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Old 03-09-2012, 02:06 AM   #1
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Chronic sciatica is now Acute

I have had chronic sciatica for 6-7 years. It has been well controlled with Ultram ER or Tramadol ER for a majority of the time. Prior to going on oral meds, my pain management doc tried something like 6-7 epidurals over a 2 year period. Only one of them worked like it should.

With the oral meds, I would have occasional acute flareups which would be controlled by adding something like Celebrex or Lyrica to the tramadol for a couple of weeks. Starting early of 7/11, I had an acute exacerbation of my back pain that is still not under control. I'm worn out & at the end of my rope. I had an MRI done in early Aug. of last year. The MRI showed several areas of facet joint arthritis, & a large amount of spinal stenosis in my lumbar spine. There is nothing major like a bulging disc that the docs can point their finger at & go, "AHA, that's the problem." Over the past 8 months, I have been put on Norco 325/5 for breakthrough pain, along with continuing the tramadol ER. Breakthrough pain is almost a laughable term now as the pain is nearly constant. We have tried Lyrica, reaching a maximum dose of 3, 75 mg. capsules a day which did nothing. Cymbalta did nothing. I had 6 weeks of physical therapy Nov.-Dec. which was moderately helpful, but the response was not as good as they therapists wanted to see. I'm now on gabapentin. We are slowly moving up the dose to a maximum of 6 pills daily. I'm now at 5 pills daily with no improvement. I go to 6 pills on Saturday, & I'm very pessimistic about 6 doing anything. I had 2 epidurals last summer which failed. I had the diagnostic injection to see if the facet joint arthritis was the problem. It was inconclusive.

I was sent to a neurologist on Monday of this week. After doing a physical exam, & reviewing last summer's MRI, his comments were that there is a lot of arthritis & generalized damage in my lumbar spine, but nothing we can point a finger at. He did say that from my description of the pain, it sounds like the problem is in the area of L4. He wants to do electromyography testing using my left leg at the end of the month, in the hope that we can track the problem doing this procedure. Even if they locate the problem with this testing, my thought is that my next stop is going to be a surgeon. I guess, if this testing finds the problem, at least a surgeon will be pointed in the right direction.

I feel like I've been through HE!!, with no hope of return. If anyone can offer any ideas or suggestions, it would be greatly appreciated. Does anyone have any experience with the electromyography testings & what was the outcome?

Thanks for reading such a lengthy post. I just wanted to make sure you had my history.

Debbie

 
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Old 03-10-2012, 07:05 PM   #2
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Re: Chronic sciatica is now Acute

How did they do the diagnostic injections on the facet joints? Was it single level or multi-level? Bilateral? What did they use? How long did you have relief if any? I have had diagnostic injections on my facet joints, and they did two levels bilateral. The doc just used lidocane, which gave me at least 6 hours of relief. We did two of these, as there can be false positives sometimes, with the same results both times.

I have never been though the testing they are planning for you.

What and where are your symptoms? From what I have read and learned, facet joint issues mimic herniated discs for symptoms. I can say that it fits in my case, since my husband herniated two discs in his lower back years ago.

The current treatment of my facet joint problems has been RF Ablation, during which they burn out pain sensor nerve endings. This does not work for all people, nor does it always work as well as it did for me. I can have this repeated in the future if needed. The doc told me that eventually it would no longer work, but by then, maybe they well have some better permanent treatments. One can wish!

 
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Old 03-10-2012, 07:52 PM   #3
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Re: Chronic sciatica is now Acute

If the epidurals were performed without knowing what was generating the pain, then it is not surprising that they were not successful. The EMG is not fun, but it will help to pinpoint where the nerves are being irritated. This may lead to a more precise positioning of the epidurals, which may well be more successful. (During my EMG, the doctor kept telling me to relax my muscles, and I kept telling her that I was.)

 
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Old 03-10-2012, 08:56 PM   #4
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Re: Chronic sciatica is now Acute

Do you not have a spine specialist that is managing your case? An ortho spine surgeon or neurosurgeon whose practice is limited to the neck and back would be able to look at your MRI and determine the best way to handle your sciatic pain. A neurologist would not be the doctor to get the most accurate diagnosis or plan of treatment from.

The EMG and Nerve Conduction Study is a subjective test.

Both tests are tolerable for most people but I have never been able to decide which one I liked least. I was happy for it to conclude...and don't like to have to repeat either of them.

The EMG is an indication of nerve damage. It will tell you which nerve, if any, may have permanent nerve damage, whether there is chronic or acute radiculopathy , etc. If the sciatic pain is caused by stenosis , this is something that is quite easy to pick up off a MRI. If it is being caused by central canal or foraminal stenosis it is difficult to affect the pain without having surgery.

Last edited by Administrator; 03-12-2012 at 11:53 PM.

