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Met with accidents. Fractured spine shown in MRI. On Butrans pain patch along with tramadol. Suggest the cure?

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I have been involved in two vehicle accidents in the last year. I am always in a tremendous amount of pain which causes me to be unhappy and lash out at my loved ones due to my unpleasantness. Nothing came back showing any injuries after my first accident other than severe soft tissue damage which caused me to have to go through physical therapy for 7 months. My MRI after this second car accident shows a fractured spine according to my orthopaedic physician. I was on a Butrans pain patch for quite a while along with tramadol but after the second wreck the pain became much worse and am now taking Nucynta only. I would be grateful if somehow I could have my MRI checked out and see if something else could have possibly been missed. I have the files of my xrays and the MRI but the site will not let me upload the MRI because they are zipped so I have them all on my dropbox account which can be viewed here: WWW.WWWW.WW

There are a lot of still images to show the scan but I will upload the other xray images on here. Thanks in advance for any help/guidance I may receive.
Posted Mon, 4 Nov 2013 in Brain and Spine
Answered by Dr. Anjana Rao Kavoor 2 hours later
Brief Answer:
Mild anterior compression fracture T 11 vertebra

Detailed Answer:
Thanks for writing in to us.

I have read your query in detail.

Its unfortunate that you have had two motor vehicle accidents in such a short time, the last one leading to a vertebral fracture.

I have gone through your X rays and MRI and also discussed them with a Radiologist through the dropbox link sent by you.

There appears a vertebral anterior wedge compression involving probably the T 11 vertebra. This is a type of fracture and supposed to be one of the milder ones. Nonetheless it can cause severe pain and I can understand your situation. There appears to be no other significant injury detected on the MRI.

There is not one single cause of compression fractures, though the word compression would indicate that the fracture occurs because of too much pressure being placed on the bone. If the bone is too weak to hold normal pressure, it may not take much pressure to cause the vertebral body to collapse. Most healthy bones can withstand a lot of pressure and the spine will bend to absorb the shock. However, if the force is too great (as in an accident) for the vertebrae to sustain, one or more of them can fracture.

The most common treatments for a thoracic compression fracture are: pain medications, decreasing activity, and bracing.
Treatment usually involves giving any of the following medications, singly or in combinations.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
Non-narcotic Prescription Pain Medication
Narcotic Pain Medications
Muscle Relaxants

Nycunta is Tapentadol and this medication is used to treat moderate to severe short-term pain (such as pain due to injury or following surgery). Tapentadol is a narcotic pain reliever (opiate-type). It acts on certain centers in the brain to give you pain relief. It also acts on a natural substance in the brain (norepinephrine) involved with pain.

I hope this helps,
Any further queries are welcome.
Dr. A Rao Kavoor
Above answer was peer-reviewed by
Follow-up: Met with accidents. Fractured spine shown in MRI. On Butrans pain patch along with tramadol. Suggest the cure? 35 hours later
Hi Dr. Kavoor,

Thank you for your quick reply. I am curious to know if you can see any kind of arthritis in my back? I was told there was by my orthopaedic. I know I have it severely in my knees and ankles. Also, would you recommend surgery for the fracture? They mentioned putting a balloon in my spine followed by bone cement.

Are there any pain medications that are used for long-term use? I've been told it will never heal back to its original state and that I will most likely be in pain for a significant amount of time especially with the both muscles running parallel on each side of spine.

Kind Regards, XXXXXXX
Answered by Dr. Anjana Rao Kavoor 9 hours later
Brief Answer:
Please find detailed answer below

Detailed Answer:
You are welcome and thanks for writing back with and update.

There is mild arthritis in the back. Right now it is not worrisome but it may progress later in life. But I reassure you that it is not something you should worry much until it actually happens.

Your fracture looks relatively stable. The procedure involving bone cement is known as Vertebroplasty. Only a few studies have been done on these surgeries. One study showed that people who had vertebroplasty for recent compression fractures noticed pain relief right away. Two other studies, involving people with painful compression fractures from osteoporosis, compared those who got the cement to those who didn't. In these two groups, there was not much difference in their pain or their ability to be active.

Because the surgeries are still somewhat new, it's not known how well they work over time.

Medications are given starting from over the counter ones to ones that are highly potent as in opioid analgesics. I would suggest you to allow yourself some time before going for higher pain killers. As you are very young, taking pain killers regularly may be harmful. Also some of the opioid analgesics can get addictive and make you dependent on them.

I hope this helps,
Any further queries are welcome.
Dr. A Rao Kavoor
Above answer was peer-reviewed by
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