Answers To Your Questions!
The below content is not a substitute for professional medical advice.
Be sure to contact your doctor with any questions you may have about your medical condition.
Answered by Dr. John Keel, Medical Director, Spine Center, Beth Israel Deaconess Medical Center.
Question:
I had 2 herniated discs removed back in 1991(L3-L5) and I still have chronic back pain in my lower back and also radiating up and down my leg. At times my spine feels as though it is swollen! Ernie in Brockton, MA
Answer:
Is the pain you experience now the same pain that you had before surgery? Back pain and leg pain can start again after surgery. This is part of why the symptom of pain itself is not an adequate indication for surgery. Pain can recur for several reasons. Residual disc material can herniate again. Scar tissue can form, and it can press on nerves. Infection is always a concern if there has been a recent medical procedure and you are having fevers. Your surgery was a long time ago, and it could be that a separate process has developed over time and is causing pain now, such as a different disc level or arthritis of the spine.
Question:
Do inversion tables work to decrease compression and alleviate back pain? My wife has been dealing with back pain for quite some time. I told her to excersise because she is so inactive. She sits all day at work and just lays on the couch all weekend. She has been experiencing an almost constant pain in her spine and numbness in legs and feet. She had injections in the spine but she feels that this did not help and may have even worsened the situation. She has also had bladder control issues in the past.Do you have any advice for us? Andre in Methuen, MA
Answer:
Many studies have been performed to determine if inversion tables and traction devices work for back pain. The overall message is that there have been conflicting results. There are many causes of back pain, and some individuals may benefit, but I would recommend avoiding expensive devices where something less costly will perform the same. Any decompression resulting from inversion is likely to return when you step out of the device. The bladder issues that are concerning with back pain are new onset loss of bladder or bowel control, due to injury to the nerves in the lower part of the spinal canal. This can be associated with numbness in the groin or thighs. If your wife is experiencing this, she needs to be evaluated by a physician immediately.
Question:
I have had the worst back pain for the past 6 months. I have trouble getting up out of a chair, lifting, turning and constant pain. I have always had a bad back but usually it stops hurting after a few weeks and I know when I hurt it from a twist or lift. I also have arthritis in both hips and knees. I am 53 and overweight and tryng to lose weight. The only thing my doctor offers is losing weight and wouldn't order any tests or let me see any specialists. Shirley in Burlington, MA
Answer:
Based on your symptoms, I do think you might benefit from evaluation by a specialist in spine pain. There may be conservative treatments for the type of pain you have. Now let's talk about medical tests: X-rays and MRIs are medical tests. Sometimes there are no good tests when it comes to pain. I do not order tests routinely for back pain. There needs to be a good reason to order a medical test. There needs to be a plan to use the information that will come from the test once you get it. I tell people to ask themselves, "How will this medical test change things for me?" For example, an MRI is a very sensitive test, and many "abnormalities" will be found even in people with no pain, which means that an MRI sees a lot of things that are actually not important. If there is not a plan to do something, like have a surgery or a procedure based on patient condition and the potential MRI result, then why put a person through an MRI? A person may be worried that they have arthritis or a degenerated disc, but if seeing if it is truly there on an MRI is not going to change the medical plan, then there is no reason to get this test. It is not a good idea to order an MRI or x-ray "just to see."
Question:
I have pain in my lower back on my right side only. It hurts to sit and to rise from a sitting position.The pain seems to come from an area the size of a fist. Do you think this could be caused by a pinched nerve (as my chiropractor believes) or could this be sciatica? John in Middleborough, MA
Answer:
Does the pain travel into your leg? That symptom would be more expected with a pinched nerve. There are a lot of structures in the low back that may cause pain, including the facet and sacroiliac joints, the iliolumbar ligament, and back muscles.
Question:
I have been having lower spine pain radiating into my right hip. What can cause this and what can I do to relieve the pain? Barbara in Avon, MA
Answer:
Pain from spine structures is often referred or perceived in other parts of the body. This can be caused in a few ways. For example, the peripheral nerves to your right hip originate in your spine. If there is something irritating the nerve within the spine itself, such as a herniated disc, then the symptoms can be felt all along the path of the nerve, even in the hip. Arthritis in the spine is sometimes felt in the hip. Different parts of the body may share a common spinal nerve level that sends signals to the brain, so a problem in one body part can be perceived in another part that does not truly have a problem. If your pain is significant, the first step for you is to see your primary care physician and determine the most likely cause. This can usually be determined by a detailed interview and a physical examination. This is often a challenge, and as a spine specialist, I need to understand problems with the peripheral joints as well as the spine.
Question:
I have been having back spasms for approximately 6 months. I have seen my doctor 2 times during this time. I have been through physical therapy on 2 occasions, and it appears to help for short periods of time (1 or 2 weeks). The pain is at the middle of my back, under the wings of my back. The muscle under the wing seems to go into spasm with the smallest of movement from typing on the key board to sitting in the car driving to using small power tools. Any preasure that I seem to apply with my right arm seems to trigger the spasms in my back. I have been taking ibuprofen for the pain; it usually takes about 2 weeks to calm down. Any help would be greatley appreciated. George in West Roxbury, MA
Answer:
This sounds like a common syndrome that has been known by a few names, such as scapulocostal syndrome, and others. This can be a very bothersome condition that takes a while to resolve when it flares up. Have you tried sitting posture modifications? Avoid hunching your back or slouching your shoulders forward, as often happens when working at a desk. Position your desk, chair and monitor so that you can look at the screen and have your hands on the keyboard while you are sitting with back and neck upright, with shoulders back and elbows close to your body. Ice packs and massage may be helpful. There are braces that help keep your shoulders back in good posture. Injections (similar to trigger point injections) are sometimes helpful.
Question:
I am scheduled for lumbar fusion in a couple of weeks. I have a lot of people trying to talk me out of this. I have severe DDD and Facet joint disease in L5-S1. Is there a high success rate for this type of surgery with my diagnosis? Debbie in Haverhill, MA
Answer:
The success rate depends more on your signs and symptoms, and not on the fact that you have degenerative disease and facet joint disease. If you are experiencing pain, but you do not have neurologic problems, then I suggest you have a second opinion. There may be nonsurgical treatment options for you.
Question:
I had severe leg pain from 2 rupturted discs putting pressure on nerves, creating intense aching in my left leg. Recently I had lower back surgery (L4 and L5 discs cleaned up). Pain was almost gone and now 4 weeks post-op, my pain level is back and worse than pre-surgery. What options are available to me? Ron in Manchester, NH
Answer:
Are you having fevers or neurological changes? If so, you need to follow up with your surgeon immediately. Is the pain you have now the same type of pain in character and location as before surgery? It is possible for scar tissue to form, resulting in a similar problem that had been caused by the discs. It is possible for disc herniations to happen again, even after surgery. Depending upon you current symptoms, options may include several medication types, physical therapy, nonsurgical procedures such as injections, and possibly revision surgery.
