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Suggest Remedies For Pain While On Coumadin Anti-coagulant Therapy
Question: Dear Dr.,
My wife has atrial fibrillation and has been on coumadin anti-coagulant therapy for about a year. Four months ago, she inadvertantly fell causing a compression fracture in L1. She wore a back/thoracic brace vest for about 9 weeks and her back seems basically healed. Because prior to wearing the vest she took large doses of Alleve, her INR soared. When this happened, she was instructed to cease taking coumadin and hasn't taken coumadin for over three months.
I'm writing to you because she has had unrelenting pain in her right side (above the illiac crest) since the fall. MRI's, CT Scans and x-rays viewed by an orthopedic surgeon have failed to detect the source of this pain coming from her lumbar vertebrae. Could the source of this pain be derived in some way due to coumadin side effects?
Your thoughts about this are appreciated.
My wife has atrial fibrillation and has been on coumadin anti-coagulant therapy for about a year. Four months ago, she inadvertantly fell causing a compression fracture in L1. She wore a back/thoracic brace vest for about 9 weeks and her back seems basically healed. Because prior to wearing the vest she took large doses of Alleve, her INR soared. When this happened, she was instructed to cease taking coumadin and hasn't taken coumadin for over three months.
I'm writing to you because she has had unrelenting pain in her right side (above the illiac crest) since the fall. MRI's, CT Scans and x-rays viewed by an orthopedic surgeon have failed to detect the source of this pain coming from her lumbar vertebrae. Could the source of this pain be derived in some way due to coumadin side effects?
Your thoughts about this are appreciated.
Brief Answer:
See a pain management specialist.
Detailed Answer:
Hi there,
Coumadin does not cause any pain unless there is significant amount of bleeding. I am glad all of the imaging has been negative for pathological issues (such as fractures), but unfortunately, this mean there is nothing to treat.
Compression fractures and spinal fractures can lead to long term pain with or without pathology. I would recommend seeing a pain management doctor who can inject the nerve that is causing the pain. Generally, with fractures or trauma, there is edema, which is also known as swelling. Edema is sometimes seen on MRI, but not CT scans or X-rays. The edema can be compressing a nerve in the spinal canal or outside of the spinal canal which is causing her pain. Fortunately, this is what pain management doctors do all day. They can inject anti-inflammatory medications and steroids at the nerve site that is causing her pain. Ultimately, she might need a nerve ablation which is burning of the nerve that is causing her pain - the pain management doctor can also help with this.
Overall, you need a pain management doctor. In the meantime, she might benefit from tylenol and anti-inflammatories, as well as steroids, but that is up to your primary care doctor.
Please let me know if you have additional questions.
See a pain management specialist.
Detailed Answer:
Hi there,
Coumadin does not cause any pain unless there is significant amount of bleeding. I am glad all of the imaging has been negative for pathological issues (such as fractures), but unfortunately, this mean there is nothing to treat.
Compression fractures and spinal fractures can lead to long term pain with or without pathology. I would recommend seeing a pain management doctor who can inject the nerve that is causing the pain. Generally, with fractures or trauma, there is edema, which is also known as swelling. Edema is sometimes seen on MRI, but not CT scans or X-rays. The edema can be compressing a nerve in the spinal canal or outside of the spinal canal which is causing her pain. Fortunately, this is what pain management doctors do all day. They can inject anti-inflammatory medications and steroids at the nerve site that is causing her pain. Ultimately, she might need a nerve ablation which is burning of the nerve that is causing her pain - the pain management doctor can also help with this.
Overall, you need a pain management doctor. In the meantime, she might benefit from tylenol and anti-inflammatories, as well as steroids, but that is up to your primary care doctor.
Please let me know if you have additional questions.
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Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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