Questions

[BlackCat1983]

Hi Everyone,

I have previously back probably about 6 months or so ago post on here and on Back Pain board. I still have back pain from time to time from L-5 S-1 protrusions. It has bothered my sciatica nerve and I always seem to be hurting from the pressure of that. Here is a little history of what I have been through I was put on Hydrocodone and Flexiril in March of 2005 when I went to the hospital for severe back pain, then about a week later ended up at a Urgent Care Center cause the pain got worse and didn't seem to let up. Then about 2 weeks later ended up at another Urgent Care Center because the pain was still really bad. It was then that the doctor there decided to schedule me for a CT Scan of the lower lumbar, which is when the L-5 S-1 were protruding so I then was sent to a Orthopedic Surgeon and he put me on Naproxen which helped with the pain but it caused me stomach problems and I was going to PT 3 times a week. The PT really didnt help. The only time that I was out of pain is when there was pressure on it. Then as soon as the Physical Therapist would take the pressure off the pain would come back. So I stopped going to PT cause the Physical Therapist said that if the PT wasnt helping then there wasn't any sense in continuing. So I went back to the Ortho doctor and he wanted me to get a Epidural Block. I decided to get a second opnion and the other ortho doctor suggested the same thing. I was going to go through with it but for one couldnt afford the co-pay and I didn't see how the Epidural Block would help long term so just decided againist it and have just been dealing with the pain with heat and Aleve ever since. Well now I am having problems with both hips being in quite a bit of pain and am not sure what is causing it. Could it be from the L-5 S-1 protrusions or could there be something else causing the pain. Does anyone else on this board deal with hip pain? Thanks in advance for any help. I hope to get to know you all.

Erica

[BrokenBladder]

I'm bumping this post up for you!! I don't know the answer but I don't want your post to get lost. Someone will come along soon with some answers.

[Mark N]

Yes, your lumbar problem could be causing the hip pain. I would recommend you go over to the spinal disorders and post there as more people are dealing with spinal issues.

[BlackCat1983]

Thanks, I will post over a spinal disorders.

Erica

[ErinENj]

Hi Erica:

I have some similar problems from my L4/L5 and L5/S1 levels. Both discs are herniated, and there isn't much left between the vertebrea at both levels. Because there's pressure on the nerves, I get neuropathic pain, pain that runs across my lower back, then through my hip and down my leg.

One question: does the pain you get in your hip originate in your back and radiates down or is it just in your hip, or even, do you have pain in your back and pain in your hip at the same time? Protrusions could cause the hip pain, but I think I'd point to that if it was a radiating pain from your lower back.

If it's from your back, an epidural might not be bad thing to have. It can reduce your pain for three months or even more. I have about 3 a year if my doc will let me. They work for some people, but not for others. It's a toss-up to say whether it will work for you, but if you can afford it, it may give you some relief.

Also, if it is radiating pain, there are meds that can be used to treat that. I'm on Lyrica and it's helped me a lot with the pain down my leg. Now I know if the pain is working down my leg then I'm doing something I shouldn't or have overdone.

Someone over on the spiney board may have better answers, but I hope this might help too. And I hope they figure this out and that it's easy to take care of!!

[lobelsteve]

If the epidural works, you are correct in that it would have no long term effect. It may help reduce your pain right now and allow you to complete a course of PT including a home exercise program.

The hip pain is likely worst over your PSIS -posterior superior iliac spine.
This is just over your butt where those little dimples are. When your back muscle lock down to protect a painful/injured segment, the SIJ picks up the slack. You are offloading your spine and overloading your SIJ because of the pain.

Things to ask your doctor:

1. ? Celebrex/Ultram/Short course of opioids
2. ? A skeletal muscle relaxer (many to choose- Zanaflex and Flexeril are my favorites-and Soma should used as a last resort.
3. Lumbar-Sacral Orthosis- the right back brace will apply pressure over the area and reduce the pain while you are up and about.
4. TENS/E-stim/INterferrential- RS4 from RS medical or IL3 from Rehabilicare are the 2 best units, folllowed closely by alpha-stim.