Question:
Is there anyting that can be done for lower back pain if you have arthritis in my back? My doctor said it's the nerves. Heidi in Andover, MA
Answer:
There is a whole medical industry devoted to low back pain of any cause. There are numerous diagnostic and therapeutic options for low back pain, as it is one of the most important medical problems in our society. Most back pain does not need surgery. The mission of the Spine Center at BIDMC to provide a comprehensive, interdisciplinary approach that directs patients to the most effective and appropriate options first.
Question:
I have neck pain whch radiates down my back. My arm feels weak when I write. MRI/CAT SCAN c5/c6 posterior disc ostephyte complex, with left paracentral disk protrusion which is partly calcified along the margin. Mild narrowing of the central canal, eccentric to left. With a uncovertebral squaring with moderate right and severe left neural forminal stenosis. Tried everything from physical therpay to corticosteroid shots. It has impacted my life; hard to read books, push a vacuum; garden, lift things. Not sure what to do next. One doctor says anterior fusion, another says just go in through the back and clean out the area, no fusion. Both say it will help the arm pain, but not sure about the neck and back pain. I'm not sure where to go from here. Any recommendations? Roberta in Shrewsbury, MA
Answer:
Are you left-handed or right-handed? I would be glad to review this or evaluate the patient in clinic. The purpose of the surgery would be to decompress areas where nerves are compressed, in hopes of improving the nerve, which affects the arm. Neck pain itself may not be affected in such a case. There are nonsurgical procedures that can help the neck pain. Regarding surgical approach, there is often more than one acceptable approach to a medical problem. One problem with second opinions is that you can end up more confused as a patient. How bad is your weakness? Is it getting worse? Do you have symptoms in your legs? Is the predominant symptom the neck pain or the arm problem?
Question:
I have been diagnosed with Lumbar Spinal Stenosis. I have been on Endocet for about 8 years; I was also on Naproxen but I got an ulcer. I noticed that the pain was tolerated much better with the naproxen along with the endocet, but since I cannot take it any longer, I only have the endocet. This drug is starting not to work so well and I'm wondering what the next step would be? Elizabeth in Medford, MA
Answer:
Endocet is a combination of acetaminophen and oxycodone, medications from two different categories. For many reasons, medications from different categories often work better when combined, as with Endocet. Naproxen is a third category again, so when you took this also you effectively had three medications targeting your pain, via different pathways in the body. However, Endocet is typically used for acute pain, and may not be the best for chronic conditions. Naproxen is an NSAID, and these are known for upsetting the stomach lining, causing bleeding or bruising, and affecting the kidneys. Regarding GI damage risk and NSAIDs, the category of NSAID may not matter as much as the duration of use. Possible options may include a long-acting medication or different categories of medications such as gabapentin or tramadol. Physical therapy or other conservative treatments may be helpful as well.
Question:
My back is sore when I get up in the morning but as time goes on, it gets better. I am an active 54 year old male, running about 40 miles per week. This has been going on for about 6 weeks. Suggestions? Thanks in advance. – Jerry, Townsend
Answer:
Jerry, stiffness in the morning is often described by people with back pain. It is not a definite sign of a specific problem, but it can be associated with inflammatory conditions such as the spondyloarthropathies, rheumatoid arthritis, and polymyalgia rheumatica. Do you have any other symptoms, or have you been ill recently? It sounds like you are very active - 40 miles a week is great!
Question:
I have been told I have arthritis and stenosis in my lumbar spine. The pain radiates to my hips and it is nearly impossible for me to walk any distance without extreme pain. I have had acupuncture at Beth Israel I have had steroid injections and two 6-week periods of physical therapy. The pain has never subsided. Because I do not hurt while I am sitting, that’s what I do most of the time, I have gained about 30 pounds in the past 2 years. The injections did help for a short period, but I am diabetic and it raised my blood sugar very high to over 300. HELP. – John, Marshfield
Answer:
There are a range of medication classes that could be helpful, John, if medications have not been tried. Epidural steroid injections can be repeated. It is true that epidural steroids have systemic effects, including increased blood glucose. What dose of steroid have you received, and how often? A spinal cord stimulator can sometimes be helpful, especially for the leg component of pain. Have you discussed these options with the clinic you visited previously? Have you tried using a walker? The pain of stenosis is often relieved when walking with support such as a cart or walker. Given the severity of symptoms, and the fact that a lot of conservative measures have been tried, an evaluation by a spine surgeon should be considered.
Question:
I have had back, knee, and especially feet pain, which has caused painful peripheral neuropathy. After knee replacement surgery two years ago, I am in more pain than a year ago. All this makes me walk tilted or bent over from back pain. Even prescription pain meds do not help!!! My quality of life as a special needs teacher and the grandmother of nine has been "put on hold." I no longer work and can not help with the grandchildren as much as I would enjoy. –Prudy, Plymouth
Answer:
Prudy, it sounds like you have more than one source of pain. What is the cause of your neuropathy? The usual pain medications may not be helpful for pain that is due to neuropathy. We call such pain "neuropathic pain," and medications used to treat it were often originally used for depression or seizures. Gait training with a physical therapist might help some of your discomfort.
Question:
I have recently had a total hip replacement and scheduled for another. My lower back problems have persisted for a number of years. I played rugby for 13 years but stopped playing in 1997 due to heart problems I believe brought on by sleep apnea(what a mess). I am 47, 6'1" and 270 lbs and I have always worked out and kept my back strong. I currently have pins and needle like pain when I am lying down to sleep. With this information, which hospital due you feel is best to deal with this problem, and a name of a doctor if possible.- Mike, Marshfield
Answer:
Mike, not sure which hospital you are having your hip replacement at or if you have a primary care physician who might refer you to a comprehensive center closer to you, but I would be happy to see you at the BIDMC Spine Center. Call 1-800-667-5356 and ask to make an appointment with Dr. John Keel.
Question:
I have spinal stenosis, 4 herniated discs, disc degeneration. I've looked into disc replacement but it isn't covered by insurance. When and what type of operation will help me? I've been dealing with this for 9 years and I'm currently on disability. –Janet, Revere
Answer:
Disc replacements and other devices are now marketed directly to patients. However, it can take a while for science to give a verdict on what really happens when we use a new device, in the long run. Be careful not to fall into the trap of becoming convinced that a new device is the cure for your symptoms. Most back pain does not require surgery. The role of disc replacement is limited, and is still controversial at this time. In general, you do not want to have a back surgery unless there is something definite in your spine that needs to be stabilized, decompressed or removed. There is a whole range of conservative options that might help you.
