Severe chronic low back pain -- what works?

[clifffaith]

I'm throwing the topic out there hoping to hear the experiences, good and bad, of fellow Tuggers.

Four years ago last month I started having back issues. First my back was "out" for about three weeks (I'd had two, maybe three "outages" over the previous ten years, always lasting less than four days). Then two months after that I started feeling a knot in my right butt cheek. Of course I Googled "right butt cheek pain" and it seemed like I likely had sciatica, and I did some exercises that seemed to relieve the knotted feel. But by the six month mark I found I had a 35 minute window of opportunity to get cats fed and breakfast on the table, before pain in my right leg forced me to sit down for a few minutes.

At that point I got myself to my GP who wrote me a Rx for flexeril and sent me for a course of physical therapy. When that offered no relief she sent me for an MRI which showed a bulging disc. Off to the spinal surgeon who said "meh, come back if it gets worse" and the rheumatologist who prescribed two more drugs (Tramadol & Diclofenac) and put me on a routine of cortisone injections, just under the skin of my tailbone, every three months. About eighteen months ago the pain was racheting upward and I had my first epidural steroid injection from a pain doctor I was referred to, administered while I was awake. I didn't see any improvement and at the followup appt the next week I told him so. Bastard looked me in the eye and called me a liar. I did not go back to him, and just kept limping (literally many days) along.

By last Memorial Day I could not walk from the car to a store without using my husband for support, so finally broke down and bought a cane. Rheumatologist sent me for a new MRI and said we have to try another epidural because insurance company won't pay for surgery until we've exhausted all other avenues. Saw a new pain Doctor at the end of August who gave me multiple precise epidural injections while I was knocked out. Blessed relief! 100% pain free by third day after procedure. Then at seven weeks and two days we were taking a small stroll on vacation and all of a sudden my right leg "says hello, I'm back". I waited until the cane level pain returned, and a few days before Christmas had another epidural which basically didn't really take. Had to continue to use the cane the first week, then the pain subsided to misery instead of agony levels. Packed the folding cane for our annual two weeks in Hawaii at the end of January, and by the third day of the trip (just over a month from the last epidural) I was back to using it.

So last Wednesday pain Doctor does a different procedure where he threads a "noodle" along the spine to administer the steroids. I'm quite a bit more comfortable, but not pain free, and feel I need to be sure my cane is available in the car at all times, just in case.

This doctor's mantra is NO SURGERY, NO SURGERY, NO SURGERY. Next step, and I strongly suspect that's where we are headed, is an external "electric impulse" device that will then be implanted under the skin if they can get it working for me. My understanding is that the device attempts to reroute and/or disrupt the brain/nerve pain signals.

So I'm wondering what has worked, or at least given some relief, to others. My Chinese pain Doctor says "meh" to acupuncture and acupressure. Tonight's NBC Nightly News mentioned both, as well as yoga. I see ads for the Laser Spine Institute, my rheumatologist says I don't want to go that way because nerves are severed to bring relief. When asked for a referral to a back specialist, my GP says I'm in excellent hands with the current doctors.

 

[VacationForever]

Feel sorry for your pain. Nothing that I can offer. I did the off the shelf (I think it was Shaq's advertisement) electric device thingy, my pain went deeper and worse. Threw that thing in the trash. I have good and bad days. So far my bad days are probably better than most of your days. Sometimes I think surgery is the only long term solution. A friend of mine went through surgery and had 100% recovery. She now gardens, runs with the dog and does everything that she could not do before. I am sure every case is different. Spine doctor from my previous insurance plan would not even see me after my MRI. Said it was not bad enough to waste his time.

 

[geist1223]

I am not a doctor and I am not offering any medical advice. I can say from previous research that surgery for back pain is not a good long term solution for many people. A multi-year study that was published in a very respected peer review medical journal several years ago found that people that had low back surgery were in the same position as people that had conservative care after 5 years. That said everyone is different and what works for one person may not work for another. Also you should not expect a cure from surgery. Surgery at best can reduce pain (not necessarily eliminate pain) and restore some function. It will not completely restore you to where you were before all this started.

 

[ronparise]

My wife had something similar. The MRI showed some arthritis and some disc compression causing irritation of the spinal sac. The pain when it came brought her to the ground

Like you the doctors said surgery wasnt needed. Nobody called her a lier but no one saw anything that would explain the pain either So we found a chiropractor that had s stretching machine and he gave her a bunch of exercises to do in the pool and she lost 25 lbs and we bought an inversion table

The combination worked

 

[artringwald]

I used to throw my back out a couple times a year. The GP would give me flexeril which certainly prevented the spasms, and I'd be better within a week. but the drugs didn't prevent it from happening again. I had been to some different chiropractors, but they didn't help much. When my daughter found one that also had a masseuse, I thought I'd try it. I get an adjustment every 3 weeks, with a massage every 6 weeks, and my back has been behaving for several years now. Good chiropractors can be hard to find.

