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PetePJ 03-30-2019 10:25 PM

Unbearable leg pain - from Spinal Issues.
 
Hello again all. I'm sorry to start another thread but the topic on this is very different.

I'm nearly 75, and I have a pretty much shot spinal column. I've recently had a lumbar rhizotomy, and I have to say that its minimising the pain in general. A continuing problem though is lower leg pain, which spreads from my feet, up to my knees, and beyond. The downside to this is that I cant walk or stand very well without the pain coming on. It gets worse and worse, and if I try to ignore it and tough it out, the pain is so bad that I have to eventually just go to bed. Once I get to sleep, the pain diminishes, and when I wake in the morning after eight hours sleep, the pain is gone; theres something about lying horizontally through the night and taking total weight off my legs that relieves the problem - whatever that is!

I've seen a neurologist, who conducted EMG tests on my lower legs. His findings were consistant with: sensorimotor axonal polyneuropathy affecting the lower extremities. Also a chronic right S1 radiculopathy.

I've also had the Brachial blood pressure test carried out on my legs, which showed there was nothing wrong with my circulation.

I've had a lumbar MRI which was the horror story I expected, but there is considerable foraminal narrowing which I'm told could be the problem in part.

So at the moment I'm totally confused as to what the awful symptoms I get might be. I get the burning tingling in both legs and feet equally, and it progresses right up my legs to my rear end and beyond! It just pounds away, and that's when I'm sitting down, like now! I should say that I did drink heavily until two years ago, and did have chronic kidney desease Stage 3. Miraculously the kidney reading has improved, and I'm outside of the disease catagory. I suspect some peripheral damage is done though and former heavy drinking is a probable factor regarding the neuropathy.

So thats it: As I type, these symptoms are pulsating away in a fashion that just doesn't altogether tie in with neuropathy symptoms. I'm not reading of people getting these all encompassing symptoms that I'm getting, throbbing and pulsating away deep in my flesh!

Any thoughts or suggestions on what my problem might be? I understand any response is only somebody trying to help, and nobody would have a solution. I'm just trying to figure out which specialist I should see next!

Many thanks: Pete. (Boy, I'm sorry I went on forever there!)

Titchou 03-31-2019 04:59 AM

Re: Unbearable leg pain - from Spinal Issues.
 
You make no mention of physical therapy. Is there some reason why no doctor has sent you?

PetePJ 03-31-2019 09:54 AM

Re: Unbearable leg pain - from Spinal Issues.
 
Physiotherapy (and topical cream) was suggested by the neurologist following the EMG diagnosis on my legs. I felt I needed something more agressive than that with what I'm going through now. Do you think that might help?

Titchou 03-31-2019 10:50 AM

Re: Unbearable leg pain - from Spinal Issues.
 
WEll,the only thing more agressive is surgery so I would certainly give PT a try. I am doing it for sciatica from 3 flattened and bulging discs along with foraminal narrowing from 30 years of jogging. Since your mattress seems to alleviate the pain, PT could reduce the pressure as well. It's working well for me.

PetePJ 03-31-2019 11:26 AM

Re: Unbearable leg pain - from Spinal Issues.
 
As you rightly say, the mattress does almost totally relieve pain. One of my biggest concerns is that I have some other more serious ussue running in tandum with the pain. It seems incomprehensable that everything I go through with the symptoms pounding away can just be a form of neuropathy; Its absolutely debilitating. I didnt know extreme symptoms could be so severe that I can feel my heart beating throughout my body when I go to bed. do you feel all of my symptoms are nothing more than I've described. I'm concerned about something underlying.

Titchou 03-31-2019 12:35 PM

Re: Unbearable leg pain - from Spinal Issues.
 
Well, I'm not a doctor but I was totally surprised at how much the PT has relieved my pain. ..just the little bit of movement from the pelvis has taken the pressure off that nerve. I thought I had torn my piriformis! And once I saw the x rays and the MRI, it was obvious the cause. The next option would be a spinal. I'm not opposed but would rather avoid. And I absolutely do not want surgery as it is pretty complex and the recovery, I am told, is pretty brutal. PT might make it liveable! I'd give it a try...it's far easier than other options.