Question:
I have had a total spinal collaspe due to osteoprosis at a young age. I have developed osteoarthrits of the spine and experience pain on a daily basis that is negatively affecting my life. Can anything be done to alleviate the pain? I am currently on reclast and have not had any recent fractures. Virginia in Manchester, NH
Answer:
Osteoporosis and osteoarthritis are two different conditions that can cause spine pain, and it is possible to have both. Osteoporosis involves decreased mineralization of bone, and can lead fractures of the spine (arm and hip fractures are also more common). Back pain in osteoporosis can be due to acute or unhealed fractures, or altered forces on the body due to changes in the overall shape of the spine. Osteoarthritis affects the joints, including the joints of the spine, and involves loss of normal cartilage, and abnormal bone growth at the joint. This can lead to joint pain and stiffness. Back pain from osteoporosis and osteoarthritis may respond to physical treatments, including exercise and braces or supports. Several classes of medications may be helpful, and there are nonsurgical procedures that may help the pain. I would say that most patients with chronic pain have more than one factor that is causing the pain. There is almost always some strategy that can be tried.
Question:
I have had a head cold for 2 wks and have had pain in my ribs since the cold began. The pain is mostly in the back ribs but also along the sides. Could this indicate anything serious? What should I do? Lillian in Peabody, MA
Answer:
I recommend that you see your primary care physician as soon as possible, since you have had this illness for some time. Have you had fevers? Symptoms you describe could be anything from a simple cold or flu that could resolve by itself, to something more serious like a pneumonia that requires treatment. Because it has been there two weeks, I think you should be evaluated by a physician. A general point from this question is that back pain can be a symptom of systemic illness, and is not always a problem with the spine itself. Fevers with back pain can be a sign of such an illness, and should be evaluated.
Question:
Is the Kyphoplasty procedure only good if the patient has a bone fracture? What about disc issues? Ruptured and degenerative dics? Susan in Billerica, MA
Answer:
Kyphoplasty is a type of procedure known as vertebral augmentation. Another well-known vertebral augmentation is vertebroplasty. These are minimally-invasive techniques that involve anesthetizing the skin and precisely placing a thin tube through the skin into the fractured or collapsed vertebral body and injecting it with a bone-filling substance to stabilize the bone and reduce pain. Specifically in kyphoplasty, a special balloon is used to correct the kyphosis, which is the shape that can result from a vertebral fracture. Kyphoplasty is typically used for vertebral compression fractures. There are several spine procedures used to diagnose and treat pain from intervertebral discs, but these are different from vertebral augmentation. Disc procedures often involve placing a special type of probe through the anesthetized skin, into the disc, then delivering energy to the disc that causes it to change shape and stop pain. There are also minimally invasive surgical techniques to remove parts of discs. It is common for someone with back pain to eventually have an MRI, and then be informed that they have ruptured or degenerated discs. However, it is not so easy to tell if this is really the cause of back pain, and many times a disc that looks abnormal on MRI is not really the problem. The first step for someone with back pain is a careful evaluation by a spine specialist, who can determine what is really causing the pain, and direct you to the appropriate treatment.
Question:
Starting with stenosis & surgery, I now show 4 dried up discs in my lumbar spine. I have done aggressive exercise as directed by my doctor for a year without much improvement. What options should I now pursue? Dave in Rockport, MA
Answer:
It is encouraging that you have been so physically active. It is possible that your exercise program is preventing worse pain. However, it sounds like something different needs to be tried if you are having pain with inadequate relief. Loss of water from discs is actually a normal or expected finding with the aging process, so it is not so easy to say that this is a problem in your case. The symptoms of spinal stenosis can improve, but this may be slow. Is the pain you have now in a similar pattern or location as before surgery? If something has changed, first a determination needs to be made about what the source of pain is. This could be accomplished by careful evaluation, possibly including diagnostic injections. You mention that you have already had recent imaging. There may be other options for you.
Question:
I have been having lower back pain now for about a year and it has gotten progressively worse. It is very painful at night. I have recently also begun feeling pain in my right hip and finding climbing stairs painful. Additionally, I can now add right shoulder discomfort to the list. I also suffer from what I thought was stress incontinence (for several years since having children). There is a history of osteoperosis in my family and I have osteopenia. I am 53 years old, active, 5'7" and weigh about 138lbs. My doctor suggested I get physical therapy. I am concerned that it might be wise to first get x rays or other diagnostic tests prior to physical therapy. Should I push for more diagnostic tests to better determine the source of the problem? Your website listed many of the above as indicators of a more serious problem--any insights as to what these more serious problems might be in my case? Jean in Chelmsford, MA
Answer:
Based on the progressive and spreading quality of your back pain, and the description of pain as being worse at night, I believe you should be evaluated by a physician who is a spine specialist in order to determine the cause of pain. A spine specialist can determine which diagnostic test to order, such as MRI, if needed. In your case, it might be good to wait on physical therapy until you have been seen by the spine specialist. There are exercise and diet recommendations for the prevention of osteoporosis. Pain that is worse when you lie flat can be concerning, but is not a diagnostic sign by itself. The bladder symptoms that are "red flags" associated with back pain are due to cauda equina syndrome, a pressing on the lowest nerves in the spinal canal. Symptoms of cauda equina syndrome include new onset of bladder incontinence or decreased sensation in the groin, buttocks or thighs. Cauda equina syndrome is a medical emergency that needs to be evaluated immediately. Chronic stress incontinence as you describe is not the same as cauda equina syndrome, but someone with stress incontinence could still develop cauda equina. Have your symptoms of incontinence worsened? Your height and weight gives you a body mass index of 21.6, which is in the normal range. Has your weight changed recently? I do not have enough information to evaluate the shoulder pain. A common reason to have shoulder pain associated with back pain brings up the concept of the kinetic chain. The kinetic chain idea is that your entire body is a series of moving parts, and movement is transfered from one end to the other. For example, if someone has a stooped posture due to a spine problem, their kinetic chain is altered, and they have to reach higher when getting something off the shelf, which can result in shoulder pain.
Question:
In April an MRI indicated degenerative arthritis . I have had four injections of steroids with no favorable results; physical therapy has not had good results either. Recent aqua physical therapy, although low key, increased the pain. I am an active 82 year old. I spent the winter downhill skiing and exercising at the YMCA until March 2008. I have been active my entire adult life. Is surgery possible for relief? John in North Reading, MA
Answer:
After a certain age, almost everyone will have signs of wear and tear on imaging tests such as MRI, even people who have never had pain. This means that we cannot use imaging alone to determine the cause of pain. There are several different types of steroid injections - which type did you have? Did you have diagnostic blocks (injections)? Arthritis of the spine often involves the zygapophyseal (facet) joints, the small, paired joints toward the back of the spine, or the sacroiliac joints. Diagnostic blocks with a numbing medication are the best test to determine if these joints are involved, but these diagnostic blocks must not be confused with therapeutic injections. A diagnostic block may make you feel better temporarily, but the pain returns. That does not mean the injection didn't work. The idea is, if the diagnostic block works temporarily, then a more lasting procedure can be done next. Arthritis of the joints of the spine can be injected directly with steroid, or the sensation to the joint can be interrupted in a way that lasts a long time, using various technologies that are similar to the injections.