I've had friends with success at a neck and back clinic that specializes in physical therapy exercises to strengthen the muscles that help hold the disk in place.

 

[klpca]

I had a similar experience to Art using a chiropractor. I was a complete non-believer, but after 30 days of excruciating sciatic pain caused by a long car ride in an uncomfortable seat, I was willing to try anything. The pain relief was noticeable after the first treatment, and completely gone within 3 weeks. I went regularly for a few months and haven't needed to go back since. I notice that you are in San Pedro. My Dr. is in San Diego. PM me if you would like her contact information. She practices a different type of chiropractic and I cannot remember what it is called, but she may be able to refer you to a similar practitioner closer to your home. She also had be use a wedge pillow for sitting. It took a lot of the pressure off of the sciatic nerve. Best of luck to you no matter what you try.

 

[Jan M.]

I've talked to a couple of people who had the laser surgery after exhausting all other options including major back surgery and having nerves cut. They had nothing but good things to say about it.

My back problems stemmed from a car accident when I was 18. When I was about 28 I had a really bad fall on a wet grocery store floor that made it much worse. I had my last MRI 6 years ago at age 59 and the doctor was really grim when discussing the results with me. Some of the bulging discs in my lower back are completely desiccated, meaning there is nothing left, there are bulging discs in my very upper back/neck and I have some spinal stenosis in my lower back. He was stunned when I told him I wasn't too concerned because I was in less pain now than I had been in years. Also that I was very pleased to hear that there were no signs of arthritis in my back. The discs that are still bulging do give me problems when I'm not careful or over do things.

Over the years I've seen a number of different "specialists". When I was 45 my family doctor sent me to a neurologist because I was in such pain that I was only able to sleep for a couple of hours when I was collapsing from exhaustion. The stress and abuse my right side had taken for too many years was finally catching up with me and I was having trouble with my shoulder, hip, thigh and knee on that right side. The neurologist was absolutely astounded that none of the other doctors had ever ordered an MRI nor had I ever had an EMG test for nerve damage. Every doctor I had ever seen in the past would waste my time and our money as our insurance doesn't cover everything on x-rays and other tests that don't show disc problems then have the nerve to tell me they couldn't see anything wrong with my back. When I would ask why they were ordering the same tests that had been done previously and showed nothing instead of ordering the better tests, the response was always "well the insurance companies..." Somehow I seriously doubt that insurance companies are happy to pay for the same worthless tests over and over. And one "specialist" even went so far as to suggest I see a psychologist because it was clearly all in my head.

Thanks to years of those "specialists" incompetence the tests the neurologist ordered confirmed that I had bulging, herniated discs and showed that I had an absolutely terrifying amount of nerve damage in my legs and feet. When the discs bulged they pinched the nerves and because it was bad enough and went on long enough the some of the nerves are permanently damaged. The doctor and techs administering the EMG test at one point thought there was something wrong with their equipment because I wasn't responding. They had to keep increasing the level and kept going over my legs and feet again and again. They kept asking me if I was okay and I told them that thanks to years of suffering with my back that I had an exceptionally high pain threshold. By the time they got to my buttocks and lower back they were putting enough juice into me to bring my whole body off the table. Once it got to that point I held out as long as I could but I finally had to say that they only had one or two more goes before I couldn't take any more. My husband was there with me and he still says it was one of the worst things he has ever seen someone go through. I was like a wrung out dishrag by the time they were done with me and not only was my husband distressed but the doctor and techs were clearly upset too. Talk about depressing! On the way home I joked to my husband that any hopes I had for a career as a spy were gone because if I was ever threatened with torture I would tell everything I knew in a heartbeat. As bad as it was I would do in again without hesitation because in the following months I saw improvement that had to be from the electrical stimulation of the nerves during that test. I was pretty excited to have that conclusion validated when not too long after that it was in the news that Christopher Reeve's doctors had used electrical stimulation of his nerves with noticeable results.