PetePJ 03-31-2019 01:09 PM

Re: Unbearable leg pain - from Spinal Issues.
 
Could I just ask which PT exercises you do that help you? Are they a certain type of exercises best for the lumbar spine; and do you go to a therapist for individual care, or a place where there are many people being treated simultaniously?

Titchou 03-31-2019 03:38 PM

Re: Unbearable leg pain - from Spinal Issues.
 
they do an eval when you get there and then set exercises for you to do at home. They will do many of the same ones there and others. They can also use local ultrasound on you that helps relieve inflammation. At the end of the session they usually use a TENS machine and a hot pack (sometimes a cold one) for about 15 minutes. You could have a different therapist each time or you can just book with the one of your choice. I go to a PT place and they may have anywhere from 3-6 patients at a time but you get your own therapist for the session. Hope this makes sense. At any rate, it isn't a class with everyone doing the same thing. It's all individualized for your condition.

PetePJ 03-31-2019 04:33 PM

Re: Unbearable leg pain - from Spinal Issues.
 
Thank you very much, I'll give that a go.

teteri66 04-01-2019 10:39 AM

Re: Unbearable leg pain - from Spinal Issues.
 
I have had four lumbar surgeries and am fused from L3 to S1. I have neuropathy in both feet...which may or may not be the result of my spinal issues...depends on which of my specialists is opining on the topic! I consider myself an expert in sciatic pain and all related issues!

Generally speaking, if one has pain /numbness/tingling in both legs, there is stenosis in the central canal. If the pain is more one sided, it can more likely be attributed to a left or right sided issue like herniated disc, facet arthropathy, foraminal stenosis, etc.

Your report of the chronic S1 radicolopathy would indicate that something is causing the S1 nerve root to be compressed...and, apparently, when you are out from under the weight of gravity (ie., sleeping in a reclining position), that compression is relieved. This is fairly common with a stenosis ... pain is worse when gravity is pushing down on the spinal column. Often pain is reduced by lying down, or leaning forward, as when leaning on a grocery cart, etc. The longer you are on your feet, the greater the nerve is being squished, oxygen and blood supply cut off, etc. causing the pain level to increase. There is nothing you can do but try to find a position that takes the pressure off the nerve a bit.

Because the spinal nerves form the basis of the nerve system in the body, a compression of a spinal nerve root can cause pain to radiate down the path of the particular nerve. This path is called a dermatome. You can look online for a ďdermatome map.Ē This will show you which area of the body is innervated by which spinal nerve. (You can check out the S1 dermatome, for example).

Depending on what else may be causing your issues, a surgery to decompress the nerve often provides quite a bit of relief...and, as spine surgeries go, isnít too bad to recover from. Of course, NO spine surgery is without the risk of complication...and one surgery often leads to more down the road. I personally do not know anyone who has had just one spine surgery!

From what you have described, your neuropathy may have been induced by alcohol but the neurologistís report of a S1 radicolopathy indicates there is nerve compression in the lumbar spine that could also cause the pain that radiates down through the buttocks, down the legs and into the feet, causing numbness and tingling.

Has it been suggested you see a spine surgeon for an accurate diagnosis and plan of treatment? If not, you might want to consider it!

Physical therapy might or might not help alleviate the symptoms. It really depends on the extent of the nerve compression!

PetePJ 04-01-2019 11:52 AM

Re: Unbearable leg pain - from Spinal Issues.
 
Thank you so much for that detailed reply. I should point out that the pain/tingling I get seems to start in my feet and progress from there upwards past my knees, and if I sit long enough on a chair thats too hard, I can feel the pain into my buttocks and beyond. The rhizotomy helped considerably for back pain but did nothing for my legs. The pain management doctor tried nerve blocks in lumbar spine but that didnt help. He has suggested that I have radiculopathy causing pain to come upwards from my feet, but he doesnt really know. He only just saw the neurologists report which bears out his theory, but he hasn't responded thus far about those comments. I'm wondering if the report might suggest a different area for him to try steroid injections? I actually saw a spine surgeon a year ago, and he went over the findings of my MRI with me. The indications are that it appears I have two/three problems he could try to fix, but he wouldn't want to pick the wrong one! I therefore ended up back with the pain management doctor who sent me to him! And I believe he's baffled. In fairness, my spine generally appears to be a mess. I just wish by some means the source of the pain in my legs when standing could be verified. Wearing a rigid Vista Back Brace helped me stand and walk tremendously yesterday, not the sort of thing I'd want to wear all the time, unless I could find a lighter weight one!

teteri66 04-01-2019 07:02 PM

Re: Unbearable leg pain - from Spinal Issues.
 
