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Doctors' Answers to "Frequently Asked Questions" - Back Pain

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Back problems [posted 1/12/99]
Question: I am suffering from a severe 24 hour constant pain in the sciatic area of the lower back. That pain goes all the way down my hip, thigh, calf, ankle, all the way to the toes which feel numb and the pain is almost unbearable. I have been prescribed Motrin 800 mg and Daypro 1200 mg per day, but with no relief. What options are there to relieve this pain, and what are the corrective options for this situation.

Answer: Try acetaminophen 750 or 1000 mg plus either caffeine or an antihistamine. Correction would depend on the cause, usually a pinched nerve in the lower spine. You'll need more data.

Changing Medications for Back Problems [posted 12/10/98]
Question: I recently had a bad bout with Sciatica & ended up with a diagnosis of "narrowing of the space between L5 & S1. I also was left with the bottom of my left foot numb & a lot of pain. After trying Vicoden which was no help, I saw a Neurologist who prescribed Neurontin. Up to 3, 300MG pills a day. It helps the pain. Now I am starting to take Ultram as part of a clinical study. Question? Should I quit the neurontin? I am trying the ultram as a last chance before 2 TKR's. I am late 50's, good shape, quite active.

Answer: Why quit what works. If you check these questions, you will see a lot of people who wish that something would work.

Back Pain & Kidney Problems [posted 12/08/98]
Question:  Can pain in your lower back that feels like your spine (like a pinched nerve), actually be your kidneys?

Answer: Could be, especially if to one side just below the ribs. Lower than this would not usually be the kidneys.

Chronic Back Pain [posted 12/08/98]
Question: I have had chronic back pain starting in boot camp. The doctors I went to for treatment would give me motrin or bedrest. Through out my four years in the marines my back problem has become increasingly worse I think it has to do with humping 100lb packs for 20 or 30 miles every week. The doctors told me it was mechanical low back pain. I tried motrin flexeral naproxin carisprodol, I do not like taking any kinds of drugs and those drugs didn't really help the pain they made me nauseous sick to the stomach and irritated. I recently was prescribed 6 tablets of oxycodone which I took at night before I went to bed they really helped me sleep good and relax for the first time in a long time. My question is: is oxycodone a good drug to use for low backpain because everything else I tried seemed to just make me sick. Are doctors allowed to prescribe oxycodone for chronic low backpain? It seems like my doctors are real hesitant to prescribe it to me. Thank You.

Answer: They are hesitant since it is a narcotic and you will develop an dependence on the drug. Have you had a CT to rule out a ruptured disc? Have you tried a TENS electrical stimulator? Massage therapy? Acupuncture? All are occasionally very helpful.

Back Pain Suggestions [posted 12/08/98]
Question: I have chronic lower backpain especially when sitting or standing for periods of time. most often when I try to sleep at night I have sharp pains in my spine and cannot sleep very good at all. I currently take tylenol three at night before I go to bed. the medicine makes my stomach fell queasy and I get irritated when I take it. what other pain relief medicine can I take to help me relax when I try to sleep at night?

Answer: I'd next try Elavil. This is an antidepressant used in chronic pain due to its ability to help with sleep and decrease the severity of the pain.

Will Back Pain & Numbness Ever Stop [posted 12/04/98]
Question: I am taking both ultran & Neuontran for severe arthritic pain in the knees, back. I also have numbness in the left foot as a result of a bout with sciatica. I have a narrowing of the gap between L5 7 S1. Question? Will the numbness ever get better? Will the combination of these two drugs help the pain?

Answer: The numbness might get better, but odds are against it if it has been for more than a few months. As to whether the meds will help, you will have to try them. We pick good options, but it is still trial and error when it comes to pain relief.

Post-Injury Back Pain Questions[posted 12/02/98]
Question: About two and a half months ago, I fell off a three story roof and landed on my rearend. At the hospital they said I strained my back. Since then I've had more x-rays and a ct-scan which have revealed nothing. My back still hurts a lot but now the pain goes to my feet. I use the relafen and it doesnt make even a slight difference in the pain. Do you have any suggestions? Why doesnt this stuff work, and why does my doctor keep feeding it to me?

Answer: He/she is hoping that there is a degree of inflammation that will improve over time, a useful thought;but, probably of little use after 2-3 months. I'd see a pain specialist.

  Information on Degenerative Disc Disease [posted 11/24/98]
Question: I'm a 30 year old female . I'm currently looking for information on "Degenerative disc disease". My orthopedic surgeon says I have it but I'm unfamiliar with the disease. I'd greatly appreciate any information you may have.

Answer:  The discs of the spine are between the bones of the spine and look somewhat like a donut. They are very elastic and filled with a jelly like material. As wear/tear/stress/weight take their toll, the donut loses its round shape and becomes deformed. This can result in pressure on the nerve as it comes out of the spinal bone since the disc is next to the nerve root. There is no effective way to restore the donut to its original shape and it must be removed or occasionally transformed with physical therapy.

