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  • Severe lower back pain. Need advice.

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    Old 06-12-2011, 02:08 PM   #1
    earthmommy
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    Severe lower back pain. Need advice.

    Hi all. I have read some very good advice here about back pain and what to do about it. I have had it for years, sometimes had to take percocet but it has worsened and for the last three months, I have taken 10/325 percocet 4 times a day, and have had another MRI. My mother and sister have had back surgery for congenital DDD, herniated discs, and spondylosis (or something like spondy...). I will post my lumbar MRI results. I am currently in pelvic traction for this but still need percocet and my daily activities are limited by the pain. I have two young girls so I do need to lift sometimes. My cervical spine hurts a lot too but I have not gotten that MRI.

    MRI for lumbar spine
    IMPRESSION
    1. There are diffuse degenerative endplate changes throughout the lumbar spine with osteophyte formations and posterior bony spurring with multilevel degenerative disc disease and mild degenerative facet hypertrophy in the lower lumbar spine with a slight lumbar levoscoliosis.

    2. At L4-L5, there is a diffuse disc bulge with degenerative facet hyupertrophy causing mild neural foraminal stenosis.

    3. At L5-S1, there is broad-based central disc protrusion with an annular fissure and mild facet hypertrophy causing mild left neural foraminal stenosis and slight narrowing of the right neural foramen.

    4. There is suggestion of transitional anatomy at the lumbosacral junction with partial lumbarization of the S1 vertebral body. Prior to any lumbar intervention, additional spine imaging is suggested to confirm proper numbering of the lumbar vertebral bodies related to transitional anatomy.

    The report part also lists miild dissc desiccation, a disc osteophyte complex measuring 2.5 mm with minimal impression on the anterior thecal sac.

    I saw my doc after this and he told me to go to PT and that a surgeon cannot help me. I know this to be bs because my mom and sis had surgeries for lesser problems( well i guess they don't feel much better though). Since I wanted to avoid surgery, i did not argue but...PAIN. Also he did not send me for additional tests even though the interpreting radiologist said it was necessary. Also, he has not sent me for an MRI of the cervical spine and neck which are genetically problematic and I was in a car accident making it worse.

    Should I see a surgeon? Ortho or Neuro? Should I go to a Pain Management doctor since my PCP's office staff sucks at getting anything done. I wanted to try Nucynta, and they still haven't appealed the insurance so I can try it. I really don't want to be on Percocet, especially taking care of kids.

    My symptoms are severe lower left back pain that runs down my leg. Cramping and pain in left booty Pain between my shoulder blade and lower left side of the neck exacerbated by lifting. I can not sit straight for more than a few minutes, and standing is also painful. Walking and lying on a soft cushion on my back make me feel temporarily better. I use a recliner to sit but still start cramping up a bit, but way better than an upright chair. Lifting the kids, the strollers, the toy bins etc make pain worse. I wake up in the middle of the night to take pain meds, and also frequently take a bath so I can go back to sleep. My daily functioning is limited. I am very athletic and vivacious and want to get back to many things I can't do. I have tingling in my left arm as well as numbness in my left arm and left. The right side feels better but is not totally free of pain. I get severe headaches in the back of my head/neck. Yikes this is getting long.

    Please any advice on how to proceed from here would be greatly appreciated. Thank you in advance for your time and help.

    Laura

    Last edited by earthmommy; 06-12-2011 at 09:23 PM.

     
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    Old 06-12-2011, 10:26 PM   #2
    lilac100
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    Re: Severe lower back pain. Need advice.

    I would definately see a spine specialist. I used ortho but as long as all they do is spine it doesn't matter. My ortho sent me to a PM doctor so perhaps have them refer you to one. Just a thought but are you young? A lot of doctors dismiss younger people based on age. It's wrong but they do. Get more then one opinion. Maybe an Ortho and a Neuro. Make sure to get a copy of the MRI in disc form if you can. I hope you find someone to help you. Do you trust your mother's surgeon? Maybe go to him for an opinion.

     
    Old 06-13-2011, 10:01 AM   #3
    earthmommy
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    Re: Severe lower back pain. Need advice.

    Thanks Lilac.

    I am thirty four and very athletic. My mom lives across the country. I am going to call my doctors office for a referral to an orthopedic surgeon, and then I will ask for a pm doc. Thanks!

     
    Old 06-26-2011, 12:31 AM   #4
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    Re: Severe lower back pain. Need advice.

    Hi Laura, our reports sounds almost exactly the same. I have had this pain for about 11 years. I have a 5 and 6 year old. I really feel I got the most answers when I went to a neurosurgeon who ordered a CT of the lumbosacral area and saw that this lumbarized area was basically bone rubbing on bone (without a disc present). They did a diagnostic block with just numbing medication and it gave me relief of relentless back/SI/buttock/leg pain for many hours. The CT shows much better bone anatomy than an MRI so it helped them inject in the right place as the "joint" was in a very abnormal location and had a very abnormal appearance. (Previous injections has failed) The next route I hope I can take is radiofrequency abalation of the sensory nerves to the area. It is not permanent but better than surgery in my eyes at this point. I will know more next Thursday. Hope this helps.