If you have S1 radicolopathy it would be unusual if it does not originate in your spine. Everything you describe...with the legs bothering you after standing and having it get more painful the longer you stand, feeling better wearing the brace, etc. is very typical of a central canal stenosis.

I suppose I could describe my neuropathy the same way...my feet are numb, ankles less numb and a bit of numbness going up toward knees...so I suppose your neuropathy could be separate from the lumbar spine issues. I donít believe it would be affected by a nerve block.

PetePJ 04-01-2019 08:05 PM

Re: Unbearable leg pain - from Spinal Issues.
 
Quite apart from the S1 radiculopathy put forward by the neurologist, I notice "A sensorimotor axonal polyneuropathy affecting the lower extremities". I've Googled polyneuropathy somewhat, and I'm wondering if that is the primary problem, quite apart from the others? The symptoms are uncannilly close to what I'm going through. I see my GP tomorrow afternoon, to see where he wants to send me next! Have you had any dealings with that my friend?

Titchou 04-02-2019 03:59 AM

Re: Unbearable leg pain - from Spinal Issues.
 
If the back brace gives you that much relief, then PT should help also. PT is essentially exercises that help to get your joint/back/etc in the proper position to relieve the pain. I had one hip higher than the other and they continue to work on getting it to stay level. We also do exercises which stretch out the vertebrae so that the discs are not as compressed and therefore not impacting the sciatic nerve. Repetition of the excerises over time cause the separation to be maintained.

teteri66 04-02-2019 07:55 AM

Re: Unbearable leg pain - from Spinal Issues.
 
In a way, I suspect you are dealing with two separate issues that have symptoms that overlap...well, the spine problems may be responsible for some of the leg and foot symptomology. The neuropathy is affecting the lower extremeties.

I am suspecting (of course, as a non medically trained layman) you have lumbar spinal stenosis which means that there is something that is causing the central spinal canal to become more narrow than normal. This puts pressure on the cauda equina, which is the bundle of nerves that wrap together and continue on from where the spinal cord terminates at about the L1 level in most people. If the pressure is severe, it can keep spinal fluid from flowing freely and can cut off blood supply and nutrients to the nerves which results in pain, tingling and numbness, or in severe cases, paralysis or loss of ability to move legs entirely. Typical symptoms include a feeling of heaviness in legs, pain when standing, walking, etc. It can also cause tingling, numbness in lower extremities.

In a way it doesnít matter too much whether your foot pain is neuropathy unrelated to spinal issues or caused by the spinal issues. Either way, you have nerve damage that is most likely irreversible! And, since it pertains to the nerves, without a Crystal ball, you wonít be able to know for certain exactly what is causing it and whether it might get better or worse! Doctors still have lots to learn about the nervous system! A ďsensorimotor axonal polyneuropathyĒ is not what is making it painful to walk and bear weight, pain that is relieved by sleeping and by wearing a back brace. I think those symptoms are most likely originating in the spine from nerve compression of a spinal nerve root or of the central canal.

I suggest you ask your GP about a course of physical therapy. You very well might benefit from it!

PetePJ 04-03-2019 10:33 AM

Re: Unbearable leg pain - from Spinal Issues.
 
So, I spent considerable time with my GP yesterday. He is of the opinion that the S1 radiculopathy is the main problem re: my back issues. I mentioned my concerns about the sensorimotor axonal polyneuropathy discovered by the neurologist, and he said he didnt think that was much of a factor with my problems - and that wouldn't be anything "sinister". My lumbar spine in general is a mess, with general foraminal narrowing and arthritis, so I'm sure that that needs attention. However having read up somewhat on what S.A.P. is all about, I'm not over the moon that something like that is put on the back burner, but I see the neurologist again in two weeks so will ask him of his opinion of how much of a factor that is; I'm certainly not happy to leave that unaddressed with no proper explanation. Meanwhile my GP really thinks I should go in for surgery on this S1 thing, and if thats whats causing my issues, he's probably right! At nearly 75 though, I'm really not up for that if I can help it.

teteri66 04-03-2019 11:25 AM

Re: Unbearable leg pain - from Spinal Issues.
 