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Back Problem & Limb Numbness [posted 11/13/98]
Question: Lately I have experienced numbness in my arms, hands and sometimes back of my head when I sleep. My physician prescribed 25 mgs of Elavil at bedtime for this. He did no testing to see what is causing this. But I do have a vertebrae problem. My question is should I try this for a month along with the other medications to see if it will work? I'm kind of leery on the mixture of all this medications. Please submit any information you can. Thank you.

Answer: I'd get nerve conduction tests to ensure that you aren't putting pressure on your cervical spinal cord or having carpal tunnel(with proximal referred symptoms). Elavil may help;but, doesn't get to the cause.

Options for Bulging Disc [posted 11/11/98]
Question: I have been diagnosed with a bulging disc with a bone spur at c4c5 and a herniated disc at c5c6 with cord compression. I was given 3 options: bed rest, steroid injections, or surgery. I opted for injections, but have since learned from several people in the medical field that I should do injections AND bed rest. Any advice would be greatly appreciated!

Answer: Bed rest is controversial as an adjunct to any back therapy. There was a recent study that showed no difference in patients who ambulate and those who have back rest. I think that some patients benefit from bed rest and some do not. But, the certainty that bed rest helps is not as clear as two to three years ago.

Back Pain Radiating into the Leg [posted 11/6/98]
Question: I've gone to 3 doctors for my back problem where I have a pain from my back pain radiated trough my right leg, they prescribe me motrin, flexeril and darvocet, and the pain it's getting worse, this pain been for 3 weeks, also I have been putting some hot pads, but it's not working, what can I do?

Answer: Have they diagnosed it as sciatica? Have ct of your lumbar spine been done? I need some more information.

How Long Can Back Injury Pain Last [posted 11/4/98]
Question: If I injured my neck by holding a cabinet up while carrying it downstairs could it cause pain for months? Also I have been getting up in the mornings with stuffiness in my sinuses and a steady pain at the very top of my neck where the spine meets my skull. When I blow my nose I have some blood. I am also having some light headiness. I have an appt for a doctor, I also have fibroid tumors that I inherited from my mother. Now I am wondering if this has to do with the cabinet or maybe some other problem. Thanks, I know you can't tell me much without seeing me, but I appreciate the help anyway.

Answer: Back injuries either lower spine or cervical are notorious for lasting long periods of time-sometimes a lifetime. The blood when you blow your nose sounds more like a sinus infection.

Anti-Inflammatory Pain Relievers [posted 11/4/98]
Question: I am allergic to Aspirin and Advil type pain relievers. I have a bad back that badly needs an anti-inflammatory. I suffer and only take Tylenol which does nothing. I have taken Salflex with no luck either. I am in desperate need of something. Please help me I can not take the pain any more.

Answer: Try ultram, potentially addicting but possibly of help. Also, antihistamines will increase the effectiveness of tylenol. Lastly, see a pain specialist for consideration of an injection.

Concerns About Potential for Addiction to Back Pain Medication [posted 11/4/98]
Question: I was told I had Scheumann's disease about 5 years ago and for about the last six years I have had chronic back pain. The pain is situated in my lumbar area, mainly in the muscles either side of the spine. I find sitting and standing for long periods of time very painful and cannot get comfortable at night. I have been taking naproxen and panadeine forte on and off for the last few years but I have now become conditioned to them. I have tried stretching programs, swimming (which I still do), acupuncture and chiropractic. I have spoken to orthopedic surgeons who say that the only way I can be healed is through surgery. I am only twenty years old and I'm afraid that by the time I reach 40 I'll be in a wheelchair. I would just like to know what course of treatment could you suggest. I don't like drugs very much, but one of my friends who is a doctor suggested Endone or Losec (Australian brand names) to treat the pain.

Answer: I'm not familiar with Endone or Losec, do you have generics? Regular use of big doses of non-steroidal anti-inflammatories is the only treatment other than surgery for most.

Concerns About Potential for Addiction to Back Pain Medication [posted 10/30/98]
Question: I have read the FAQ for "Back Pain" and found some similar situations, but my pain is slightly different. I have had pain in the lower back for approximately 5 years. I caused the injury lifting a light, but bulky item. The pain seems to be the worse after sleeping for a medium-long period of time. I cannot sleep on my stomach, or on my back, only on my side. I have went through X-rays and an MRI. I have visited a D.O., a few different Chiropractors, and finally a Osteopathic Surgeon (he performed the MRI). It seems better with exercise hiking, walking, mountain biking, light weight lifting, etc. I currently try to exercise a minimum 3-4 times a week, but the pain is pretty persistent whether exercising or not. I am guessing it is a severe sprain to the muscles because when I stretch the lower back it helps relieve the pain/stiffness. The MRI did not reveal any apparent causes. Any suggestions?

Answer: Well, you have a common problem. Chronic back pain without any obvious relief. Sometimes a pain specialist can inject the spine with relief. Occasionally, a TENS unit will help. I have also had patients respond to acupuncture and massage therapy. Good luck.

