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Has Chronic Back Pain. Done MRI. What Are The Findings And Required Treatment? Has Mild Depression, Anxiety.
If a patient came to you with; chronic back pain - MRI May 2005: Chanes consistent with disc protusion at L5/S1 to the left with some compromise of the left S1 nerve root. Low grade-noncompressive disc protusion is present at L2/3. Signal in bone marrow appears otherwise normal (disc desiccation and reduction in high dense signal L5/S1 with lessor changes L2/3. Some associated end plate reactive degenerative changes present.
CT Mar 2013: There are spondylotic changes present throughout visualized spine, in particular T12/L1 and L5/S1 levels. End plate sclerosis noted at T12/L1.
Then MRI Jul 2013: Advanced disc disease at L5/S1, Moderate DDD at L2/3. No localized disc herniation or other focal neural compressive lesion demonstated. narrowing and desiccation of L2/3, stating no herniation. Advanced degenerative narrowing L5/S1 with anterior and posterior osteophytic lipping. No primary marrow pathology.
Other symptoms: one third back Thoracic to sacrum - burning, numbness, shooting, raidating, tingling, pulsating freezing etc with bilateral sciatica. Daily chores such as dishes, getting food out of shopping trolley, walking etc flares everything and stays there for hours. This is on daily basis.
Patient is 45 years female has BMI 51.2, has mild depression and anxiety
Medications: is currently on Monoplus 20/12.5, Zandip 10mg, Lexapro 20mg, Lorstat, Tramadol 100mg 1xdaily, panadol osteo and vit d.
Tried and cannot take Ibpruferon, voltaron, targan due to BP
Tried and does not work Lyrica and Durogesic patch (patch made patient sick)
Physiotherapy cannot continue until depression sort. Cannot afford other treatments or possible bariatric surgery.
How would you treat this patient and or what other tests are required / recommend. I thankyou kindly for your opinion on this matter. Regards Karen
CT Mar 2013: There are spondylotic changes present throughout visualized spine, in particular T12/L1 and L5/S1 levels. End plate sclerosis noted at T12/L1.
Then MRI Jul 2013: Advanced disc disease at L5/S1, Moderate DDD at L2/3. No localized disc herniation or other focal neural compressive lesion demonstated. narrowing and desiccation of L2/3, stating no herniation. Advanced degenerative narrowing L5/S1 with anterior and posterior osteophytic lipping. No primary marrow pathology.
Other symptoms: one third back Thoracic to sacrum - burning, numbness, shooting, raidating, tingling, pulsating freezing etc with bilateral sciatica. Daily chores such as dishes, getting food out of shopping trolley, walking etc flares everything and stays there for hours. This is on daily basis.
Patient is 45 years female has BMI 51.2, has mild depression and anxiety
Medications: is currently on Monoplus 20/12.5, Zandip 10mg, Lexapro 20mg, Lorstat, Tramadol 100mg 1xdaily, panadol osteo and vit d.
Tried and cannot take Ibpruferon, voltaron, targan due to BP
Tried and does not work Lyrica and Durogesic patch (patch made patient sick)
Physiotherapy cannot continue until depression sort. Cannot afford other treatments or possible bariatric surgery.
How would you treat this patient and or what other tests are required / recommend. I thankyou kindly for your opinion on this matter. Regards Karen
Fri, 8 Nov 2013
Hi and welcome to HCM
The MRI report is suggestive of spinal disc herniation with nerve root compression in the spine. The spinal disc herniation is also called slipped disc- it is a condition affecting the spine, in which a tear in the outer, fibrous ring of an intervertebral discallows the soft, central portion to buldge out.
The main treatment of such pain is bed rest along with pain killers and muscle relaxants. Muscle relaxants can help with the symptoms if used in appropriate dosage in combination with a potent analgesic.
You can get the appropriate drugs prescribed from an Orthopedician or a spine surgeon after examination.
Meanwhile she can follow these measures:
- If the pain is severe, she needs bed rest till the pain resolves.
- Get some analgesics prescribed and apply analgesic spray or ointments.
- While resting, keep a pillow under the knees if it doesn't bother you.
- Avoid lifting heavy objects.
- Back strengthening exercises and stretching exercises for hamstrings daily as advised by a Physiotherapist.
- Avoid exercises in times of pain.
Hope this will helps you. Take care.
The MRI report is suggestive of spinal disc herniation with nerve root compression in the spine. The spinal disc herniation is also called slipped disc- it is a condition affecting the spine, in which a tear in the outer, fibrous ring of an intervertebral discallows the soft, central portion to buldge out.
The main treatment of such pain is bed rest along with pain killers and muscle relaxants. Muscle relaxants can help with the symptoms if used in appropriate dosage in combination with a potent analgesic.
You can get the appropriate drugs prescribed from an Orthopedician or a spine surgeon after examination.
Meanwhile she can follow these measures:
- If the pain is severe, she needs bed rest till the pain resolves.
- Get some analgesics prescribed and apply analgesic spray or ointments.
- While resting, keep a pillow under the knees if it doesn't bother you.
- Avoid lifting heavy objects.
- Back strengthening exercises and stretching exercises for hamstrings daily as advised by a Physiotherapist.
- Avoid exercises in times of pain.
Hope this will helps you. Take care.
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