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Pain Management board


Because it has been so long since I've been on here, I wanted to put my MRI results and then explain briefly what my problem is:

MRI Results

The L1-L5 vertebral bodies are visualized in anatomic alignment without evidence of fracture or dislocation. The vertebral body heights and signal characteristics appear within normal limits. There is disk desiccation at the L4-5 level where there is an annular tear and small posterior disk protrusion. There is no significant spinal canal stenosis or neural foraminal narrowing at this or any of the other visualized levels.

The conus medullaris terminates at L1-2 level, which is within the normal limits.

Incidental note is made of a cystic structure in the left lateral pelvis which is likely the ovary.

Note that there is a transitional vertebra at the lumbosacral junction. It has an enlarged transverse process that appears to have an articulation with the underlying sacrum on the right.

Impression:

Degenerative disk disease at the L4-5 level with a small posterior disk protrusion and annular tear but not significant spinal canal stenosis or neural foraminal narrowing.

X-Ray Results

An AP and lateral view were obtained of the lumbar spine. There are five lumbar vertebrae. No compression or deformities are seen. The L5 vertebral segment has undergone partial sacralization. The transverse process of L5 on the right has hypertrophied and articulates with the superior aspect of the sacrum. The L5-S1 disk space is mildly narrowed. It is likely rudimentary. The rest of the discs have normal height. The pedicles and spinous processes appear to be intact. The sacroiliac joints are normal in appearance.

Impression:

1. Partial sacralization of the L5 segment.
2. The L5-S1 disk space is mildly narrowed and is believed to be rudimentary.
3. No fractures.

I have been undergoing pain for three years now (and I'm only 21 now) and didn't have a real memory of my "injury" because there was not anything significant that I could remember that would warrant such pain. I have been in the hospital for about two years and initially was taking motrin, naproxin and flexeril. That all too soon stopped working so I tried physical therapy for four months. That made my symptoms much worse. So, they put me on narcotics (which I'm still on them for what seems like too many months to be on Vicodin) and referred me to the pain management clinic. There, I received one ESI and that didn't do a thing for me so they didn't do another one. Meanwhile my physiatrist put me on oxycodone and methadone (separately of course) but those are drugs I will not be on ever again. The symptoms of the pills alone was too great.

After that, this year, I had a successful medial branch block. This gave the doctor the chance to perform a procedure called radiofrequency lesioning on me. I did this on April 15. I was pleased at how well the procedure went, there were no complications. The doctor told me that I was the best patient he ever had because it was real easy for him to get the needles in the right spots for him to lesion the nerves that feed to my facet joints thus cutting the pain receptor that tells my brain there's pain. I was sore immediately after but didn't seem to notice the underlying pain, the pain I've been dealing with for three years. The next day I actually felt pretty good. Then, out of the blue, I woke up on Sunday and my pain was back. I know the difference between muscular pain and my discogenic pain and it was clear to me that something just wasn't right. Ultimately, the procedure didn't work. I don't know why. That's why I'm writing. I mean, if I had a successful medial branch block, then how could the procedure not work? I think I may know why. If you have the medial branch block, they're injecting numbing stuff EVERYWHERE. So naturally it would get rid of my pain because it's even covering those nerves that the lesioning wouldn't be able to do. I mean, my legs were completely numb from the branch block because the numbing stuff went over my sciatic nerve. But with the radiofrequency nerve lesioning, they can't lesion the sciatic nerve because that would cause paralysis. So...that part makes sense to me I guess. I just feel so lost right now. The procedure DID narrow the scope of the pain however I think now it's making me focus on the root of the pain, my disc. I only have one bad disc but it's literally killing me. Ever since the procedure, my sciatica has been getting worse. It use to be on the left side but now it's primarily on my right leg. On bad days both legs hurt but nonetheless, everyday, I'm still dealing with the same level of pain. It gets worse EVERY DAY. On average from 1-10, my pain level is still a 6. That's what its average was and still is.

What do I do now? I'd like to get another MRI because the above one was a year ago and I think, well I hope, that maybe another MRI could show an updated extent of the damage. I wish they could give me a new disc entirely (it's my lumbar spine) but, it hasn't been done enough in California that I would even consider getting the ADR. I wish I could get that. If Cali were at the stage that Germany is right now then I'd totally be in line to get the ADR done. My husband suggests a micro-d. I'd go for it if that's what the doctor's told me. Thing is, I just don't know what to do. Am I just going to wait for it to get worse before my doctors do anything about it. May 3 is my followup appointment for the procedure and I am so angry that I don't have good news for them.

Any thoughts on this is greatly appreciated...