Concerns About Potential for Addiction to Back Pain Medication [posted 10/30/98]
Question: I was prescribed vicodin for sciatica and eventually had a laminectomy and partial discectomy at my L5-S1 level. The pain was reduced somewhat but still lingers. I was referred to a chronic pain program and still have been getting prescribed vicodin for pain. I have been taking the medication for approximately 18 months with an average of three tablets daily. My doctor wants me to get off the medication altogether but right now it seems to be the only thing that helps my pain. I'm afraid once I go off the medication I will have terrible withdrawal symptoms. I have already tried going with out the medication for a few days and it was hell. I experienced insomnia and restlessness. What's the best way of dealing with the withdrawal? Based on my daily dosage and time on the medication what's your impression on my addiction and dependency towards this medication? Is this something I might have to deal with via a drug rehab program like Brett Favre or Chevy Chase? I'm 29 years old, I don't have a history of chemical dependency in my family, and I rarely drink. My doctor said pain can be dealt with four ways: surgery, pharmacologically, physical therapy, or cortisone-type injections. I've tried them all. Is there any other pain medications that might work in my situation that don't have the potential for "addiction" like vicodin and hydrocodone?

Answer: Well, all the narcotics eventually will result in dependence. This is different from addiction. That is, you aren't indulging in anti-social behavior to get your drugs. If you are going to have chronic pain and have tried the other alternatives why not stay on the narcotics? You need a physician who understands chronic pain and isn't stuck on right wing drug dependence messages.

Bulging Disc Affecting Bladder Control [posted 10/30/98]
Question: I am a 35 year old female diagnosed with bulging disc @ c4 w/bone spur and ruptured disc c5 and also cord compression. This has been going on since April. I have stopped working this week, physical therapy 3x week. My internist thinks I should call the neurosurgeon immediately as I am having balance problems and not one pain free day since April. Also, when asked if I have bladder problems, I'm not sure how to respond. The only difference I have noticed is I have to race to the restroom at the first sign or I do not make it. I'm talking not even waiting 5 minutes. Is this what they mean? I assumed they meant losing control completely. Should I seek another opinion? My neurosurgeon wanted to try to do w/o surgery and I agreed until I finally decided that physical therapy and rest wasn't going to fix it. I have times that I feel I'm just going to lose it. The pain is constant but it's not to the point of keeping me down. I can function, just not nearly at my normal capacity.

Answer: They are asking about bladder control to see if any downstream nerves are affected by the disc. However, it would be very unusual to have only bladder problems. If you do, this can be documented by a urologist. I would do this prior to surgery unless the pain is intractable.

Suggestions for Chronic Back Pain [posted 10/28/98]
Question: I have had a history of back problems, while delivering a foal the mare backed me into a wall and set down on me. This would not of been so bad if it wasn't for the fact that I had my right arm completely inside the mare adjusting the foal. Since this time I have endured traction, rest and two operations over twelve years. The operations were a great success for about three days and after that the pain increased and numbness has taken over the back and fingertips of my right arm, also the top and tips of my right leg. My treatment so far has been: a root block attempt, 3 steroid injections, two months of enduring the torture of a place called the pain clinic. My current medication is 75 Mg of effexor and 160 mg of oxycontin daily. All the doctors I have seen say the same thing, "get used to it as it's going to stay this bad and possibly worse latter on. I an a 42 year old white male with hopefully a few more good years left in me. This thought is what keeps me going at this point I don't sleep with any regularity and always hurt.

I need a ray of sunshine but will settle for some reinforced hope. Is there any new medications that will end the discomfort and let me get on with my life? I currently lay aprox. 18 to 22 hrs. a day. I have a good day every now and then and spend all this time trying to get some exercise in the form of walking. I'd walk more if it didn't hurt so bad but I can't seem to find the right combination of medication to allow me to strengthen my muscles. My question is what would you recommend be my next step?

Answer: Acupuncture, massage therapy might be a start. Also, have you tried a TENS unit, sometimes very effective. Some of the nontraditional chinese exercise problems could be helpful.

Compression Fracture [posted 10/16/98]
Question: My father has just been diagnosed with a compession fracture in his middle back. The doctors are talking surgery. He has been in extreme pain for three weeks and nothing is helping. He has been on prescription pain pills,muscle relaxers,heat and cold treatment. I can not find any information on back compression fractures, the causes, and the treatment. He was warned that the surgery could result in loss of movement. He is 75 years old and has not fallen recently.

Answer: Compression fractures occur when the supportive strength of the spine is insufficient to support the downward forces of the spine. Young people get these falling off horses and buildings, as ones bones become thinner something as simple as a sneeze or stepping off a curb can cause the compression. First is the diagnosis. That is what caused the bone weakening? There are several potential causes in men. They can and do get osteoporosis, especially if there is a deficiency of testosterone. Other potential causes include hypothyroidism,hyperthyroidism, hyperparathyroidism, multiple myeloma, osteomalacia(vitamin D deficiency). While diagnosing his problem won't fix his back, it could prevent further fractures in the future. Treatment of compression fractures is difficult and braces tend to be more helpful than surgery. Sometimes use of calcitonin will help the pain and should be attempted for 4-6 weeks.