The neurologist sent me to physical therapy and put me on muscle relaxants and anti inflammatory meds to get the pain under control. He also told me to use cold packs instead of the heat I'd been using. He really lectured me about not letting anyone talk me into surgery. He said most people weren't significantly better off after the surgeries and some were even worse off but that someday there would be a surgery that would help people like me. Now 20 years later there is laser surgery and it is minimally invasive with almost immediate results. From what I've read they can seal up bulging discs in addition to doing other things now with the laser surgery.

 

[Phydeaux]

From the OP's remarks, none of these 'Band Aide' approaches have had success, for the long term. That only leaves one option, doesn't it?

 

[Glynda]

I too had a lot of pain from a bulging disk, arthritis and severe stenosis in my lower spine. I did a couple of rounds of PT, took many different drugs leading up to my becoming a zombie on Morphine. I had the TENS unit. I had all the injections ending with a series of Radio Frequency Ablation. Finally, I stopped all pain meds except Flexeril. I lost forty pounds. Stopped gardening. Stopped vacuuming and mopping my house and hired a housekeeper. We bought a new mattress. I don't know which did it but until about three months ago, when I stupidly lifted three heavy boxes that UPS left at the bottom of the steps in the rain and carried them up and into the house, I have been pain free. There was another time I had a year pain free and that was when I saw a chiropractor who used the Activator Method. When the pain returned and I saw him again, it did not work again, however. I saw numerous orthopedic doctors and pain specialists and none recommended surgery. Sorry you are hurting so! I can understand your frustration! Having your life so disrupted by pain sucks!

 

[artringwald]

In the news today.

Forget the drugs, the answer to back pain may be Tai chi, massage

The answer to lower back pain may lie not in prescription drugs, but in Tai chi, heat therapy or massage, according to health guidelines released Tuesday.

New guidelines from the American College of Physicians (ACP) detail which treatments may help with lower back pain, and make it clear that physicians should suggest prescription drugs as a last resort.

One in four U.S. adults report having lower back pain, which typically goes away in a few days or weeks without treatment, according to the guidelines. The guidelines published in the Annals of Internal Medicine, mark a change from previous medication-first recommendations for treating lower back pain.

 

[geist1223]

In a prior job I had to review numerous MRI'S and Imaging Reports. I also spoke with many surgeons - orthopedic and Neuro. They had all seen Imaging Studies of the low back that were so bad they were surprised the person could walk. Yet the patient reported no pain and no restrictions on function. They had also seen Imaging Studies that were as pure as could be seen and yet the patient reported significant pain and restrictions on function. They explained that you treat the patient not the Imaging Study. They would all point to my Pot Belly and tell me that is a large contributor to low back problems.

 

[VacationForever]

In a prior job I had to review numerous MRI'S and Imaging Reports. I also spoke with many surgeons - orthopedic and Neuro. They had all seen Imaging Studies of the low back that were so bad they were surprised the person could walk. Yet the patient reported no pain and no restrictions on function. They had also seen Imaging Studies that were as pure as could be seen and yet the patient reported significant pain and restrictions on function. They explained that you treat the patient not the Imaging Study.

Tell that to the spine doctor who refused to see me.

 

[rickandcindy23]

I have sciatic pain in my butt but know it's my other hip. It feels just like my right hip did before my surgery, and now the right hip is great, and my left butt cheek is hurting quite a bit. It's not bad enough yet to go to the doctor, it took about five years before it was unmanageable on the right side, so I have to assume it will have to be much worse to get a new hip. My complaints fell on deaf ears initially, with my doctor, and it will again.

 

[clifffaith]

Feel sorry for your pain. Nothing that I can offer. I did the off the shelf (I think it was Shaq's advertisement) electric device thingy, my pain went deeper and worse. Threw that thing in the trash. I have good and bad days. So far my bad days are probably better than most of your days. Sometimes I think surgery is the only long term solution. A friend of mine went through surgery and had 100% recovery. She now gardens, runs with the dog and does everything that she could not do before. I am sure every case is different. Spine doctor from my previous insurance plan would not even see me after my MRI. Said it was not bad enough to waste his time.

I bought one of the electric devices in early December. I also felt I was worse the next day so haven't used it again. I have a former co-worker and a client who feel their surgeries were successful, but my pain guy is insistent that there is no way to avoid scar tissue which will make matters worse.

