Suggest Treatment For Back Pain

Posted on Mon, 4 Jul 2016

Question: I am suffering from back pain. My problems were diagnosed (disc bulge L5/S1 with foraminal canal root compression) . At the begging, I was treated by using of celebrex200mg daily with physio. But after 3/4 month my treating Neurologist find celebrex 200mg coused my renal function deteriorated and ceased using of Celebrex. Now I am taking epidural injection from since august 2015.
Pain is responding to injection and I felt comfortable after injection. But, pain get aggravate with physical moment (flexion, walking, longtime sitting and standing). My treating GP advised me to stop manual laboring work. He also advised to changed my job,(as my job was manual laboring job).

Now I need an advice on the following-

1. Is my current treatment is optimal?
2. And what will be the consequence/impact of manual laboring on me.
3. How long my current treatment (epidural injection ) should continue?
4. What will be the next treatment option if pain stop response to injection?

Answered by Dr. Neeraj Kumar (43 minutes later)

Brief Answer:
Take treatment as advised and get rheumatologist opinion too

Detailed Answer:
Hello XXXXXXX
I have gone through your question and understand your concerns.
Back pain with lumbosacral radiculopathy can be managed by medications. Physiotherapy plays a major role and should be continued.
Along with pain killers and muscle relaxant, pain modulator drugs like pregabalin or amitryptiline or gabapentin can be used.
Epidural injections should not be taken for long as it may lead to arachnoiditis and weakness or sensory loss in lower limbs.
Physical activities can be resumed with symptomatic relief. Avoid lifting heavy objects, stooping forward, squatting.
Next line of management is surgical and depends upon neurodeficit and response to medication.
One other point of investigation is sacroiliatis as suggested in recent Mri. For this you need to consult a rheumatologist.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Neeraj Kumar (28 minutes later)

i will test sacroiliatis.
pain killer previously deteriorated my renal function,and stopped advised by nephrologist, Are there any risk of using pregabalin or amitryptiline or gabapentin for renal function.

Answered by Dr. Neeraj Kumar (33 minutes later)

Brief Answer:
Drugs to be decreased if renal function impaired

Detailed Answer:
Hello,
They all have renal excretion and dose has to be adjusted if renal function is impaired at present.
Provide recent reports of serum urea and creatinine.
Regards
Dr N Kumar

Above answer was peer-reviewed by : Dr. Yogesh D