Question:
I was diagnosed with a herniated disc last year. It eventually got better and I had no pain. Lately after doing some heavy lifting it reoccured again. Now I can't stand for more than 30 minutes or have severe pain when washing dishes. Any advice? Harold in Chelsea, MA
Answer:
Herniated discs are a common source of back pain. What many do not know is that the body does heal and reabsorb these discs over time. However, back pain can happen again, and a disc that has healed can rupture again. Most episodes of acute low back pain will respond to conservative care, such as physical ways of pain treatment, activity modification, medication and targeted injections. A very small number (maybe even as low as 1%) require surgery. My advice to everyone is to learn or review proper lifting techniques. Lifting with the legs, and holding the weight close to your center of gravity, tremendously reduces the forces on your spine. If you are having severe pain, consider seeing your primary care physician, and consider a referral to a comprehensive spine care center, where you will be directed to the appropriate therapy.
Question:
I have radiating from one side to the other lower back pain, only in bed, on waking up in early morning. No GU problems, very active tennis player of 68, no pain on running or walking. Primary care offers PT; should I be consulting an orthopedic or neurology specialist? Kate in Souderton, PA
Answer:
I am encouraged to hear that you are so physically active. You are describing a pattern of morning pain. This can be associated with irritation of joints, as in arthritis. In some cases, it can be associated with a special category of arthritis, called spondyloarthropathy. Back pain in spondyloarthropathy tends to be worse in the morning, and improves with activity. Spondyloarthropathy pain usually begins earlier in life that age 68, and is more common in men, but women also have it. Physical therapy can be beneficial for this pattern of pain. Because back pain in general is so common and important, physicians from many medical specialties are dedicated to diagnosing and treating disorders of the spine. If you seek consultation with a specialist, you want to go to one who specifically specializes in spine disorders. This could be a physiatrist, orthopedist, neurologist, or others. When you talk to your primary care doctor, discuss if you need an evaluation by a rheumatologist or a spine specialist.
Question:
I have had low back pain on a daily basis for 9 years. Sometimes after driving it takes me 5 - 10 minutes to be able to get out of the seat. Several times my back has "pinched" while picking something up or twisting to the side (to look either left or right) and I have fallen to the ground because I could not hold myself up. I am 35 now and getting concerned about this ongoing problem. Should I be worried? Sam in Northwood
Answer:
Chronic lumbosacral spinal pain is most commonly attributed to the intervertebral discs, facet or zygapophyseal joints, and sacroiliac joints. Wear and tear commonly affects these structures of the spine. Lifting and twisting causes especially high stress on the spine, so proper technique is important for everyone. You describe difficulty in getting out of the car – this may be start pain. Start pain can be due to irritation of joints, arthritis, or in some cases, a type of arthritis known as spondyloarthropathy. You have had pain for nine years – what diagnostics or treatments have been tried? Are things getting worse? If you are concerned then you should seek a medical opinion about your condition, if you have not already done so. A better understanding of your condition may reduce your worry. The medical definition of pain includes the emotional component, and it is often this part that is the worst.
Question:
I'm a 40yr old female that has suffered from chronic back pain since 2004. I have been on pain meds ever since. I have also tried physical therapy and steroid injections with no relief. According to the MRI I have arthrits. Is there any medication that I can bring up with my PCP? I have been on Percocet for four years and I would like to try to get of this narcotic if possible. Lydia in Framingham, MA
Answer:
While Percocet is a useful medication in many instances of acute pain, patients with chronic back pain have other options. There are too many to list here completely, but here are a few general thoughts: Some of the NSAIDS have analgesic properties as good as Percocet. Acetaminophen can be given without the oxycodone component. Tramadol is an option to replace oxycodone, and this can be used with acetaminophen. There are several classes of adjuvant pain medications, such as tricyclics, that can be helpful for chronic pain. Supervised physical therapy is best when it gets you started on a plan of action that can continue after your sessions are complete. For example, you can learn to use exercise, ice, heat, TENS, or other techniques at home. Sometimes, a refresher in supervised physical therapy is necessary if it has been a while since your last session, or if your condition has changed. There are many types of steroid injections – which did you have? It is possible that a different injection could work for you.
Question
Are there any tests for reflex symathetic dystrophy? Dotty in Gloucester, MA
Answer:
Reflex sympathetic dystrophy and causalgia are the old terms for a spectrum of pain disorders now referred to as complex regional pain syndromes (CRPS) type I and type II. Symptoms of CRPS include severe pain that is disproportionate to any inciting event, and there may be associated changes in skin, hair, nails or even bones and soft tissues. There is no specific test for CRPS, and diagnosis is usually based on the history and pattern of signs and symptoms. There are tests that may be used to help support the diagnosis, including bone scan, fine-detail x-ray, and various types of electrodiagnostic tests of the nervous system.
Question:
I have had occasional lower back pain for the past several months around the kidney area that has not improved. My blood work came back fine. What could be the cause of this nagging situation? Mark in Topsfield, MA
Answer:
Lumbosacral spinal pain is most likely due to irritation of ligaments, muscles, small joints (zygapophysial or facet joints), or even the intervertebral discs. The sacroiliac joints may also be involved. There are disorders that cause back pain, which may be associated with nonspecific blood test abnormalities. For example, it is possible to have a kidney problem that causes back pain, such as an infection. In such a case, a blood test might reveal an infection or kidney dysfunction. However, there are no specific blood tests that diagnose back pain.
Question:
I had pain for a few days and went to my doctor, but he wouldn’t even order an x-ray. Should I go see someone else? JD in Natick, MA
Answer:
Patients need to ask “How would this MRI change things for me?” As surprising as it may seem, most back pain does not require any imaging. That's because about 90 percent of acute back pain episodes resolve on their own. An MRI may not improve the outcome in these cases, and an unnecessary MRI could actually lead you down the wrong path, such as having an unnecessary procedure.
Imaging can be deceiving sometimes, as numerous studies have shown. For example, if you take 100 people who have no medical problems-- and no back pain--and you do an MRI, there will often be a “spine problem” that shows up. In fact, up to half will have a bulging or herniated disc, despite the fact that the person has no back pain.
Very sensitive tests like MRI may fool you into thinking you have found the cause of pain, when really it is not significant. On the other hand, an MRI might truly reveal the cause of pain, but then what? For most acute back pain episodes, conservative therapy for the first few weeks resolves the problem. For example, the body can absorb and heal disc herniations. In these cases, getting an MRI too early would not be helpful for the treatment plan.
In general, imaging can also expose patients to other risks, such as radiation, and imaging adds tremendously to the overall cost of health care. The bottom line--qualified spine specialists know when to order an image study and when not to. Find a doctor you trust and work together toward resolving your back pain.