Head and Neck Problems [posted 10/16/98]
Question: I have a hurting(sometimes it even feels like it is burning) in the back of my head, just below the crown of the head and going across. Also with this I have neck problem. Every time I turn my head it pops and cracks. I also hurt down both my arms, down to my elbows. Please give me some info on this. I also burn in may shoulders blades and a little below.

Answer: Most likely a pinched nerve as it exits your spine to your arms and lower neck. This will need xrays-probably a CT to determine the severity of the problem.

History of Back Pain & Injuries [posted 10/15/98]
Question: I injured my back when I was about 8 yrs old due to a fall on stairs, falling unconscious for a time. I was not X-rayed at the time, and I was too afraid of the doc to admit it hurt. A year later I fell and jarred my back. I was x-rayed at that time and was told I had aggravated an old injury and that that injury was 2 crushed discs in my back, and advised it would heal with time. That seemed to be the case,and I had no further problems until I experienced pain when I was about 12-14 yrs old; I was told then that I had aggravated an old injury (now told there were "3" crushed discs) and was sent for some physical therapy. Everything seemed fine after that until about 5 or 6 yrs ago ( now about 37-38 yrs old ) when I was helping my hubby put in a driveway. This involved a lot of heavy lifting and overall exertion on my part. Anyway I started to have ALOT of pain in my back after that and I went to my family doctor for help. He told me I had again aggravated the old injury and gave me some anti-inflamitories. That seemed to do the trick for a time, but ever since then so many things I do cause me to suffer pain in my back (vaccuming, cleaning etc.) Is there nothing I can do to strengthen my back or ways to learn to do these things that won't cause me so much pain all the time? I'd appreciate any info you can give me. Thank you in advance.

Answer: Usually, physical therapy to teach protective exercises is proscribed along with the anti-inflammatories. I'd see a back specialist with your history, preferably one that doesn't do surgery.

Nerve Block Procedure [posted 10/8/98]
Question: My doctor wants to do a nerve block @L4-5.L5-S1 with sensorcaine injection. Is there an advantage to this type of procedure vs. having an ESI with solu medrol? I'm a Radiologic Tech. and need to know how long this type of procedure(s) can be effective. I don't want surgery if I can help it as I don't want to be out of work.

Answer; Usually we combine the anesthetic and follow it with steroids when it is demonstrated to work on the pain. Uncommon to use one or the other.

Disc Problem Without Pain [posted 10/6/98]
Question: I have been on dialysis for over 6 years. I have , in the past 6 months started to feel tingling and numbness in my feet. I have been to a orthopedic doctor who ordered a CT and found a disk that was severely out of place, but I experienced no back pain. My neurologist ordered an MRI to better see the disc problem,and an EMG. The EMG show severe loss of conductivity in both feet, so I was placed on NEURONTIN 300mg, 1xD. This is my first day and i already started to feel reduced pain in both feet. However, I feel dizzy, lightheaded and very tired. I also have an increased hunger and have eaten much more than usual. Can you tell me if this is normal and will the dizziness and fatigue ever go away. thank you

Answer: The dizziness and fatigue tend to persist in most patients, so does the change in appetite.

Chymo-Papain Injection Surgery [posted 10/6/98]
Question: In 1983 I had chymo-papain injection surgery for a prolapsed disk in the L-4 L-5 region of the spine. Out of curiosity I am wondering why they discontinued it. Was there long term side effects or didn't it work for most people. It worked just fine for me.

Answer: Didn't seem to work in controlled studies and there were a few severe allergic reactions.

Back Pain [posted 8/12/98]
Question: I have had pain in my middle back that starts on the left side and then moves to my lower abdomen. I have several small cyst on my ovaries. The pain does subside for one week after my period.

Answer: Possibly kidney or ovary - you'll need an ultrasound and a urinalysis.

Mid-Back Pain [posted 8/12/98]
Question: Could kidney problems be a cause of long lasting pain in mid-lower back region? I want to rule out spinal damage as the region is sore to touch or when lying on my back.

Answer: Kidney problems, particularly stones, or obstruction could cause chronic pain. If the pain is over the kidney (about 3 inches away from center) it is probably the kidney (or muscle). If over the spine probably spinal in origin - where is the tenderness?

Chronic Low Back Pain [posted 8/11/98]
Question: I have been suffering for 5 years with chronic back pain. Some of the back pain has been alleviated. The low back pain was thought to be originating at L4-5, but was not corrected through PT nor surgery. An EMG shows significant nerve damage, but as of yet it is still undetermined as to the specific cause. What procedures or tests can be performed to help clarify the problem? I will talk over all suggestions with my orthopedic doctor. Your input will be greatly appreciated. I'm very frustrated and need to find some relief in order to return to some form of my former life.

