yearly basis.  It is worth a try anyway.  He referred me to a clinic that is very close to my house.  I will let you know how that works out.  Thanks again for your suggestions.  You have been very helpful!

[ggreg]

No, I have not been to a pain clinic.  But now that you have described how your legs are, I can tell you that I take a different medicine for that, a Codeine mixture, and that stops the leg pain, whereas the Lyrica only stops the back pain.  I think the neurologist might give you additional medicine like I have to take, when you tell him about your legs bothering you despite the Neurontin.  Or he may have a better solution.  I am so pleased you and your husband will go to the neurologist this week!  And I'm glad you got an old back brace you can tinker with, might help.

[cellie3155]

Thanks for responding to my post.  I appreciate your suggestions.  I tried physical therapy early on but had a lot of difficulty with the pain.  I try to stretch on a daily basis and it does help a little. I also have a back brace but forget to use it.  I will get it out and try wearing it today.

I have been on Neurontin since April and have gradually increased the dosage up to 1200 mg per day but it does not give me much relief from the aching in my legs and back which worsens throughout the day.  By night time I’m in really bad shape and have a lot of trouble sleeping.  It has helped tremendously with the numbness burning and tingling that I had in my legs and feet though.  I’m glad to hear that Lyrica is working for you but our prescription insurance is not at all good.  I simply cannot afford it.

You mentioned going to a pain management clinic.  Have you been to one and if so have you had any success with that?  I have heard so many negative things about the steroid injections from people I know as well as from posts on the internet, but at this point I’m ready to try just about anything.  

I have an appointment with my neurologist on Friday afternoon.  I am taking my husband with me and I am going to ask him to explain the report in more detail and ask him about other treatments.  I will let you know how that goes.

[ggreg]

Well, the report indicates some of your lumbar nerves are being squeezed due to changes in your spine. The squeezed nerves is what is causing the numbness and discomfort in your lower back, on into your legs and feet.  Generally docs take the moderate treatment route with things like this, which includes proper pain control, possibly physical therapy, sometimes a back brace, that kind of thing.  

Now, you just got Neurontin.  Usually they start you off on a lower dose to begin with, and gradually triple it, for example, over a period of a few months.  In other words, next time you visit the neurologist, he should increase your neurontin, and so it continues until you reach a plateau of comfort.  This increase is in the literature and he should know about it.  I mean, it's possible he started you off at the recommended final dose, you can look the drug up online and find out what that is, atho it varies from person to person.

I've taken Neurontin for lumbosacral back pain, but I prefer its cousin Lyrica, which I'm on now.  Lyrica is more expensive.  Both stop pain the same way, it's just Neurontin upset my stomach so bad that I had to take Lyrica.  Some insurances cover it all the way, some not.  But I don't think the switch will make any difference as far as pain goes.  Anyway, the first time I took Lyrica an hour or so before bedtime, I woke up for the first time in years with no back pain.  Used to be I could barely get out of bed.  If you still have back pain, either the dose of your Neurontin isn't high enough, or you need another type of pain medicine.

I think you should go back to the neurologist and tell him how your symptoms are doing, and let him decide what to do.  In the meantime, you can do a couple easy things at home to help yourself out with this thing.  One is to stay physically flexible by doing very easy stretch exercises, I had a friend who had sciatica down one leg (nerve pain) and did yoga for a while, and his pain went away.  But when I tried yoga, I wrenched my back for a few days, so I didn't try that again.  But simple and easy stretching should be okay, and if it hurts, don't do that particular stretch again.  

Also, keeping the tummy muscles really tightened helps hold the lower back together better, which I suck in my tummy every time I lean over or bend over, as a habit.  But don't do sit-ups, that's too hard on the back.  And nice very warm baths on a regular basis is therapeutic to the muscles that tend to spasm in a situation like ours, gets them relaxed.  And you can buy a little back wrap with velcro from the pharmacy and strap that on whenever you're going to do any busy work or stuff that might make your back worse.  And if you'll add alka seltzer to your medicine plan, take it at diff times than your medicines, it helps inflammation and encourages sleep.

Keep in mind if your neuro isn't doing enough for you to make the pain stop, you can always take your scan report to a different neurologist, or you can go to a pain clinic where they have more varieties of pain control than just one medicine.  And also keep in mind I'm no expert, I'm just telling you things I've learned from my own experience.  It could be that the things I'm telling you won't help or could possibly hurt your back worse (stretching).  In addition, if you get a little wrap back brace from the drugstore, don't wear it all the time or your muscles will actually get weaker.  I hope some of this helps, and sorry I couldn't give you anymore details about your scan report than I have... next time you go to your neurologist, ask him to explain it for you.