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Back Pain and depression

I have back pain every day for the last 4 months to the point that after work all I do is lay in bed the rest of the day.  What should I be taking should I ask the pain management to prescribe me something or should I just try to keep dealing with this issue one my own?

MRI of the lumbar spine performed 03/21/2012 at UPMC McKeesport.

Multiplanar multiphase magnetic resonance imaging lumbar spine was
performed without contrast including the following sequences:
Sagittal STIR, T2 and T1, axial T1 and T2.

The lumbar spine alignment is anatomic. The vertebral body heights
are maintained throughout. There is no evidence of an epidural mass
or collection. The conus and cauda equina are unremarkable with the
conus ending at the lower end plate of L1. The prevertebral and
paraspinal soft tissues are unremarkable.

T12-L1 through L2-L3: No significant central canal or neural
foraminal narrowing is present.

L3-L4: The central spinal canal is mildly congenitally small due to
short pedicles resulting in mild canal narrowing.

L4-L5: Central spinal canal is congenitally small. There is a focal
central disc protrusion indenting the ventral aspect of the thecal
sac resulting in mild spinal canal narrowing. However, the lateral
recesses and neural foramen remain patent.

L5-S1: The central spinal canal is congenitally small. There is a
mild diffuse disc bulge resulting in no significant central canal or
neural foraminal narrowing.

My signature below is attestation that I have interpreted this/these
examination(s) and agree with the findings as noted above.

1. L4-L5: Congenital spinal stenosis. Focal central disc protrusion
resulting in mild central canal stenosis.
2. Congenital spinal canal stenosis. No significant interval change.
2 Responses
Avatar universal
I have also had physical therapy and gone through 3 epidurals which havent helped
1331804 tn?1336870958
Your MRI indicates that you have spinal stenosis throughout the lumbar spine developed as part of a birth defect vs. stress and strain on the spine.  Spinal stenosis is narrowing of the spinal canal.  I have this same condition at L4-L5 but mines was caused by stress applied to the disc over time by carrying things (like backpacks) too heavy for me.  

Spinal stenosis is a very pain condition because the nerve roots that exit the thecal sac through the vertebrae become pinched.  The small disc bulges that you have are applying pressure to the thecal sac (housing where the nerves are located).  

Spinal stenosis can cause a lot of nerve pain (burning throughout the low back into the hips, pulsating throb and achiness in the low back and hips, shooting pain and pins and needles sensation that runs through the buttocks and hips and down one or both legs).

Nerve pain is best treated with anti-convulsants and SNRI/SSRI anti-depressants.  Neurontin (generic: Gabapentin) or Lyrica (generic: NA) and Cymbalta (generic: NA) are good medications to try to help with this pain.  Opioid medications may still be helpful to you but their effectiveness on nerve pain is limited; however, they may provide some additional meaningful relief due to synergistic effects.  A muscle relaxer and anti-inflammatory are helpful too.  I take over the counter Aleve along with a two different types of muscle relaxers, an anti-convulsant, an anti-depressant, and long-acting and short-acting opioid medications.  I also get periodic epidural steroid injections.  For me, the injections don't provide much relief by themselves as the sole treatment.  However, together with my medication therapies I noticed substantial relief during certain periods (95-98% reduction in pain).

My medications are managed by my primary care physician.  You may have better luck with a Pain Management Physician depending on the state in which you reside.

I hope you are able to find effective pain management soon.  Please keep us updated.

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