[mrsdoubtfyre]

I'd suggest you try icing the area. Carefully, for no longer than 20 minutes,
up to 3 times a day. Place a thin towel between you and the cold pack.
Occasional cold helps sometimes. When I had PT, and IFc treatments a cold
pack was put on my leg during them.

Excessive heat can overstimulate nerves, and cause rebound pain. If you elect to
continue heat, try not to keep it there for more than 10 minutes.

Another approach is using Lidoderm patches. These really work, but are
expensive, if your insurance won't pay for them. They need a doctor's order,
however. Some experimentation as to placement is necessary, for full
effect, so if you get them plan on moving them around, perhaps. I'd start on the lower back on the affected side.

There are over the counter patches, called Salonpas, that contain methyl salicylate in them. They can provide a local
relief for some people. So can Biofreeze rub. Sometime a little experimentation is needed to see what really will
work for you. These two are not expensive or damaging in any way, and worth a try.
http://salonpas.us/
There are many types of Salonpas, I use only the methyl salicylate one as it is mostly anti-inflammatory and
can help you avoid oral NSAIDs.

[BlackCat1983]

LobelSteve and mrsdoubtfyre:


as to the following lobelsteve:
Things to ask your doctor:

1. ? Celebrex/Ultram/Short course of opioids
I have tried Ultram and it didnt work for me. Celebrex I havent tried the Ortho doctor just wanted me to take Aleve and like I stated before do the Epidural Block, which I can't afford right now.


2. ? A skeletal muscle relaxer (many to choose- Zanaflex and Flexeril are my favorites-and Soma should used as a last resort.
I can not take Flexeril, I had a reaction to it, cant handle that one. There was another one that my sister in law suggested that I ask about, I did and got turned down by the doctor he wasnt willing to try it. Can't remember the name of it other than it started with a "S" Not tried Zanaflex.




3. Lumbar-Sacral Orthosis- the right back brace will apply pressure over the area and reduce the pain while you are up and about.
4. TENS/E-stim/INterferrential- RS4 from RS medical or IL3 from Rehabilicare are the 2 best units, folllowed closely by alpha-stim.

The doctor nor the PT person was willing to consider a back brace as I got told it would just cause the muscle to become weaker and then it would just cause things to spiral and get worse.

The PT never worked the first time.

Thanks for the suggestions lobelsteve.


mrs doubtfyre:

I will look into the salonpas patches or the Bioderm rub and see if that will help. Thanks for the suggestions.

Erica

[lobelsteve]

[QUOTE=BlackCat1983;59234]LobelSteve and mrsdoubtfyre:


as to the following lobelsteve:
Things to ask your doctor:

1. ? Celebrex/Ultram/Short course of opioids
I have tried Ultram and it didnt work for me. Celebrex I havent tried the Ortho doctor just wanted me to take Aleve and like I stated before do the Epidural Block, which I can't afford right now.

Aleve is over the counter- so why see the doctor?
Epidurals are expensive- negotiate a rate and make payments if needed. I know that a $600 epidural can be talked down to almost half of that, and then the office would let you pay $20/month for however long it takes. At least good doctors (kind doctors) will. Then you just have to determine if it is worth ~ $300 to POSSIBLY get rid of your pain for awhile.


2. ? A skeletal muscle relaxer (many to choose- Zanaflex and Flexeril are my favorites-and Soma should used as a last resort.
I can not take Flexeril, I had a reaction to it, cant handle that one. There was another one that my sister in law suggested that I ask about, I did and got turned down by the doctor he wasnt willing to try it. Can't remember the name of it other than it started with a "S" Not tried Zanaflex.


Maybe Skelaxin?, Soma is a last resort owing to its own abuse, addiction,withdrawal, and street value isues. It metabolizes to meprobamate (Milltown) a barbiturate like, sedative-hypnotic.

3. Lumbar-Sacral Orthosis- the right back brace will apply pressure over the area and reduce the pain while you are up and about.
4. TENS/E-stim/INterferrential- RS4 from RS medical or IL3 from Rehabilicare are the 2 best units, folllowed closely by alpha-stim.

The doctor nor the PT person was willing to consider a back brace as I got told it would just cause the muscle to become weaker and then it would just cause things to spiral and get worse. They do not know what they are talking about. If they help reduce your pain you will be able to do core strengthening exercise (dynamic lumbar stabilization) and reduce your chances of ever having another exacerbation of back pain.

