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What do you mean by para central disk protrusion on left at L4-5 and disk bulges in a CT scan report?

DOCTOR OF THE MONTH - May 2014
May 2014
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Radiologist
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I have R) leg and L) back pain - ct scan shows para-central disk protrusion on left at L 4-5 and disk bulges on both discs above and below. However, pain pattern and pictures don't match. I was started on Lyrica and it worked from the first dose! I can walk again,!!! :)))) What does this mean? Thanks
Posted Fri, 24 Jan 2014 in General Health
 
 
Answered by Dr. Vivek Chail 1 hour later
Brief Answer: Please find detailed answer below Detailed Answer: Hi, Thanks for writing in to us. I have read through your query in detail. Lyrica (pregabalin) is a recommended medicine for the treatment of nerve compression related pain (neuropathy). Glad to hear that you are feeling much better from the first dose itself. Concerning the pattern of pain, I would like to know a bit more in detail. The disc protrusion at L4 L5 and disc bulges above and below mean that some of the nerve roots might be getting irritated and this results in pain perception. The medication is working at these areas and that is the reason you feel better. I hope that answers your query partly. Do write back if you have any doubts. Regards, Dr.Vivek
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Follow-up: What do you mean by para central disk protrusion on left at L4-5 and disk bulges in a CT scan report? 20 minutes later
Pain pattern L) initial ecxruciating pain at back of leg, one handwidth above knee. Intermittent pain, so many minutes apart, lasting for few seconds - stabbing knife of fire, gasp for breath - eventually stopped, left leg feeling like a lump, difficult to walk. Pain now feels like lead, at back of leg sometimes down to calf. Intermittent "pins and needles" position dependant. The further or longer I walk the worse the pain. I also have an ache/ pain on the L) lower back, directly adjacent to the spine. There is also sone pain down the left leg, two hadwidths down from the buttock. Does the responce to Lyrica have diagnostic value in determining the cause of pain as neurogenic?
 
 
Answered by Dr. Vivek Chail 8 hours later
Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX, Thanks for writing back with an update. Pregabalin (lyrica) is a new medication which is used to treat neuropathic pain, seizures and also as an anti anxiety medication. While pain of neurogenic nature is well treated by Lyrica, there are situations like cancer related pain and HIV related peripheral neuropathy which are not responsive to it. The mechanism is that the pregabilin molecule binds to calcium channels on nerves and may modify the release of neurotransmitters (chemicals that nerves use to communicate with each other). Reducing communication between nerves may contribute to pregabalin's effect on pain and seizures. It is approved for use to treat in fibromyalgia, diabetic nerve pain, spinal cord injury nerve pain, and pain after shingles. Concerning diagnostic value, if a person is getting pain relief of spinal cord origin after taking lyrica then in all possibility it is a neuropathic pain which you are having. However, if there is significant pain relief, you must continue to take all precautions not to stress the nerves in your spine as that can cause the pain to return. Hope that your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek
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