 

[clifffaith]

My wife had something similar. The MRI showed some arthritis and some disc compression causing irritation of the spinal sac. The pain when it came brought her to the ground

Like you the doctors said surgery wasnt needed. Nobody called her a lier but no one saw anything that would explain the pain either So we found a chiropractor that had s stretching machine and he gave her a bunch of exercises to do in the pool and she lost 25 lbs and we bought an inversion table

The combination worked

Two years into my ordeal I lost about 35 pounds. 15 of those are back. I keep saying I'd like to lose thirty pounds again (at 61 I will never see 125 on the scale, but I think weighing 150 instead of 180 can't help but be an improvement). Although I've seen a chiro in the past with some success for headaches and back issues, the leg pain feels so different it never even crossed my mind to see a chiro. After the initial 3 week period four years ago where my back was "out", 90% of my pain is in my right leg.

 

[clifffaith]

I had a similar experience to Art using a chiropractor. I was a complete non-believer, but after 30 days of excruciating sciatic pain caused by a long car ride in an uncomfortable seat, I was willing to try anything. The pain relief was noticeable after the first treatment, and completely gone within 3 weeks. I went regularly for a few months and haven't needed to go back since. I notice that you are in San Pedro. My Dr. is in San Diego. PM me if you would like her contact information. She practices a different type of chiropractic and I cannot remember what it is called, but she may be able to refer you to a similar practitioner closer to your home. She also had be use a wedge pillow for sitting. It took a lot of the pressure off of the sciatic nerve. Best of luck to you no matter what you try.

Well it definitely seems like it couldn't hurt to see a chiropractor. It just never occurred to me since I have mostly leg pain. Haven't seen my gal in probably 8 years. Think I'll wait a bit until I see how the most recent pain Doctor procedure works out, then when the pain starts to come back toward cane level I'll go see the chiro.

 

[TUGBrian]

same as above...going to an actual chiropractor did wonders when something "popped" in my back one day...

part of the regular visits included most of the above...and i really loved their little "tens" unit to shock the back....the one the doctor had included like 8 or 10 different pads all placed from your buttox to your mid back...and they would cycle in intensity and frequency.

i never wanted to get up from the little tables while that thing was going!

 

[clifffaith]

I've talked to a couple of people who had the laser surgery after exhausting all other options including major back surgery and having nerves cut. They had nothing but good things to say about it.

The neurologist sent me to physical therapy and put me on muscle relaxants and anti inflammatory meds to get the pain under control. He also told me to use cold packs instead of the heat I'd been using. He really lectured me about not letting anyone talk me into surgery. He said most people weren't significantly better off after the surgeries and some were even worse off but that someday there would be a surgery that would help people like me. Now 20 years later there is laser surgery and it is minimally invasive with almost immediate results. From what I've read they can seal up bulging discs in addition to doing other things now with the laser surgery.

I've been using heat for relief. Just like when I had migraines I wanted heat, not ice. GP said as long as it is bringing relief/comfort to go with it. I see the testimonials on the laser ads, and assuming that they are real people, not actors, I can hear the relief in their voices as they tell their stories. Strange that none of my doctors show any interest in it. Maybe it is too "new fangled".

 

[clifffaith]

Glynda mentioned being a zombie on morphine. Becoming drug addled is of concern to me. A good friend of my mother's was a pain killer addict for thirty years, slurring her words and yet still in pain. The GP is concerned about the Tramodol, the rheumatologist says, meh, nothing addictive about it. My issue is that my three drugs, taken twice a day, do not give me pain relief. Rheum. said, well take an extra Tramodol at lunchtime. Well here's the thing, I get no relief so I can't remember to take an extra dose. If I have a headache I take Tylenol and the pain goes away. If it doesn't completely go away another dose does it. I had gum surgery on Friday. The 800mg ibuprofen tablets wear off in five hours like clockwork letting me know it's time for another. I take a pill and am good for another five hours. The darn back medication doesn't work that way at all. The only thing I notice is on the rare occasions I forget to take my nighttime pills, I wake up at 2am. And during the seven weeks last fall that I was pain free and off the pills, it took me three weeks before I could sleep through the night without being awake from 3am to 5am. Pills don't make me sleepy, but lack of them makes it so I can't sleep through the night due to wakefulness, not pain.

 

[easyrider]

I would throw out my back every once in a while. Lifting things or reaching for things was the usual way my lower back would go out. I would be in severe pain for three or four days and usually not very mobile for a week. I went to the chiropractor who did xrays which revealed disc damage. The chiropractor was able to do a maneuver that did help reduce the pain significantly but I could still feel some pain.

I did purchase an inversion machine which helps, but not right away. I also purchased an electrical muscle simulator which helped right away.

My doctor would give me flexorol and hydrocodone. This worked best for me.