The PT never worked the first time. It typically does not. Although most PT thes days is a hotpack and get on the bike for 10 minutes. Or you will get a McKenzie guru who only wishes to torture you and hold you to rigid guidelines that may not correlate with what you can tolerate.

Thanks for the suggestions lobelsteve.

welcome!

[Kathi49]

Erica,

I am just going to add my two cents worth as I was going through very similar problems or should I say symptoms. Yet, my situation is not the discs so much as it is the facets. I do have a bulge at L4/L5. Anyway, here's what I had to do to get this mess figured out and this has taken a loooong time.

I didn't know if I had sciatica, piriformis syndrome, coccydynia, what???!!! So, of course my PM does an MRI of my lumbar sacral area that showed more facet degeneration than anything else. I couldn't sit or drive without being in severe pain. Yet, when I walked I was fine. Anyway, he did the ESI, then an SI and finally facet injections. The facet injections gave me pain relief the longest. But in the interim he sends me into PT with a specialist they use. While doing lumbar exercises and pelvic floor exercises I begin to have SEVERE pain. My PT had me to stop immediately and told me to get myself to my ob/gyn; that the pelvic floor exercises shouldn't hurt that badly. Oh, and in the meantime I am supposed to wear a sort of soft back brace and an SI belt. Neither one of those helped and caused worsening of pain. And my PM is also against wearing any kind of brace. However, I did get a different story from the PT gal. In any case, I ended up just ripping them off because the pain was so bad.

So, I go to see my ob/gyn and am diagnosed with a cysctocle and rectocle. She, then, refers me to a Urogynecologist who does extensive testing. In the long run, and during several discussions his belief is that the nerve pain and/or damage was causing the muscles of the pelvic floor not to work properly. Not his words exactly but the muscles were being pulled apart. So, he grades this cystocele and rectocele as a Grade 1; not enough to warrant surgery but enough to go into pelvic floor PT ONLY because the lumbar excercises only worsened everything. So, he tells me that FIRST I need to get the nerve problem going on in my lumbar/sacral area calmed down because with that kind of pain, pelvic floor PT may send me over the top. Anyway, long report...too much to put in here.

I go back to my PM and gave him the Uro report and said was in agreement. My PM then sets me up for a Rhizotomy of the L4, L5 and S1 based on the relief the facet injections gave me. I had the Rhizotomy last week and it was a blessing. The pain I had in my tailbone, buttocks, leg, hip you name it, is gone on the left side (the left side was the worst). The problem still exists as they are arthritic. But now, I can finally go into PT with a gal the Uro uses. However, the Uro doc did say that if the pelvic floor PT causes pain, to stop immediately and he will do the repairs.

I know, I know this has nothing to do with your disc problem. It is just that it took me FOREVER to isolate what was causing what. In the long run, I had more than just the spinal issue going on.

[jane2]

Epidurals can help and sometimes you may have to have more than one round. The relief may last six months to a year if it works. I know of someone with sciatica who had one or two rounds of epidurals and that fixed the problem and then a year later another round and that was it. That's an unusually good outcome.

Epidurals are very common procedure and they don't always work. However, sometimes they do and sometimes they work for awhile but that could be six months to a year and they can be repeated, but not endlessly. I think it's worth trying and you will never know unless you do. The only reason I haven't done it is I react very strangely to steroids and badly. That's very unusual.

Most people have some bad disks if you were to look and we don't always know why some people had pain and others down and sometimes if you're lucky you can pinpoint the pain and that may or may not give you a cure or an answer. My feeling about epidurals is they are far less invasive than something like surgery.



I just wanted to say that EPIs can help and it is th part of e first line of treatment after physical therapy and ice and Aleve (or other anti-inflammatories).

Good luck and you might continue to think about it. It's good to question everything before you try it. If you do decide to try it, I would do it with an anesthesiologist.

[Kathi49]

Good points Jane! I agree. My husband has a badly herniated disc but, two ESI's later(about 8 months apart), he has been good to go for about two years now. Too bad mine didn't last very long. But, again, it was my facets not the discs.