Be sure to contact your doctor with any questions you may have about your medical condition.
Answered by Dr. John Keel, Medical Director, Spine Center, Beth Israel Deaconess Medical Center.
Question:
I had 2 herniated discs removed back in 1991(L3-L5) and I still have chronic back pain in my lower back and also radiating up and down my leg. At times my spine feels as though it is swollen! Ernie in Brockton, MA
Answer:
Is the pain you experience now the same pain that you had before surgery? Back pain and leg pain can start again after surgery. This is part of why the symptom of pain itself is not an adequate indication for surgery. Pain can recur for several reasons. Residual disc material can herniate again. Scar tissue can form, and it can press on nerves. Infection is always a concern if there has been a recent medical procedure and you are having fevers. Your surgery was a long time ago, and it could be that a separate process has developed over time and is causing pain now, such as a different disc level or arthritis of the spine.
Question:
Do inversion tables work to decrease compression and alleviate back pain? My wife has been dealing with back pain for quite some time. I told her to excersise because she is so inactive. She sits all day at work and just lays on the couch all weekend. She has been experiencing an almost constant pain in her spine and numbness in legs and feet. She had injections in the spine but she feels that this did not help and may have even worsened the situation. She has also had bladder control issues in the past.Do you have any advice for us? Andre in Methuen, MA
Answer:
Many studies have been performed to determine if inversion tables and traction devices work for back pain. The overall message is that there have been conflicting results. There are many causes of back pain, and some individuals may benefit, but I would recommend avoiding expensive devices where something less costly will perform the same. Any decompression resulting from inversion is likely to return when you step out of the device. The bladder issues that are concerning with back pain are new onset loss of bladder or bowel control, due to injury to the nerves in the lower part of the spinal canal. This can be associated with numbness in the groin or thighs. If your wife is experiencing this, she needs to be evaluated by a physician immediately.
Question:
I have had the worst back pain for the past 6 months. I have trouble getting up out of a chair, lifting, turning and constant pain. I have always had a bad back but usually it stops hurting after a few weeks and I know when I hurt it from a twist or lift. I also have arthritis in both hips and knees. I am 53 and overweight and tryng to lose weight. The only thing my doctor offers is losing weight and wouldn't order any tests or let me see any specialists. Shirley in Burlington, MA
Answer:
Based on your symptoms, I do think you might benefit from evaluation by a specialist in spine pain. There may be conservative treatments for the type of pain you have. Now let's talk about medical tests: X-rays and MRIs are medical tests. Sometimes there are no good tests when it comes to pain. I do not order tests routinely for back pain. There needs to be a good reason to order a medical test. There needs to be a plan to use the information that will come from the test once you get it. I tell people to ask themselves, "How will this medical test change things for me?" For example, an MRI is a very sensitive test, and many "abnormalities" will be found even in people with no pain, which means that an MRI sees a lot of things that are actually not important. If there is not a plan to do something, like have a surgery or a procedure based on patient condition and the potential MRI result, then why put a person through an MRI? A person may be worried that they have arthritis or a degenerated disc, but if seeing if it is truly there on an MRI is not going to change the medical plan, then there is no reason to get this test. It is not a good idea to order an MRI or x-ray "just to see."
Question:
I have pain in my lower back on my right side only. It hurts to sit and to rise from a sitting position.The pain seems to come from an area the size of a fist. Do you think this could be caused by a pinched nerve (as my chiropractor believes) or could this be sciatica? John in Middleborough, MA
Answer:
Does the pain travel into your leg? That symptom would be more expected with a pinched nerve. There are a lot of structures in the low back that may cause pain, including the facet and sacroiliac joints, the iliolumbar ligament, and back muscles.
Question:
I have been having lower spine pain radiating into my right hip. What can cause this and what can I do to relieve the pain? Barbara in Avon, MA
Answer:
Pain from spine structures is often referred or perceived in other parts of the body. This can be caused in a few ways. For example, the peripheral nerves to your right hip originate in your spine. If there is something irritating the nerve within the spine itself, such as a herniated disc, then the symptoms can be felt all along the path of the nerve, even in the hip. Arthritis in the spine is sometimes felt in the hip. Different parts of the body may share a common spinal nerve level that sends signals to the brain, so a problem in one body part can be perceived in another part that does not truly have a problem. If your pain is significant, the first step for you is to see your primary care physician and determine the most likely cause. This can usually be determined by a detailed interview and a physical examination. This is often a challenge, and as a spine specialist, I need to understand problems with the peripheral joints as well as the spine.
Question:
I have been having back spasms for approximately 6 months. I have seen my doctor 2 times during this time. I have been through physical therapy on 2 occasions, and it appears to help for short periods of time (1 or 2 weeks). The pain is at the middle of my back, under the wings of my back. The muscle under the wing seems to go into spasm with the smallest of movement from typing on the key board to sitting in the car driving to using small power tools. Any preasure that I seem to apply with my right arm seems to trigger the spasms in my back. I have been taking ibuprofen for the pain; it usually takes about 2 weeks to calm down. Any help would be greatley appreciated. George in West Roxbury, MA
Answer:
This sounds like a common syndrome that has been known by a few names, such as scapulocostal syndrome, and others. This can be a very bothersome condition that takes a while to resolve when it flares up. Have you tried sitting posture modifications? Avoid hunching your back or slouching your shoulders forward, as often happens when working at a desk. Position your desk, chair and monitor so that you can look at the screen and have your hands on the keyboard while you are sitting with back and neck upright, with shoulders back and elbows close to your body. Ice packs and massage may be helpful. There are braces that help keep your shoulders back in good posture. Injections (similar to trigger point injections) are sometimes helpful.
Question:
I am scheduled for lumbar fusion in a couple of weeks. I have a lot of people trying to talk me out of this. I have severe DDD and Facet joint disease in L5-S1. Is there a high success rate for this type of surgery with my diagnosis? Debbie in Haverhill, MA
Answer:
The success rate depends more on your signs and symptoms, and not on the fact that you have degenerative disease and facet joint disease. If you are experiencing pain, but you do not have neurologic problems, then I suggest you have a second opinion. There may be nonsurgical treatment options for you.
Question:
I had severe leg pain from 2 rupturted discs putting pressure on nerves, creating intense aching in my left leg. Recently I had lower back surgery (L4 and L5 discs cleaned up). Pain was almost gone and now 4 weeks post-op, my pain level is back and worse than pre-surgery. What options are available to me? Ron in Manchester, NH
Answer:
Are you having fevers or neurological changes? If so, you need to follow up with your surgeon immediately. Is the pain you have now the same type of pain in character and location as before surgery? It is possible for scar tissue to form, resulting in a similar problem that had been caused by the discs. It is possible for disc herniations to happen again, even after surgery. Depending upon you current symptoms, options may include several medication types, physical therapy, nonsurgical procedures such as injections, and possibly revision surgery.