     
    Old 06-26-2011, 09:10 AM   #5
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    Re: Severe lower back pain. Need advice.

    I'm sorry I didn't see your post sooner. I hope you are still checking in to read comments.

    I suggest you get a cervical MRI or CT scan before trying to proceed with pain management or any form of treatment. Leg pain can also be caused by issues with the cervical discs, and since you mention pain in your shoulders and arms and severe headaches. Given your family history, and what you mention in your lumbar MRI, I imagine there is a very good chance that you are also having degenerative changes in your cervical spine.

    In some parts of the country, orthopedic spine surgeons are not as prevalent as neurosurgeons, so take some time looking online to see who is available and what their training is before asking for a referal. Particularly now, PCPs tend to refer to specialists within their own "umbrella" group, who may or may not be the best specialist available to you...so I suggest you do some research on your own first. Most doctors have some sort of website these days, or you can go to one of the groups that rates doctors to see their educational background, training, etc.

    Look for a fellowship-trained spine surgeon, an ortho or neuro surgeon who devotes his/her practice to issues of the neck and back. You don't want an ortho who also does joint replacements, or a neuro who prefers to operate on the brain!!

    Your PCP does not really have the specialized knowledge to order additional testing. What you're referring to in the MRI, [B]Prior to any lumbar intervention, additional spine imaging is suggested to confirm proper numbering of the lumbar vertebral bodies related to transitional anatomy.[/B]
    just is putting into the record that this radiologist who wrote the report noticed that you have an extra vertebra. He is stating that if you have any procedures in the future, when a technician or doctor is sizing up your spine to determine where to insert the needle, or make the incision, they should run a quick x-ray first to determine how many vertebrae you actually have and use that as the reference point...rather than assuming you have 5 lumbar vertebrae, resulting in using the wrong location for the procedure.

    Given your family history and the results of your MRI, it looks to me like the sacrilization of the S1 vertebra may not really have much to do with your pain. At least, I would not assume it is the major pain generator. Many people have this "condition" and are not aware of it as it is asymptomatic.

    Your PCP is correct in that a lot of your MRI discuses issues that pertain to degenerative processes that fall under the umbrella description of "degenerative disc disease," for which surgery is not recommended. However, there may be other things going on that might eventually require surgery. Given your history, I think it would be a good idea to take your MRI to a spine specialist for a consultation. You may not need his/her expertise yet, but unfortunately, it looks like you will at some point in the future.

    They may want to do an flexion/extension X-ray to check you for spondylolisthesis, and as mentioned earlier, I think you should also get a cervical study done to either rule that area in or out.

    Hope you have received a referral by now and will come back and let us know how things are going.

     
    Old 06-26-2011, 12:48 PM   #6
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    Re: Severe lower back pain. Need advice.

    Thanks for the information. My doc is referring me to a pain management doctor to get steroid injections. Is this what you are referring to? Hopefully, they will do further testing, like a CAT Scan, and some testing on my painful cervical spine. What is nerve abalation? Please do keep me informed on your progress.

    Thanks again,
    Laura

    Last edited by earthmommy; 06-26-2011 at 12:49 PM.

     
    Old 06-26-2011, 03:57 PM   #7
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    Re: Severe lower back pain. Need advice.

    You can go that route, but I think you'd be better off first going to a spine specialist (neuro or ortho spine surgeon) who has the training and experience to read your MRI accurately, perform a short neurological exam, and take an oral history to arrive at an accurate diagnosis. By starting with pain management, you may be treating the pain, but you don't really know what you are treating, whether it is likely to improve or get worse on its own, etc.

    PMS are more than happy to keep injecting steroids into your spine, if it makes you more comfortable, even for a day or two....the problem is you are just treating the symptoms and not addressing the issue that is causing the pain.

    It may be that you could accomplish this through physio and not need medication, if you knew what you were dealing with.

     
    Old 06-26-2011, 04:10 PM   #8
    earthmommy
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    Re: Severe lower back pain. Need advice.

    Oh thanks for answering many questions I had but didn't specifically ask. I begged my PCP to send me to a Spine Specialist Ortho and he said the next step is PM. I was horrified because I want to get off of pain meds, but he claimed that they are the ones who will order further testing to confirm a diagnosis. I don't really believe it but it would be progress, even if it is the way to go to get to an ortho or neuro.

    You have really helped me understand some things that confused me. You are exactly right about who I should see and I am trying....insurance. Hopefully I will get there. I appreciate everything you said and your knowledge on the subject.

    Thanks!
    Laura

     
    Old 06-26-2011, 08:39 PM   #9
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    Re: Severe lower back pain. Need advice.

    I would check with your insurance carrier to see if you have to do things that way. It sounds like some rule that has been set up within a practicing group of doctors, rather than a requirement of an outside source.

    My insurance didn't require referrals, and I think out of all the specialists I consulted with, and altogether it was probably around twenty, only two required a referral. I know different areas do things differently, but it might be worth at least checking into.

    I'm happy to try to answer any of your questions.

     
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    annular tear, back pain, bulging disc, degenerative disc disease, hip and butt pain, lower back pain, stenosis, surgery



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