Sounds right to me! (based on the little I know about your situation). There is no urgency to learning more about the neuropathy because it will make little to no difference...but I donít know what you mean by ď sinister.Ē

There are very few neuropathies that are caused by something that can be addressed or reversed after the fact. Once you have it, there is no way to stop its progress...or, to predict IF it will continue to progress. Iím pretty sure mine has been gradually moving up out of my foot and ankle as the years go by. Without seeing my neurologistís records, I donít know for sure, but it certainly feels lik3 I am getting more numb and it is creeping up my calf.

Before you can contemplate surgery and decide if it is worth it to you, you need to know specifically what needs to be done! If you could get by with a decompression at one level, recovery would be much, much easier than if you need a fusion in addition to the decompression.

Canít remember if you have had a recent MRI? Did the GP suggest you make an appointment with an orthopedic spine or neuro surgeon?
Those specialists will provide you with the most accurate diagnosis and plan for treatment. Some (but, alas, not all) surgeons are very conservative and will only suggest surgery if it is truly the best option. They will usually recommend all conservative treatments first...such as physical therapy, a series of epidural steroid injections, etc. You do not have spine surgery for pain relief but to stabilize an unstable spinal segment and for nerve compression.

PetePJ 04-03-2019 01:34 PM

Re: Unbearable leg pain - from Spinal Issues.
 
Thank you for your response. I have no idea what my GP meant by "sinister" either, but that was what he said; Maybe he felt I would worry too much if he didnt beef his statement up a bit! I go back to the neurologist in two weeks so I'll ask him for further clarification. All that was suggested when I went to him previously though was Topical Cream and physiotherapy, so other than the ability for it to progress, he cant be too concerned! What I do know though is that my widespread symptoms have spread alarmingly in a very short space of time. As I sit typing on a padded chair, the tingling buzzing sensations are pulsating through the backs of my legs into my rear end! My entire legs back and front are engulfed in this issue.

Re: An MRI, yes I had one about 10 days ago, but I have to find another spine surgeon since the existing one doesnt take my insurance any longer; quite a process finding one!

By the decompression at one level, you still meant surgery I imagine?

teteri66 04-18-2019 06:20 PM

Re: Unbearable leg pain - from Spinal Issues.
 
Whatís going on now? Have you learned anything further?

My neuropathy changes all the time. About two months ago, it was scaring me as I felt like it was changing so quickly. Now it is back to being the way it was. But my feet feel a little different almost every day...some days much worse than others....

PetePJ 07-02-2019 04:22 PM

Re: Unbearable leg pain - from Spinal Issues.
 
Okay, firstly my sincere apologies for taking so long to get back to you; unavoidable but none the less I didn't mean to appear rude.

So...I've made quite a lot of progress regarding the various back pain issues. My pain management doc seems to have got his recent epidurals spot on for me, and they're coping with the general back pain issues very well.

Not so good on the lower leg issues though; All of the specialists have differing opinions about what is causing my problems, and none of them agree with each other. My GP is of the opinion that my multiple lumbar issues are the culprit, although the neurosurgeon (who was in far too much of a hurry with me) doesn't agree. He says that I wouldn't get the type of problems I have simultaneously in both legs at the same time if it were lumbar issues. My GP however thinks that with the nerves on both sides of my lumbar spine being so totally choked up, thats entirely possible?

What I do know is that of late, my lower legs go steadily numb and tingly when I sit on a hard chair for a long period. When that sets in, it doesn't subside all that quickly even if I stand up or move around. It seems to get steadily worse until I go to bed. Its always ALL cleared up in the morning, and walking or standing doesn't seem to bring it on; just sitting for a long period at my computer seems to be the trigger. I dont get cold feet to go with this, but I guess that doesn't necessarily rule out a circulation issue? (my blood flow has been checked properly and is apparently OK?) About all I do in a day is sit at my computer, until of late the dreaded symptoms drive me off! Any thoughts?


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