Answer: Clearly this is from a disc or some pressure necrosis on the L4-5 nerve root. The surgery was to remove any pressure on the nerve and prevent further deterioration. However, often the damage can be permanent after sufficient pressure/time. The question is whether any further surgery would be of any help. This is a difficult decision and you will need to get a 2nd opinion. This is because the first surgeon either did not see the problem or did not fix it correctly. It may be that there is no fixable problem, but if I were in your position, I would find a national level expert in spinal surgery. You might check "Best Doctors in the ______". This is a publication found in different regions: Northeast, Southeast, etc. This is a good place to start to find a doctor in your locale who can give you a second opinion.

Back Inplant - Epidural Catheter [posted 8/6/98]
Question: What is the procedure in which a back implant for extreme pain with a tube injects morphine directly into the spinal column?

Answer: I think you are thinking about an epidural catheter. This is implanted in the spinal cord and used to treat severe pain. Often used after surgical procedures, but is usually not left for long periods due to the risk of infection. The tube is implanted by an anesthesiologist usually in an operating room.

Lower Back Pain [posted 8/5/98]
Question: I was having pain in my left side around my hip and the P.A.C. said it was probably bricitus. She put me on naproxen 500 mg 2 times a day. I played basketball, which I haven't played in a couple months and now I have some lower back pain along with numbness in the back of my legs and foot, also my butt and private area. Is this serious?

Answer: Two possibilities - one that it is bursitis in which case stop doing athletic things until the hip heals. Two, it was misdiagnosed and is really involving the lower spinal nerves. The treatment of naproxen would still be the same for this condition, but it might require low back x-rays. The other advice still holds - stop doing exercising while your joints are less than 100%.

Chronic Back Pain [posted 7/27/98]
Question: I have had 5 back operations and still suffer chronic pain. At the moment I am taking 5 mg Palfium tablets, 3 hourly. I regularly have to have 5 mg Pethodine injections. It appears that the surgeon has erred in fusing L5-S1, and is now wanting to fuse both sacroiliac joints. Is their some other options for pain relief as these drugs are becoming less effective. I also take valium for muscle spasms, but find this makes me depressed. Your help would be appreciated if there is a way to avoid further surgery.

Answer: I'd see a pain specialist if you haven't already. Using other non-addicting medications to enhance the Palfium is the usual tact. Steroid injections are also of help in occasional patients.

Back Pain [posted 7/21/98]
Question: I have severe back pain. What would be the best medicine to relieve the pain? Is Darvocet a good one?

Answer: Darvocet is fine, but will be mildly addicting if taken long term. Non-steroidal anti-inflammatories (like Motrin) are the usual starting point. Then, tylenol is added to these, lastly, narcotics like Darvon.

Lower Back Pain [posted 7/17/98]
Question: For two weeks now I have had some slight back ache. Three days ago the ache turned into severe pain. The doctor prescribed Flexeril 10 mg 3 times a day. All this has done is made me light headed and sleepy. The pain is still there. Could I be treating a misdiagnosed problem or should I be doing something else along with this medication to relieve the pain.

Answer: Did you see your doctor? Did he/she do a neurological exam? Severe back pain usually indicates a ruptured disc-especially after a mild prodrome. Other possibilities are kidney stones, etc. Re-check with your doctor.

Chronic Back Pain [posted 7/17/98]
Question: In September 1996, I had a laminectomy for a ruptured disk. At first, the MRI indicated two ruptures, but then it was determined that one disk was just extremely deteriorated. Since then I have had chronic pain due to spinal compression with two very thin lower disks. The spine specialist says that my disks continue to deteriorate (I am 42 and ruptured the disk putting in a deck around my pool). His only suggestion is to have four hollow screw-like devices placed where the bad disks are via surgery through the abdomen. I am currently on vicodin (1 pill per day after work and 2-3 on the weekends). He stated that this surgery is much dangerous than my laminectomy and would require a vascular surgeon because of the veins and arteries in this area. I am in pain without the vicodin even with a back brace and ibuprofen about 80% of the time. Are there any alternatives? I don't want to spend the rest of my life either in pain or on narcotics.

Answer: Back problems are unfortunately usually chronic. By the time one gets to surgery it is only as a last resort. Even then pain is not relieved in 30% and in 10% of back surgery is worse after the surgery than before. I'm not familiar with the procedure you are describing unless he/she is attempting to fuse the spine. I would get a second opinion. Go to a national level person prior to the surgery. However, if the pain is not relieved by the first surgery the options are always limited and the relief less than 100%.

Back Problems
Question: I have been having muscle spasms in my back only at night when I'm going to sleep. Sometimes they are on one side of lower back, sometimes on the other. I am not experiencing real pain, but the spasming actually causes my back to "jump" from the mattress for a second, and then it usually subsides for a few minutes and happens again. It seems to only happen when I am going to sleep. Do you know what this is symptomatic of, and should I be concerned?