Bill

 

[turkel]

I am sorry your in pain. Did a doctor recommend you take 800 mg of Motrin every 5 hours? A normal prescription strength dose is 600 mg every 6 hours or 800 mg every 8 hours. Have you tried alternating your medication say Motrin 800 mg then the Tramodol after 4 hours then at the eight hour mark take the Motrin again? This way your not taking more medication overall but you are taking something more frequently.

I hope you get some relief soon.

 

[clifffaith]

I am sorry your in pain. Did a doctor recommend you take 800 mg of Motrin every 5 hours? A normal prescription strength dose is 600 mg every 6 hours or 800 mg every 8 hours. Have you tried alternating your medication say Motrin 800 mg then the Tramodol after 4 hours then at the eight hour mark take the Motrin again? This way your not taking more medication overall but you are taking something more frequently.

I hope you get some relief soon.

The Motrin is strictly for the gum surgery pain, although I said to Cliff that I wondered if my leg is feeling a bit better six days after the last procedure because the Motrin is now in the pain killer mix. For whatever reason, I can take the big prescription tablets of Motrin for several days before my stomach starts to complain. Can't take even a single dose of the over the counter stuff without wishing I hadn't due to stomach issues. Gums are even waking me up during the night for another Motrin. I'm hoping in another day I won't need it at all. $1600 worth of gum surgery because I have the misfortune of having a cavity below the gum line on the furthest back tooth. Then I still have to pay for the filling in two months after I'm healed.

 

[Glynda]

Glynda mentioned being a zombie on morphine. Becoming drug addled is of concern to me. A good friend of my mother's was a pain killer addict for thirty years, slurring her words and yet still in pain. The GP is concerned about the Tramodol, the rheumatologist says, meh, nothing addictive about it. My issue is that my three drugs, taken twice a day, do not give me pain relief. Rheum. said, well take an extra Tramodol at lunchtime. Well here's the thing, I get no relief so I can't remember to take an extra dose. If I have a headache I take Tylenol and the pain goes away. If it doesn't completely go away another dose does it. I had gum surgery on Friday. The 800mg ibuprofen tablets wear off in five hours like clockwork letting me know it's time for another. I take a pill and am good for another five hours. The darn back medication doesn't work that way at all. The only thing I notice is on the rare occasions I forget to take my nighttime pills, I wake up at 2am. And during the seven weeks last fall that I was pain free and off the pills, it took me three weeks before I could sleep through the night without being awake from 3am to 5am. Pills don't make me sleepy, but lack of them makes it so I can't sleep through the night due to wakefulness, not pain.

They started me on the various brands of hydrocodone. Helped at first and I liked it better than anything I ever took in an addictive sort of way. I looked forward to taking the next one. It made me feel good all over....until it didn't. Then came Tramadol in various doses, Ultram, I think it was. That never seemed to do much. I can't remember the others before the morphine and the morphine was not the only thing they were giving me at the time. When we moved to Charleston, I went to Southeastern Spine Institute and my new doctor walked in the room and announced, "We're getting you off all this stuff today." I was both terrified and relieved. He told me that his experience is that patients find that they don't have any more pain once off the drugs than they did on them. That was my experience. Coming off of them was very easy. I was terrified that I was going to go through some sort of withdrawal, but no, I didn't. Not at all. He prescribed an oral medication for maybe two weeks that offset withdrawal and he prescribed a Butrans' Patch for pain. After a few months, I decided to stop the patch and see just where my pain level really stood. How was I to know if the procedures had worked or the pain patch was masking pain? And I did the other things mentioned in my previous post. I haven't been back to the doctor since. I haven't needed him. But a visit is coming. I am experiencing some mild back pain and a good bit of sciatica during the night.

 

[DavidnRobin]

Recent NYT article on back pain -
https://mobile.nytimes.com/2017/02/13/health/lower-back-pain-surgery-guidelines.amp.html



Sent from my iPhone using Tapatalk

 

[Htoo0]

I've known quite a few people who have had back surgeries. A few have said it was totally worth it while others said it was perhaps the biggest mistake of their lives. Not a great endorsement but if it works for you, it's great. In my twenties I was told I had the lower back of a seventy year old (car accident when I was 7 and a lot of lifting/jumping etc). Was visiting a chiropractor 2-3 times a week to avoid the leg pain and continue to work. I was introduced to an inversion table and that seemed to be fairly effective. Now in my sixties I still live with some lower back aches but when it gets bad I go back to my table and it clears it up. For me it's a rocking motion for a stretch/relax cycle while some friends like hanging instead. For a cost of $150-300 it may be worth trying and the best part is you can simply stop if it hurts or doesn't help. Hope you can find a solution.