Question:
Is there anyting that can be done for lower back pain if you have arthritis in my back? My doctor said it's the nerves. Heidi in Andover, MA
Answer:
There is a whole medical industry devoted to low back pain of any cause. There are numerous diagnostic and therapeutic options for low back pain, as it is one of the most important medical problems in our society. Most back pain does not need surgery. The mission of the Spine Center at BIDMC to provide a comprehensive, interdisciplinary approach that directs patients to the most effective and appropriate options first.
Question:
I have neck pain whch radiates down my back. My arm feels weak when I write. MRI/CAT SCAN c5/c6 posterior disc ostephyte complex, with left paracentral disk protrusion which is partly calcified along the margin. Mild narrowing of the central canal, eccentric to left. With a uncovertebral squaring with moderate right and severe left neural forminal stenosis. Tried everything from physical therpay to corticosteroid shots. It has impacted my life; hard to read books, push a vacuum; garden, lift things. Not sure what to do next. One doctor says anterior fusion, another says just go in through the back and clean out the area, no fusion. Both say it will help the arm pain, but not sure about the neck and back pain. I'm not sure where to go from here. Any recommendations? Roberta in Shrewsbury, MA
Answer:
Are you left-handed or right-handed? I would be glad to review this or evaluate the patient in clinic. The purpose of the surgery would be to decompress areas where nerves are compressed, in hopes of improving the nerve, which affects the arm. Neck pain itself may not be affected in such a case. There are nonsurgical procedures that can help the neck pain. Regarding surgical approach, there is often more than one acceptable approach to a medical problem. One problem with second opinions is that you can end up more confused as a patient. How bad is your weakness? Is it getting worse? Do you have symptoms in your legs? Is the predominant symptom the neck pain or the arm problem?
Question:
I have been diagnosed with Lumbar Spinal Stenosis. I have been on Endocet for about 8 years; I was also on Naproxen but I got an ulcer. I noticed that the pain was tolerated much better with the naproxen along with the endocet, but since I cannot take it any longer, I only have the endocet. This drug is starting not to work so well and I'm wondering what the next step would be? Elizabeth in Medford, MA
Answer:
Endocet is a combination of acetaminophen and oxycodone, medications from two different categories. For many reasons, medications from different categories often work better when combined, as with Endocet. Naproxen is a third category again, so when you took this also you effectively had three medications targeting your pain, via different pathways in the body. However, Endocet is typically used for acute pain, and may not be the best for chronic conditions. Naproxen is an NSAID, and these are known for upsetting the stomach lining, causing bleeding or bruising, and affecting the kidneys. Regarding GI damage risk and NSAIDs, the category of NSAID may not matter as much as the duration of use. Possible options may include a long-acting medication or different categories of medications such as gabapentin or tramadol. Physical therapy or other conservative treatments may be helpful as well.
Question:
My back is sore when I get up in the morning but as time goes on, it gets better. I am an active 54 year old male, running about 40 miles per week. This has been going on for about 6 weeks. Suggestions? Thanks in advance. – Jerry, Townsend
Answer:
Jerry, stiffness in the morning is often described by people with back pain. It is not a definite sign of a specific problem, but it can be associated with inflammatory conditions such as the spondyloarthropathies, rheumatoid arthritis, and polymyalgia rheumatica. Do you have any other symptoms, or have you been ill recently? It sounds like you are very active - 40 miles a week is great!
Question:
I have been told I have arthritis and stenosis in my lumbar spine. The pain radiates to my hips and it is nearly impossible for me to walk any distance without extreme pain. I have had acupuncture at Beth Israel I have had steroid injections and two 6-week periods of physical therapy. The pain has never subsided. Because I do not hurt while I am sitting, that’s what I do most of the time, I have gained about 30 pounds in the past 2 years. The injections did help for a short period, but I am diabetic and it raised my blood sugar very high to over 300. HELP. – John, Marshfield
Answer:
There are a range of medication classes that could be helpful, John, if medications have not been tried. Epidural steroid injections can be repeated. It is true that epidural steroids have systemic effects, including increased blood glucose. What dose of steroid have you received, and how often? A spinal cord stimulator can sometimes be helpful, especially for the leg component of pain. Have you discussed these options with the clinic you visited previously? Have you tried using a walker? The pain of stenosis is often relieved when walking with support such as a cart or walker. Given the severity of symptoms, and the fact that a lot of conservative measures have been tried, an evaluation by a spine surgeon should be considered.
Question:
I have had back, knee, and especially feet pain, which has caused painful peripheral neuropathy. After knee replacement surgery two years ago, I am in more pain than a year ago. All this makes me walk tilted or bent over from back pain. Even prescription pain meds do not help!!! My quality of life as a special needs teacher and the grandmother of nine has been "put on hold." I no longer work and can not help with the grandchildren as much as I would enjoy. –Prudy, Plymouth
Answer:
Prudy, it sounds like you have more than one source of pain. What is the cause of your neuropathy? The usual pain medications may not be helpful for pain that is due to neuropathy. We call such pain "neuropathic pain," and medications used to treat it were often originally used for depression or seizures. Gait training with a physical therapist might help some of your discomfort.
Question:
I have recently had a total hip replacement and scheduled for another. My lower back problems have persisted for a number of years. I played rugby for 13 years but stopped playing in 1997 due to heart problems I believe brought on by sleep apnea(what a mess). I am 47, 6'1" and 270 lbs and I have always worked out and kept my back strong. I currently have pins and needle like pain when I am lying down to sleep. With this information, which hospital due you feel is best to deal with this problem, and a name of a doctor if possible.- Mike, Marshfield
Answer:
Mike, not sure which hospital you are having your hip replacement at or if you have a primary care physician who might refer you to a comprehensive center closer to you, but I would be happy to see you at the BIDMC Spine Center. Call 1-800-667-5356 and ask to make an appointment with Dr. John Keel.
Question:
I have spinal stenosis, 4 herniated discs, disc degeneration. I've looked into disc replacement but it isn't covered by insurance. When and what type of operation will help me? I've been dealing with this for 9 years and I'm currently on disability. –Janet, Revere
Answer:
Disc replacements and other devices are now marketed directly to patients. However, it can take a while for science to give a verdict on what really happens when we use a new device, in the long run. Be careful not to fall into the trap of becoming convinced that a new device is the cure for your symptoms. Most back pain does not require surgery. The role of disc replacement is limited, and is still controversial at this time. In general, you do not want to have a back surgery unless there is something definite in your spine that needs to be stabilized, decompressed or removed. There is a whole range of conservative options that might help you.