Answer: Both painful and painless muscle "twitches", or spasms, are not uncommon symptoms. The causes are quite varied, and range from simple spasms due to excess stimulants in the body, such as nicotine from cigarettes, or caffeine in coffee, to conditions of the nerves that supply the muscle involved, to conditions that affect the spinal cord of higher nerve centers in the brain. There are other, more widespread system-wide diseases as well, that although usually present with spasms of many different muscle groups, can on occasion just affect one specific area. "Restless leg syndrome" is a disorder of frequent painless muscle spasms that typically affects the leg and may extend to the lower back, but does not usually involve the back alone. In the back, a common cause for your symptom is that of muscular strain. Either due to recent physical injury or exertion. A problem with the disc or bones in the spine at the level of the nerve roots that supply the affected area of your back may also be at work. The key to determining the cause, is a thorough history and physical examination by your health care provider. Often this alone can give you the answer, as the presence or absence of certain key facts on history, or findings on examination, can lead to the diagnosis. Your health care provider can also determine if further testing is needed.

Low Back pain
Question: I have been experiencing low back pain in the right pelvis. I tried taking tylenol, motrin, and soaking in tub only to achieve minimal relief. I walk three miles 5 days a week, in 45 minutes. The pain is not felt in walking and not bothersome in standing. It is most noticeable in sitting and lying on my stomach (my favorite sleeping position). I am a 58 year old female and am taking fosamax (for 14 months) and Vitamin D (800 mg) daily.

Answer: There are some very simple rules in medicine - if it causes pain, stop doing it. I'd recommend a rest from your walking regimen (try swimming, or cycling to keep muscle tone). Add non-steroidal anti-inflammatories (double the over the counter dose is nearly prescription strength). Once the pain is gone in 4-5 days, don't stop the NSAIDS. Start your walking at 1/4 your present regimen. If the pain is not better in one week of NSAIDS it is time to see a physician.

Back pain
Question: I had a laminectomy on my lower back 14 years ago and I am now 36 years old. I've battled low back pain for 4 to 5 years now. I also have had pain down the back of my left leg into my foot. If I have surgery it has been recommended I have a fusion because I have two degenerated discs next to each other. My doctor says because of my age I should put it off as long as I can and I tend to agree. However, the pain is really bothering me. It effects my work, makes me irritable, and I don't know what to do. I've tried multiple treatments- i.e. physical therapy, chiropractors, etc. What can I do to relieve the pain? When is surgery no longer an option, and a necessity? My leg still feels strong and I have no problem with my balance.

Answer: When the pain is no longer bearable, it is time for surgery. Be advised that the pain may persist. Have you seen a pain specialist (usually anesthesia)? Injections of steroids in the epidural area may be effective. Have you tried a TENS unit? This is an electrical stimulator that is occasionally of major help.

Back Pain
Question: I have been suffering from a back pain for about two weeks now. I can hardly get up and the extreme pain forces me to walk totally erect with little or no bending all the time. I feel like it may be a slipped disc, but I am not sure. I have been looking around for information on a remedy and most offer massage therapy. Is this the only answer? I was also wondering if I could take any antibiotics to relieve the extreme pain.

Answer: Back pain is extremely common and fairly difficult to prevent. That is because the human back was not designed for its current posture. Lifting, turning, and other strains all produce pressure on the disc interspaces that tend to damage discs. Once ruptured or inflammed, these dics tend to put pressure on the local nerve roots, producing a "pinched" nerve and its subsequent pain. However, the most common source of back pain cannot be demonstrated to be due to a ruptured disc. Treatment of common low back pain or a ruptured disc in the initial stages is the same. Heat, anti-inflammatory drugs, massage, and bedrest. Antibiotics are of no use. NSAIDS like advil, motrin, aleve, etc., are the mainstay. Whether bedrest helps is controversial, but usually recommended. If there is any loss of strength, bladder, orbowel control, a physician should be contacted immediately. In general, physicians avoid any surgical approach to back pain unless there is loss of neurologic ability or function.

Back Pain
Question: I am taking drugs for lower back pain, due to a worn disk. I have been advised to have an epidural for longer term relief. What are the risks of the epidural?

Answer: Epidural steroid injection of the back is a relatively recent development in treatment of low back pain. The side-effects are usually short-term and involve pain, infection, and ongoing leakage of spinal fluid. Long-term side effects appear fairly rare if any.

Question: Is Soma a muscle relaxer for the back? Is it sold over the counter for a consumer to purchase? Is this a medication that an individual who suffers from back pain could take? The pain is more noticeable when it rains or is damp.

Answer: There are several traditional methods of treating back pain. These include 1) anti- intlammatories 2)muscle relaxants(especially if muscle spasm is present) 3)heat and occasionally ice 4) physical therapy or chiropractic manipulation 5)rest(although this is used less frequently after some recent research). Most muscle relaxants like Soma, Flexeril, etc are prescription. I'm not aware of any sold currently over the counter. Sometimes antihistamines achieve the same effect. These are sold over the counter as Benadril, Chlortrimeton etc.

Epidural Risks
Question: I am taking Brufen Retard for lower back pain, due to a worn disk. I have been advised to have an epidural for longer term relief, as I am considering starting a family. What are the risks of the epidural ?