 
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Old 03-11-2012, 01:40 AM   #5
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Re: Chronic sciatica is now Acute

I have not seen a spinal specialist as of yet. I have been pushing my pain management doc to see a neurosurgeon since Dec., but keep getting told that we are not there, yet. IMO, if the EMG locates the problem, I think I'm still going to end up at a neurosurgeon because my pain management doc is hinting that he has done all he can do.

When it comes to the facet joint problem, the injections were done at multiple levels with lidocaine. I was all happy as I got about 75% reduction in pain that day for about 6 hours. When I went back in for the follow-up, the pain doc said that 75% was not enough. If it was the facet joints, the injection should have given me 100% relief. The plan was to do the ablation if the diagnostic injection had worked.

I, now, have been limping for so long, & over compensating on my right side for the left side issues that my right knee is starting to bother me. I'm seriously considering making an appointment with a neurosurgeon, & at least going in for a consult. After nearly 9 months of this, I am worn out.

Thanks for the replies.

Last edited by stardeb55; 03-11-2012 at 01:46 AM.

 
Old 03-11-2012, 07:03 AM   #6
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Re: Chronic sciatica is now Acute

[QUOTE=stardeb55;4942557]I have not seen a spinal specialist as of yet. I have been pushing my pain management doc to see a neurosurgeon since Dec., but keep getting told that we are not there, yet. IMO, if the EMG locates the problem, I think I'm still going to end up at a neurosurgeon because my pain management doc is hinting that he has done all he can do.

When it comes to the facet joint problem, the injections were done at multiple levels with lidocaine. I was all happy as I got about 75% reduction in pain that day for about 6 hours. When I went back in for the follow-up, the pain doc said that 75% was not enough. If it was the facet joints, the injection should have given me 100% relief. The plan was to do the ablation if the diagnostic injection had worked.

I, now, have been limping for so long, & over compensating on my right side for the left side issues that my right knee is starting to bother me. I'm seriously considering making an appointment with a neurosurgeon, & at least going in for a consult. After nearly 9 months of this, I am worn out.

Thanks for the replies.[/QUOTE]

Even my pain management doc was happy with at least 80% on my facet joint injections. He didn't expect 100% from them, even though the first one, that's what we got. Did he do one or two of the diagnostic injections? Two is kind of a standard as the first one can either be false positive or the second one can show more conclusive. That's what my pain management doc told me.

Keep pushing to get to the docs that you need to see. It's your body and your pain, which you shouldn't have to live with if there are things that can be done. I would consider a orthopedist or neurosurgeon that specializes in the spine as tetonteri suggested. The spine is such a complex structure as I have been learning over the last 6 years, that you really need someone who's focus has been on the spine.

 
Old 03-11-2012, 02:46 PM   #7
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Re: Chronic sciatica is now Acute

I live in the metropolitan Phoenix, Az. area. Barrow's Neurological Institue is here in town. Barrow's is one of the of the foremost neurological clinics in the country so I am very lucky. They have a neurosurgical office with 4 neurosurgeons across the street from my hospital in Scottsdale, so that's where I will be going. I had a really bad week this past week, nothing was working to even tone my pain levels down. I called the pain management doc on Fri. telling them that I was in bad shape, & could anything be done to at least get my pain knocked down to 5-6 where I'm at least funcitonal, instead of the 8-9 that it's been running all week. The answer was no, he has to see you in the office. I'm going this Thurs. morning, & have pretty much decided that I'm going to tell him I'm worn out, my patience is at an end to try to find an answer to this, etc. I will tell him that I will do the EMG testing at the end of the month, but I intend to make an appointment with one of the neurosurgeons ASAP.

I have misplaced my copy of last summer's MRI report, will get a new copy tomorrow & post the specifics for everyone's input.

Thanks,
Debbie

 
Old 03-13-2012, 06:26 AM   #8
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Re: Chronic sciatica is now Acute

hi,i have been off work for 8 months now,i twisted my leg at work,and all went down from then,i had terrible pain in leg and back,put on tramadol and paracetamols,did absolutly nothing for me,after 6 months wait, had an MRI scan, which found degeneration on the lumber of spine,,,,told nothing they can do,,,not happy this pain is literally excrusiating,now on morphine patches 10mg, not much better even with that ,only good thing is with this patch and amitriptyline i am now sleeping, also have been on patches 3 weeks now and find im not that hungry , have lost 11lb,,which is good as i have another 2 stone to lose,,,i do apologise for my spelling lol,,,,

 
Old 03-15-2012, 04:35 PM   #9
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Re: Chronic sciatica is now Acute

I finally have a copy of my MRI from early Aug. 2011, about a month after this all started. My whole lumbar area seems to be a jumbled up mess, so here we go:

T12-L1: concentric disc bulge with small posterior central annular tear. Mild to moderate bilateral facet joint arthrosis. Ligamentum flavum buckling. Mild central canal stenosis & mild, bilateral neural fomaminal stenosis.