Question:
I have had a total spinal collaspe due to osteoprosis at a young age. I have developed osteoarthrits of the spine and experience pain on a daily basis that is negatively affecting my life. Can anything be done to alleviate the pain? I am currently on reclast and have not had any recent fractures. Virginia in Manchester, NH
Answer:
Osteoporosis and osteoarthritis are two different conditions that can cause spine pain, and it is possible to have both. Osteoporosis involves decreased mineralization of bone, and can lead fractures of the spine (arm and hip fractures are also more common). Back pain in osteoporosis can be due to acute or unhealed fractures, or altered forces on the body due to changes in the overall shape of the spine. Osteoarthritis affects the joints, including the joints of the spine, and involves loss of normal cartilage, and abnormal bone growth at the joint. This can lead to joint pain and stiffness. Back pain from osteoporosis and osteoarthritis may respond to physical treatments, including exercise and braces or supports. Several classes of medications may be helpful, and there are nonsurgical procedures that may help the pain. I would say that most patients with chronic pain have more than one factor that is causing the pain. There is almost always some strategy that can be tried.
Question:
I have had a head cold for 2 wks and have had pain in my ribs since the cold began. The pain is mostly in the back ribs but also along the sides. Could this indicate anything serious? What should I do? Lillian in Peabody, MA
Answer:
I recommend that you see your primary care physician as soon as possible, since you have had this illness for some time. Have you had fevers? Symptoms you describe could be anything from a simple cold or flu that could resolve by itself, to something more serious like a pneumonia that requires treatment. Because it has been there two weeks, I think you should be evaluated by a physician. A general point from this question is that back pain can be a symptom of systemic illness, and is not always a problem with the spine itself. Fevers with back pain can be a sign of such an illness, and should be evaluated.
Question:
Is the Kyphoplasty procedure only good if the patient has a bone fracture? What about disc issues? Ruptured and degenerative dics? Susan in Billerica, MA
Answer:
Kyphoplasty is a type of procedure known as vertebral augmentation. Another well-known vertebral augmentation is vertebroplasty. These are minimally-invasive techniques that involve anesthetizing the skin and precisely placing a thin tube through the skin into the fractured or collapsed vertebral body and injecting it with a bone-filling substance to stabilize the bone and reduce pain. Specifically in kyphoplasty, a special balloon is used to correct the kyphosis, which is the shape that can result from a vertebral fracture. Kyphoplasty is typically used for vertebral compression fractures. There are several spine procedures used to diagnose and treat pain from intervertebral discs, but these are different from vertebral augmentation. Disc procedures often involve placing a special type of probe through the anesthetized skin, into the disc, then delivering energy to the disc that causes it to change shape and stop pain. There are also minimally invasive surgical techniques to remove parts of discs. It is common for someone with back pain to eventually have an MRI, and then be informed that they have ruptured or degenerated discs. However, it is not so easy to tell if this is really the cause of back pain, and many times a disc that looks abnormal on MRI is not really the problem. The first step for someone with back pain is a careful evaluation by a spine specialist, who can determine what is really causing the pain, and direct you to the appropriate treatment.
Question:
Starting with stenosis & surgery, I now show 4 dried up discs in my lumbar spine. I have done aggressive exercise as directed by my doctor for a year without much improvement. What options should I now pursue? Dave in Rockport, MA
Answer:
It is encouraging that you have been so physically active. It is possible that your exercise program is preventing worse pain. However, it sounds like something different needs to be tried if you are having pain with inadequate relief. Loss of water from discs is actually a normal or expected finding with the aging process, so it is not so easy to say that this is a problem in your case. The symptoms of spinal stenosis can improve, but this may be slow. Is the pain you have now in a similar pattern or location as before surgery? If something has changed, first a determination needs to be made about what the source of pain is. This could be accomplished by careful evaluation, possibly including diagnostic injections. You mention that you have already had recent imaging. There may be other options for you.
Question:
I have been having lower back pain now for about a year and it has gotten progressively worse. It is very painful at night. I have recently also begun feeling pain in my right hip and finding climbing stairs painful. Additionally, I can now add right shoulder discomfort to the list. I also suffer from what I thought was stress incontinence (for several years since having children). There is a history of osteoperosis in my family and I have osteopenia. I am 53 years old, active, 5'7" and weigh about 138lbs. My doctor suggested I get physical therapy. I am concerned that it might be wise to first get x rays or other diagnostic tests prior to physical therapy. Should I push for more diagnostic tests to better determine the source of the problem? Your website listed many of the above as indicators of a more serious problem--any insights as to what these more serious problems might be in my case? Jean in Chelmsford, MA
Answer:
Based on the progressive and spreading quality of your back pain, and the description of pain as being worse at night, I believe you should be evaluated by a physician who is a spine specialist in order to determine the cause of pain. A spine specialist can determine which diagnostic test to order, such as MRI, if needed. In your case, it might be good to wait on physical therapy until you have been seen by the spine specialist. There are exercise and diet recommendations for the prevention of osteoporosis. Pain that is worse when you lie flat can be concerning, but is not a diagnostic sign by itself. The bladder symptoms that are "red flags" associated with back pain are due to cauda equina syndrome, a pressing on the lowest nerves in the spinal canal. Symptoms of cauda equina syndrome include new onset of bladder incontinence or decreased sensation in the groin, buttocks or thighs. Cauda equina syndrome is a medical emergency that needs to be evaluated immediately. Chronic stress incontinence as you describe is not the same as cauda equina syndrome, but someone with stress incontinence could still develop cauda equina. Have your symptoms of incontinence worsened? Your height and weight gives you a body mass index of 21.6, which is in the normal range. Has your weight changed recently? I do not have enough information to evaluate the shoulder pain. A common reason to have shoulder pain associated with back pain brings up the concept of the kinetic chain. The kinetic chain idea is that your entire body is a series of moving parts, and movement is transfered from one end to the other. For example, if someone has a stooped posture due to a spine problem, their kinetic chain is altered, and they have to reach higher when getting something off the shelf, which can result in shoulder pain.
Question:
In April an MRI indicated degenerative arthritis . I have had four injections of steroids with no favorable results; physical therapy has not had good results either. Recent aqua physical therapy, although low key, increased the pain. I am an active 82 year old. I spent the winter downhill skiing and exercising at the YMCA until March 2008. I have been active my entire adult life. Is surgery possible for relief? John in North Reading, MA
Answer:
After a certain age, almost everyone will have signs of wear and tear on imaging tests such as MRI, even people who have never had pain. This means that we cannot use imaging alone to determine the cause of pain. There are several different types of steroid injections - which type did you have? Did you have diagnostic blocks (injections)? Arthritis of the spine often involves the zygapophyseal (facet) joints, the small, paired joints toward the back of the spine, or the sacroiliac joints. Diagnostic blocks with a numbing medication are the best test to determine if these joints are involved, but these diagnostic blocks must not be confused with therapeutic injections. A diagnostic block may make you feel better temporarily, but the pain returns. That does not mean the injection didn't work. The idea is, if the diagnostic block works temporarily, then a more lasting procedure can be done next. Arthritis of the joints of the spine can be injected directly with steroid, or the sensation to the joint can be interrupted in a way that lasts a long time, using various technologies that are similar to the injections.