Answer: Low back pain is a common problem and unfortunately, has few good treatment options. Initially, anti-inflammatories and physical therapy are used to relieve the pain. If these regimens are insufficient, surgery or injection is the next line of treatment. Usually, surgery is a last resort and only used with clear pressure of the disc on the nerve or nerve root. In the absence of an x-ray showing this I would recommend a trial of an injection. In my experience, this is only a temporary relief and will buy 6-9 months of relief at best. Long term side effects appear minimal if there are only a couple of injections. There is always a risk of infection, leakage of spinal fluid from the injection site and trauma to other nerve roots causing more severe pain.

Question: I injured my back 6 months ago lifting a 23 lb. child from floor level while sitting on my bed. Since then I've had 6 chiropractic treatments to get re-aligned. I'm normally a very active person: cardio exercise, weight training, roller blading. At this point my lower back and hamstrings are still very stiff. My lower back is still sore at times, although not as bad as before. OK, here's my question! What activities are OK and won't cause further injury but will help to strengthen my back?

Answer: Back injuries and back pain is one of the more common and unrelenting problems in medicine. Realistically, if your back doesn't improve in four to six weeks after an injury, it probably won't get better. Like many things in medicine, the more different treatments that are available-the less likely that any one will work. I always suggest that if one approach doesn't work that different treatment regimens be tried-that is physical therapy, acupuncture, tai chi, rolfing. Like most things check with several different sources to determine who in your community is good at their trade. I will tell you that different physical therapists or chiropractors will produce markedly different results with the same patients. So, I would try a different chiropractor or go to a physical therapist. If the pain persists you should get a cat scan or MRI to ensure that you don't have a ruptured disc. Realistically, even if you have a ruptured disc and the pain improves or goes away you are not going to consider surgery. Surgery is the last option for a ruptured disc that is unrelenting, loss of muscle strength or unbearable pain. Pain centers can inject your spine;but, I haven't been impressed with the duration of relief.

Lower Back Pain
Question: What do you do for occasional severe lower back pain?

Answer:Rest, heat, Non-steroidal antiinflammatories(like Advil, Motrin, Aleve,). Avoid lifting. After it clears get a list of exercises to strengthen your lower back and do these 2-3 times a week to avoid further problems.

Neck and Back Pain
Question: I have chronic neck and back pain. Can you recommend any natural remedies?

Answer:Aspirin is technically natural coming from herbal ingredients initially. Stretching exercises like yoga are helpful and strengthening exercises for the upper neck/back and abdominal muscles are time tested to help.

Neck Pain
Question: What's the best way to get rid of a pain in the neck that was acquired during the middle of the night?

Answer: Heat, non-steroidal anti-inflammatories(aleve, motrin, etc.) local analgesia(Ben-Gay, etc.) Finally, get a cervical pillow if this becomes a recurring problem. Also, exercises on the upper torso to strengthen the neck muscles will help over time.

Lower Back Pain
Question: I am 48yrs old and my lower back has been hurting. I also have an upper resp. infection. My Dr. has been treating me and I have been having lower back pain for a couple of weeks and urinating frequently. I am 49. My family doctor prescribed Hytrin and antibiotics, I also have an upper resp. infection. Now I am getting full of fluid in my body. He didn’t check anything on me but my urine. I don’t have HBP. Any suggestions?

Answer: Hard to tell how much of your problem started with your prostate in which case it may be perfect treatment. Hytrin is to treat prostate problems as well as hypertension and I suspect that is why you are on both. You will not be able to eliminate the urinary infection if you cannot completely empty your bladder-hence, the Hytrin.

Back Spasms
Question: I have been suffering back spasms for a number of years. It first began when I was 16 and began weight lifting. The pain would go away after some time. My question is that, recently my lower back has been hurting me and I sleep on a motionless water bed. Should I be sleeping on a more firmer bed? Also, when do I go see a doctor about the pain?

Answer: You might try a firmer bed. Waterbeds either make your back lots better or lots worse-depending on whether you would benefit from flexion or extension exercises. I'd start with a Family Practice or Internist you may need x-rays; but, certainly an exercise regimen and physical therapy. The real question is whether you ruptured a disc lifting. This will need a CT scan usually. However, in general we avoid surgery even if you have a ruptured disc unless there is intractable pain or loss of muscle strength/neurologic control of bladder or bowels.

Toradol & Alcohol
Question: My brother Paul has a very bad back condition with extreme pain. He unfortunately needs to put off a much needed surgery and in the interim was given a prescription for Toradol 10mg to help with the pain. My family and I have observed weird behavior from my brother Paul: depression, hallucinations, forgetfulness, and he's short tempered to name a few. Please note that my family has witnessed on occasion that he was drinking beer. My question to you is: Is this drug habit forming, and in your professional opinion what would you prescribe as opposed to Toradol and what would be the risks with the drug you selected?

Answer: Toradol is a narcotic which like all narcotics is potentially addicting. Unfortunately, if there is marked pain there are few options. Ultram may be a long term option. Currently, this is advertised as non-addicting and has similar efficacy to narcotics. I don't use this narcotic a lot in my practice; but, other narcotics are potentially as much trouble. I usually start with Tylenol; then Tylenol #3 or Ultram. Finally, narcotics.

