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Suggest Remedies For Severe Lower Back Pain With A History Of Sciatica
Question: Dr. Rynne, my name is XXXXX. I am not the patient. The patients name is XXXXXXX White. He is not here now. He has severe pain in his lower back. A few months ago sciatica was mentioned. In his younger days he said he pulled transmissions and motors with his bare hands. He was in the army. He is now retired. He turned 69 at he end of February. He attends a V.A. Hospital in White River Vermont. And a clinic in Littleton, N.H. He has tried physical therapy. They have him on a narcotic. He was sent to Dartmouth Hitchcock for steroid shots. Nothing seems to be working. He has fallen a few times. The first time was right after he returned from Iraq. He was driving a truck over there when they had to stop. The man behind him was not paying attention and rammed him, causing nerve damage in his neck. Which added to his pain. Lately, he walks stooping over. He can't straighten up all the way. Yet, he complains it hurts to bend over. It is kind of funny. So, I tease him and tell him not to bend over. He just came home. He told me he is now on on Hydro-Morphin. 2 mgs. He wants something stronger. And he wants to switch his meds to White River. What else can he do? Will he need surgery on his back? We are afraid the doctor will slip and cause paralysis. Can you help?
Brief Answer:
Read below.
Detailed Answer:
I have read your question since several hours ago but I didn't answer it as you mention Dr Rynne at the beginning and I wasn't sure whether you exclusively wanted him to answer or mentioned him only because he is on the front page. I assume my other colleagues haven't answered for that same reason. However seeing that the question has been on for several hours now, I am going to answer it hoping it wasn't that specific doctor you wanted to answer.
Judging from the description of his past history of intense physical work and army activity, along with the symptoms bending forward I would say a herniated disc disease is most likely, a displacement of the cartilage disc situated between your vertebrae which leads to it compressing a nerve root in the spine.
Now regarding management it is usually started with physical therapy and anti-inflammatory painkillers which lead to improvement in most patients, but I guess he has tried those. If not enough medication for chronic neuropathic pain such gabapentin or pregabalin are next attempted medication. Opioids like hydromorphin are usually the last resort in terms of pain killers and are not preferred to be used regularly due to potential for dependence and abuse.
If symptoms persist then steroid shots are the next step. It seems that is not working in Mr White's case as well.
So in this setting since these conservative measures seem to have been tried then surgery seems to be the remaining option. Now that of course depends on spine imaging results, assuming they confirm the diagnosis I mention (perhaps if you could provide some MRI report I might be more precise). If that is the case you shouldn't be afraid of doctor slipping and causing paralysis. That is extremely unlikely. It is a fairly routine simple procedure for the surgeon. While I do not operate myself, as a neurologist I do refer plenty of patients for surgery in my everyday practice and in 8 years I do not recall a single case of there being such a complication, as I said it's extremely rare. As for success rates, if there is a visible compression on MRI which can be removed over 80% of patients improve after surgery.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I have read your question since several hours ago but I didn't answer it as you mention Dr Rynne at the beginning and I wasn't sure whether you exclusively wanted him to answer or mentioned him only because he is on the front page. I assume my other colleagues haven't answered for that same reason. However seeing that the question has been on for several hours now, I am going to answer it hoping it wasn't that specific doctor you wanted to answer.
Judging from the description of his past history of intense physical work and army activity, along with the symptoms bending forward I would say a herniated disc disease is most likely, a displacement of the cartilage disc situated between your vertebrae which leads to it compressing a nerve root in the spine.
Now regarding management it is usually started with physical therapy and anti-inflammatory painkillers which lead to improvement in most patients, but I guess he has tried those. If not enough medication for chronic neuropathic pain such gabapentin or pregabalin are next attempted medication. Opioids like hydromorphin are usually the last resort in terms of pain killers and are not preferred to be used regularly due to potential for dependence and abuse.
If symptoms persist then steroid shots are the next step. It seems that is not working in Mr White's case as well.
So in this setting since these conservative measures seem to have been tried then surgery seems to be the remaining option. Now that of course depends on spine imaging results, assuming they confirm the diagnosis I mention (perhaps if you could provide some MRI report I might be more precise). If that is the case you shouldn't be afraid of doctor slipping and causing paralysis. That is extremely unlikely. It is a fairly routine simple procedure for the surgeon. While I do not operate myself, as a neurologist I do refer plenty of patients for surgery in my everyday practice and in 8 years I do not recall a single case of there being such a complication, as I said it's extremely rare. As for success rates, if there is a visible compression on MRI which can be removed over 80% of patients improve after surgery.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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