L2-L3: There is a concentric disc bulge present present without evidence of a discrete annular tear. Mod. bilateral facet joint arthrosis with ligamentum flavum buckling resulting mod. central canal stenosis. No appreciable neural foraminal stenosis.

L3-L4: There is a concentric disc bulge present. Marked right & mild left facet joint arthrosis. Ligamentu flavum buckling. Small right paracentral annular tear & protrusion positioned to affect the exiting right L3 nerve root. There is a mild amount of right perifacet edema, presumably reactive. Mild central canal stenosis. Left neural formen is mildly narrowed.

L4-L5: There is a concentric disc bulge present with a grade I (2 mm) anterolisthesis of L4 on L5. Marked bilateral facet joint arthrosis is present, more pronounced on the right, with right perifacet edema. No annular tear identified. Mild central canal stenosis. Mod. right neural foraminal stenosis.

L5-S1L Dis desiccation with concentric disc bulge. Marked right & mod. left facet joint arthrosis. No annular tear. No perifacet edema. No central canal stenosis. Marked right & mod. left neural foraminal stenosis.

Radiologist interpretation:

1) Small incompletely characterized distal syringohydromyelia. comparison to prior imaging would be useful if available.

2) Multilevel degenerative disc disease changes as described above with central canal stenosis, most pronounced at L2-L3 & L3-L4.

3) Multilevel neural foraminal stenosis as descrived above.

4) Multilevel marked facet joint arthrosis with presumably reactive perifacet edema, most pronounced at L4-5 bilaterally.

I have had a horrible 10 days. Saw the pain doc this morning & he is changing me to Nucynta ER & Nucynta 50mg. for breakthrough pain. We are stopping the Tramadol ER & Norco, along with the neurontin. The only thing the neurontin did, once I got up to 5-6 pills daily was make me loopy. I asked about setting up a neurosurgeon consult, again, today. For the first time, the pain doc agreed that this was a good idea, so I will get that scheduled in the morning. I will have to scheduled after the EMG as I want that info for the neurosurgeon.

Any input is welcome.

Thanks,
Debbie

 
Old 03-15-2012, 04:48 PM   #10
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Re: Chronic sciatica is now Acute

Do you have more pain on the right side?

I would suggest you also make an appointment with an orthopedic spine surgeon for a consultation.

Last edited by teteri66; 03-15-2012 at 04:49 PM.

 
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Old 03-15-2012, 05:37 PM   #11
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Re: Chronic sciatica is now Acute

On very rare occasions I have had right sided pain. This is what has caused the problem getting this pinned down as my pain has by far & away been on the left side, but the MRI shows a mostly right sided problem.

Debbie

Last edited by stardeb55; 03-15-2012 at 06:41 PM.

 
Old 03-15-2012, 07:16 PM   #12
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Re: Chronic sciatica is now Acute

The central canal stenosis can be tricky, as the pain can switch from side to side, and I suspect that imaging taken on different days could show more stenosis on one side or the other. You also have marked bilateral foraminal stenosis at L5-S1, so not terribly surprising that you would have pain on both sides of your body.

Another thing to note is that pain that moves around can be indicative of spinal instability, which in which your case shows up as a Grade I anterolisthesis. I suspect that Teri will have much more analysis forthcoming.

I also would recommend making an appt with an ortho spine surgeon, as you have been treated primarily by neurosurgeons. It would be good learn the contrasting approaches to your condition, by way of comparison.

 
Old 03-15-2012, 07:59 PM   #13
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Re: Chronic sciatica is now Acute

Perhaps my prior posts weren't clear, I have not seen a neurosurgeon. Treatment has been primarily my pain management specialist, until he sent me to a neurologist 2 weeks ago. The pain doc, prior to today, has always said we weren't there yet, when I questioned him about a neurosurgery consult.

Debbie

 
Old 03-15-2012, 08:07 PM   #14
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Re: Chronic sciatica is now Acute

I neglected one probably important section of the MRI. There was a comparison done to a previous MRI from 2006 which my pain doc had to fight to get the comparison done, that probably why I forgot. Anyway, here's the important part, I think.

"Previously noted prominence of the central canal of the distal thoracic cord has slightly increased since the prior examination. given the apparent increase, additional MR imaging of the thoracic cord is recommended to assess for more superior disease within the thoracic canal or cord with secondary central canal enlargement." I have not had a thoracic MRI as no one seems to have made a big deal out of the above. This is another reason that I think a neurosurgeon needs to take a look.

Debbie

 
Old 03-15-2012, 09:27 PM   #15
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Re: Chronic sciatica is now Acute

Or an orthopedic spine surgeon.

 
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