Ruptured Disc
Question: I need as much information as possible on ruptured disc in the L4 L5 area, because I have heard that a rupture in this area can cause the loss of control in the bladder , I'm 33 years old, and am experiencing some problems in controlling this. I’d like to know if this is a related problem or are the two separate issues.

Answer: Probably related. If the disc is the cause, you will need surgery. A urologist can perform tests on the sphincter(muscle) which controls your bladder and see if it is neurologically impaired. This is usually a reason to proceed with surgery.

Back Surgery
Question: I had back surgery two years ago which included repair of a disc space, removal of a mutant ligament. I am still having sciatica down the left leg and into the hip and my activities have to be monitored because if I do too much I have to be in bed for two days after, I have not had one day since surgery that I have not had some pain, but most of the time it is manageable. Is this as good as its going to get? I cant face all those mri, cat scans and mylograms again. I do take some pain medication, such as naprosyn, soma and loratabs when necessary. As I get older will this get worse?

Answer: Unfortunately, it sounds like you have been dealing with low back symptoms for quite a long time. Although surgery on the lower back can relieve the symptoms for which it was performed, there can be some residual symptoms which persist after surgery. Perhaps a visit to your physician is in order. Although you mentioned that you are not in favor of further imaging with myelography, MRI or CT scans, a discussion with your physician may provide some insight into how you can manage your symptoms more effectively. In addition, he or she can provide information on support groups that exist to help patients with chronic low back symptoms, which are suffered by a great many individuals. You describe your symptoms as manageable on most occasions, which should be reassuring. Perhaps, with help from your physician, there are other modalities of therapy you can pursue to improve symptom control even further. Even basic exercises, designed with the low back pain patient in mind, can prove beneficial. See if your physician would recommend these for you, and what other treatments, if any, would be of benefit in your particular case.

Back Pain & Vomiting
Question: I've had severe back pain once or twice a year accompanied by bloating and gas since about age 20. However, in the last 4 months the frequency, pain and gas problem has increased significantly. Now, instead of just gas, I experience vomiting, and diarrhea which is very obviously directly related to the back pain. I've learned to ward off the most severe effects by laying on the floor with my knees raised for about two hours. If this problem continues to worsen, what are some possible options?

Answer: You don't tell me where the back pain is;that is lower, middle, or upper back. If in the middle this suggests either an ulcer or gall bladder dysfunction. In any case, vomiting with back pain is highly unusual. You really need to see your doctor before this progresses. Possibly, taking an H2 blocker like Tagamet or Pepcid would fix the problem. But, the vomiting suggests either an obstruction or an ulcer-see your doctor.

Numbness in Arms & Legs
Question: Five years ago I injured my back in an accident. I had to have micro-surgery, followed by a repair. As a result I developed a serious infection and was laid up for over a year. Since then I recovered almost completely and was able to resume a normal life. Recently I slipped on a wet floor and am now in extreme pain. My back has serious constant sharp pain, and radiating pain in both legs, with numbness in my toes. I also experience occasional numbness in my right arm. What the is going on and how do I get my doctor to quit considering it a strained muscle?

Answer: Ask for a 2nd opinion with a neurologist or neurosurgeon.

Question: I’m being treated for a chronic low back problem and currently taking 240 tablets of oxycodone per month. Is this medication going to cause addiction problems for me and how long will this therapy be effective.

Answer: You'll probably already addicted if this has persisted for greater than three months. Addiction is the only option if you cannot relieve the pain in any other manner. But, I would not persist with this course unless you have exhausted all options(pain clinic, neurosurgeon/back surgeon, physical therapy, acupuncture, massage therapy are some). The drug will continue to relieve the pain, but, you may require higher doses due to tolerance acquired by your body.

Question: I am 48 yrs. Old, can this be the cause of headaches, sinus, allergies? Is this fixable in todays society? I heard of inserting a metal rod in your spine, is this possible?

Answer: “Curvature of the spine” can have several meanings, each associated with varying significance. In brief, health care providers break down the spine into four parts extending from the head to the lower back. The “cervical” spine is in the neck, below which is the “thoracic” spine in the mid-and upper back. Below this is the “lumbar” spine in the lower back, and then in the region just below this, there is the “sacrum”. Curvature of the spine has a different meaning, and poses different problems to the patient and health care provider, depending on where in the spine it occurs, and to what extent. Furthermore, the direction of the curvature is also important, as several portions of the spine are a supposed to have a mild front to back curvature. Certain types of headaches, particularly those that affect the back of the head and upper neck (“occipital headaches”) can be caused by disease of the cervical spine (but not all headaches of this type are due to disease of the spine, and not all patients with disease of the spine get headaches). There are a variety of diseases that affect the spine and result in symptoms, including disk disease, fracture, loss of bone density due to poor diet and age, as well as changes that are simply due to the aging process. The treatment of spinal problems depends heavily on the severity, location, and type of problem the patient is experiencing. An evaluation by your health care provider would be helpful. He or she can perform a history and physical, and determine what course action would be best for you, so as to improve your symptoms.

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