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Old 10-04-2010, 01:10 PM   #1
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L4-L5, L5-S1 back pain

Hello everyone,
Im 32 and I have been suffering from lower back pain since about 2003. I first found out that I had a herniated disc in 2003 via a MRI. Which I was able to manage the pain with physical theropy for several years. About 1.5 years ago I was squating during a work out and felt what I can best describ as "grape being squished" between my disc. After several days of excruciating pain, I made it to my doctor and had a second MRI done. It showed that L4-L5 was now herniated as well and that both discs had what appeared to be a tear in the annulus.
I have had injections, nerve blocks, facet block none of which offered any relief. I also had a disc-o-gram done and were not able to duplicate the pain.
My pain is centralized around the disc itself and I have no pain, numbness down my butt or legs. Even though my MRI shows that I should have pain and numbness down my left leg due to nerve impengement on the left side of both discs. It seems to be the worst while I sit, standing for too long does the same thing. The only thing that has ever offered any relief is decompression of the disc. I get 100% relief when I hang upside down on my inversion table and the same if I do some type of traction at theropy. but this will only last for about 10 minutes then gravity seems to re-compress my discs and back to more pain.
I have been on pain meds for almost a year and a half now, oxycodone 30mg 4 times a day. they used to work great, so much that I only needed to take 3/4 of one every few hours, then I had to go up the the full 1 tab every few hours. Now, 1 tab does very little in relieving the pain even after bumping it up to 5 per day. When the meds worked I was able to get through the day with minimal pain, but now it seems as if I am immune to the oxycodone.

Does anyone have any info as to what could help me? surgery? Im only 32 and want to avoid this, but the pain seems to only be worse as each month goes by. Ive gotten to the point where I have no life.
Here are my 2 previous MRI results:


Date:2/13/2009
Technique: Sagittal T1 weighted, T2 weighted sequences as well as axial T2 weighted sequence is performed.

Findings: There are no prior MR examinations for camparison at this time. At the L5-S1 intervertebral disc space there is disc deydration. There is abroad based disc herniation lateralizing greater towards the left as compared to the right. The disc herniation displaces the S1 nerve root posteriorly. There is a slight flattening of the S1 nerve root. the right S1 nerver root is normal. There is no significant compression of the thecal sac. The neural foramina are normal bilaterally.
At the L4-L5 intervertebral disc space there is also a broad based central disc herniation. There is also disc dehydration. There is a slight extradural indentation of the thecal sac at the L4-L5 intervertebral disc space. There are mild facet arthritic changes seen at this level. There is a mild foraminal stenosis bilaterally.
Opinion:
1. Central disc herniation at the L4-L5 intervertebral disc space as above.
2. A broad based moderately prominent disc herniation on the left side at teh L5-S1 intervertebral disc space.
----------------------------------------------------------
Most recent MRI

Date:3/12/10

FINDINGS: The sagittal T1 demonstrated normal vertebral height. Mild intervertebral disc space narrowing at the L5-S1 interspace is seen. A slight bulging of the intervertebral discs both at the L4-L5 and L5-S1 interspace location is seen which apperars relatively mild.

The sagittal T2-weighted images showed mild desiccation of the intervertebral discs at both the L4-L5 and L5-S1 interspace location. Again mild bulging of the intervertebral disc is appreciated at the lower two interspace locations. No real copromise of the AP dimension of the canal is seen. Above the L4-L5 level the intervertebral discs were normally hydrated and normal in appearance.

The axial images demonstrated a slightly asymmetrical left-sided bulge of the intervertebral discs at the L5-S1 interspace location. There is a subtle bright signal seen within the asymmetric buldge that maybe represents the equivalent of a radial tear in the intervertebral disc at the L5-S1 interspace location. The abnormality here is a bulge rather than protrusion. The axial images through the 4-5 interspace location showed mild symmetrical expansion of the intervertebral disc. There is a shallow directly midline bulge. In addition there is a similar bright signal seen in the posterior midline annulus suggesting the equivilent of a radial rear in this position. No compromise of the AP dimension of the canal is appreciated at this interspace location as well. Axial views through the L3-4, L2-3, and L1-2 interspace location are unremarkable.