Question:
I was diagnosed with a herniated disc last year. It eventually got better and I had no pain. Lately after doing some heavy lifting it reoccured again. Now I can't stand for more than 30 minutes or have severe pain when washing dishes. Any advice? Harold in Chelsea, MA
Answer:
Herniated discs are a common source of back pain. What many do not know is that the body does heal and reabsorb these discs over time. However, back pain can happen again, and a disc that has healed can rupture again. Most episodes of acute low back pain will respond to conservative care, such as physical ways of pain treatment, activity modification, medication and targeted injections. A very small number (maybe even as low as 1%) require surgery. My advice to everyone is to learn or review proper lifting techniques. Lifting with the legs, and holding the weight close to your center of gravity, tremendously reduces the forces on your spine. If you are having severe pain, consider seeing your primary care physician, and consider a referral to a comprehensive spine care center, where you will be directed to the appropriate therapy.
Question:
I have radiating from one side to the other lower back pain, only in bed, on waking up in early morning. No GU problems, very active tennis player of 68, no pain on running or walking. Primary care offers PT; should I be consulting an orthopedic or neurology specialist? Kate in Souderton, PA
Answer:
I am encouraged to hear that you are so physically active. You are describing a pattern of morning pain. This can be associated with irritation of joints, as in arthritis. In some cases, it can be associated with a special category of arthritis, called spondyloarthropathy. Back pain in spondyloarthropathy tends to be worse in the morning, and improves with activity. Spondyloarthropathy pain usually begins earlier in life that age 68, and is more common in men, but women also have it. Physical therapy can be beneficial for this pattern of pain. Because back pain in general is so common and important, physicians from many medical specialties are dedicated to diagnosing and treating disorders of the spine. If you seek consultation with a specialist, you want to go to one who specifically specializes in spine disorders. This could be a physiatrist, orthopedist, neurologist, or others. When you talk to your primary care doctor, discuss if you need an evaluation by a rheumatologist or a spine specialist.
Question:
I have had low back pain on a daily basis for 9 years. Sometimes after driving it takes me 5 - 10 minutes to be able to get out of the seat. Several times my back has "pinched" while picking something up or twisting to the side (to look either left or right) and I have fallen to the ground because I could not hold myself up. I am 35 now and getting concerned about this ongoing problem. Should I be worried? Sam in Northwood
Answer:
Chronic lumbosacral spinal pain is most commonly attributed to the intervertebral discs, facet or zygapophyseal joints, and sacroiliac joints. Wear and tear commonly affects these structures of the spine. Lifting and twisting causes especially high stress on the spine, so proper technique is important for everyone. You describe difficulty in getting out of the car – this may be start pain. Start pain can be due to irritation of joints, arthritis, or in some cases, a type of arthritis known as spondyloarthropathy. You have had pain for nine years – what diagnostics or treatments have been tried? Are things getting worse? If you are concerned then you should seek a medical opinion about your condition, if you have not already done so. A better understanding of your condition may reduce your worry. The medical definition of pain includes the emotional component, and it is often this part that is the worst.
Question:
I'm a 40yr old female that has suffered from chronic back pain since 2004. I have been on pain meds ever since. I have also tried physical therapy and steroid injections with no relief. According to the MRI I have arthrits. Is there any medication that I can bring up with my PCP? I have been on Percocet for four years and I would like to try to get of this narcotic if possible. Lydia in Framingham, MA
Answer:
While Percocet is a useful medication in many instances of acute pain, patients with chronic back pain have other options. There are too many to list here completely, but here are a few general thoughts: Some of the NSAIDS have analgesic properties as good as Percocet. Acetaminophen can be given without the oxycodone component. Tramadol is an option to replace oxycodone, and this can be used with acetaminophen. There are several classes of adjuvant pain medications, such as tricyclics, that can be helpful for chronic pain. Supervised physical therapy is best when it gets you started on a plan of action that can continue after your sessions are complete. For example, you can learn to use exercise, ice, heat, TENS, or other techniques at home. Sometimes, a refresher in supervised physical therapy is necessary if it has been a while since your last session, or if your condition has changed. There are many types of steroid injections – which did you have? It is possible that a different injection could work for you.
Question
Are there any tests for reflex symathetic dystrophy? Dotty in Gloucester, MA
Answer:
Reflex sympathetic dystrophy and causalgia are the old terms for a spectrum of pain disorders now referred to as complex regional pain syndromes (CRPS) type I and type II. Symptoms of CRPS include severe pain that is disproportionate to any inciting event, and there may be associated changes in skin, hair, nails or even bones and soft tissues. There is no specific test for CRPS, and diagnosis is usually based on the history and pattern of signs and symptoms. There are tests that may be used to help support the diagnosis, including bone scan, fine-detail x-ray, and various types of electrodiagnostic tests of the nervous system.
Question:
I have had occasional lower back pain for the past several months around the kidney area that has not improved. My blood work came back fine. What could be the cause of this nagging situation? Mark in Topsfield, MA
Answer:
Lumbosacral spinal pain is most likely due to irritation of ligaments, muscles, small joints (zygapophysial or facet joints), or even the intervertebral discs. The sacroiliac joints may also be involved. There are disorders that cause back pain, which may be associated with nonspecific blood test abnormalities. For example, it is possible to have a kidney problem that causes back pain, such as an infection. In such a case, a blood test might reveal an infection or kidney dysfunction. However, there are no specific blood tests that diagnose back pain.
Question:
I had pain for a few days and went to my doctor, but he wouldn’t even order an x-ray. Should I go see someone else? JD in Natick, MA
Answer:
Patients need to ask “How would this MRI change things for me?” As surprising as it may seem, most back pain does not require any imaging. That's because about 90 percent of acute back pain episodes resolve on their own. An MRI may not improve the outcome in these cases, and an unnecessary MRI could actually lead you down the wrong path, such as having an unnecessary procedure.
Imaging can be deceiving sometimes, as numerous studies have shown. For example, if you take 100 people who have no medical problems-- and no back pain--and you do an MRI, there will often be a “spine problem” that shows up. In fact, up to half will have a bulging or herniated disc, despite the fact that the person has no back pain.
Very sensitive tests like MRI may fool you into thinking you have found the cause of pain, when really it is not significant. On the other hand, an MRI might truly reveal the cause of pain, but then what? For most acute back pain episodes, conservative therapy for the first few weeks resolves the problem. For example, the body can absorb and heal disc herniations. In these cases, getting an MRI too early would not be helpful for the treatment plan.
In general, imaging can also expose patients to other risks, such as radiation, and imaging adds tremendously to the overall cost of health care. The bottom line--qualified spine specialists know when to order an image study and when not to. Find a doctor you trust and work together toward resolving your back pain.