Impression:
1. At the L5-S1 interspace location there is a mild amount of disiccation and asymmetrical left sided bulge of the intervertebral disc. In the midst of this bulge, there is a bright linear signal that could represent equivalent of a radial tear through the annulus. No Protrusion per e is seen however.
2. At the L4-L5 interspace mild generalized expansion is seen. There is a very shallow directly midline protrusion. Just behind this protrusion there is a bright signal in the annulus also suggestion the possiblility of a radial tear in the annulus. Again no significant impression on the thecal sac is seen but the findings here may also be cause for pain.
-------------------------------------------------------------

I have recently read about a standing or sitting MRI. Could having one of these done give a better picture of what is going on in my back? My pain goes from about a 7-8 sitting to about a 2-3 when I lie down. It seems that since the pain is extremely bad while sitting taking a picture while I am lying down would not show what is causing the problem. However taking a picture of my back whilee Im sitting when the pain is at its worst would show a true picture of what is going on. make sense?

I am looking for any help at this point, surgical or other. I dont want to keep living like I have been.

Thanks everyone!

Loren
PS sorry for the length of this post!

 
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Old 10-04-2010, 02:04 PM   #2
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Re: L4-L5, L5-S1 back pain

What surgical options are you being given? I think I have an idea, but would be curious what your doctor thinks. I've been in your boat. Had a microdiscectomy at L5-S1 in Oct 2008 (was 36 at the time), and am scheduled for L3-S1 fusion 10 days from this post.

Get a second opinion, especially for surgery. It doesn't hurt to get an independent set of eyes.

As for the meds, the body does become immune after a while. My pain management team wanted to increase my MS Contin to 30mg, but I'm not looking to become even somewhat dependent on narcotics. I take percocet when the pain becomes too much to bear.

 
Old 10-04-2010, 04:53 PM   #3
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Re: L4-L5, L5-S1 back pain

Hi Loren. It could be that the positional MRI might show your problems better if there is one in your area. Also, a myelogram and ct scan will show the doctors any nerve impingement, but it's strange that having these problems is not causing you any leg pain at all.

I agree that surgery may an option but only after a minimum of 2 doctors (spine specialists) agree that it is necessary. It's possible that if you have the other MRI or the myelo-ct scan, something else will show that can be helped by pain management by a pm specialist.

Sometimes surgery is just all that's left and we just have to bite the bullet. I just have a feeling that there is something more going on that hasn't been diagnosed yet, so don't let anyone rush you into the OR.

Keep in mind that we become tolerant to our meds after a while and may have to have a stronger dose or a change in meds. People with chronic pain rarely become "addicted" but more likely to be dependent on them in order to live somewhat normal lives. I've been on pain meeds for over 20 years and am not addicted. I've been very careful not to ever take them unless really necessary and try to find other ways to manage my pain. I've had times when I could go 2 or 3 days without meds at all. Right now, I'm on the road to my 7th lumbar surgery and cannot do without my meds at all.

I hope you will keep posting and let us know what you find out and how you are doing.

Carol

 
Old 10-04-2010, 05:50 PM   #4
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Re: L4-L5, L5-S1 back pain

Thanks for the response. I have not yet talked with a surgeon, I am currently looking for one in my area (New Orleans) that has a good reputation for treating patients and not just rushing to get them on the table. Any recommendations or possibly any web sites that may help find one? Also the pm doctor Im seeing now does not really specialize in pain management how can I find one who specializes in people with cronic pain?
I have seen 3 doctors thus far, one who did the injections, nerve block, and facet block, one who is more of a pain management doc that is not sure what the source of my pain is, and one pain management doc who said "have surgery your young and should be fine" All 3 said that I should have pain going down my leg but I dont. never have. Only pain in my lower back. It also seems to go away when I lay down. It also helps tremendously when I do decompression therapy. I know the pain is caused by one of the discs (L4-L5 or L5-S1) being compressed. I just dont know why. I have an idea why the disc-o-gram did not duplicate the pain, as it can take 25-30 minutes before my back starts hurting in the morning after I get up. There is no way that filling the disc with a fluid through a syringe can duplicate the same pressure that my body weight can produce.
I just really am losing hope that I will ever have a normal life again. My job requires me to sit for many hours a day, which kills me. So by the time I get home I am out of pain meds and cant do anything but lay down on an ice pack. It is causing problems with my wife and kids because I cant do anything. I hate living this way. From what I have read, surgery doesnt help pain in the lower back. Which is really discouraging because if that is the case Im going to be miserable forever....? I am hoping that someone out there has had a similar situation and found a way to heal.
Thank again for your responses.

Loren

 
Old 10-04-2010, 08:42 PM   #5
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Re: L4-L5, L5-S1 back pain

Loren-

I had my first surgery at age 33. I was unable to walk more than 20 yards before the pain caused by the expelled lumbar disc material rubbing against my nerve made me sweat and almost pass out. After a standard laminectomy, I was up and back to work in 6 weeks. It gave me back my life. I'm 47 now. Still not perfect, but I can walk without pain.

I support your effort to get treatment without surgery, but be sure that you keep the option open. A good surgeon doing a micro discectomy can really do wonders if it turns out that's what you need. I'm sure there are good surgeons in LA. Especially at teaching hospitals.

Good luck in your search.

wb

BTW, you might want to see if a Lumbar MRI with contrast ( an injection of Gadolinium by IV) will show the tear or bulge more effectively.

Last edited by whackedback; 10-04-2010 at 08:43 PM. Reason: PS addtion

 
Old 10-05-2010, 11:18 AM   #6
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Re: L4-L5, L5-S1 back pain

Most good Orthopedic Spine Surgeons and Neurosurgeons fully evaluate and determine what non-surgical and surgical options you may have. I know you may fear surgery, should that be an option, but it sounds like you have decreased qualify of life right now with the pain. I'm someone who will do any surgery any time if it will give any relief.
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Fusions: L5-S1 (87), L4-S1 (93), C5-C7 ('06), L3-S1 ('10)
C5-C7 foraminotomy 08

 
Old 10-07-2010, 08:39 AM   #7
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Re: L4-L5, L5-S1 back pain

Loren,

I am sorry you are going through this pain. I have the same pain with no leg pain, and I know what you mean when you say you have no leg pain, they look at you like you are lying? I have been getting injections and I take vicodin when needed. It is so hard to live with this pain. My marriage is at a very fragile state and we are looking at divorce and I believe a big part of it is the pain and mood swings I have with the medication. I will pray that you find some relief and that your family have a better understanding of what you are going through.

God Bless
Julie

 
Old 10-07-2010, 12:10 PM   #8
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Re: L4-L5, L5-S1 back pain

Though you aren't in pain, the fact is that the nerves are being impinged on and eventually will cause permanent damage. It sounds to me that you have tried just about everything you can, but still have the pain.

Perhaps it is time to rethink your surgical option. Get at least 2 opinions from orthopedic spine specialists and/or neurosurgeons....or one of each.

You are lucky at this point not to be having nerve pain. It's the WORST and hardest to control. I think eveyone here would agree with that....and no one wants it to be a permanent part of their lives if they can help it.

Good luck with whatever you decide; I hope you will let us know.

Carol

 
Old 10-07-2010, 01:01 PM   #9
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Re: L4-L5, L5-S1 back pain

Thanks Carol for the advice I will seek a second Doctor to see what they have to say. I will post when I find out!

Julie

 
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