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What is the best treatment for spinal stenosis and severe disc herniation?

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Orthopaedic Surgeon
Practicing since : 1998
Answered : 4917 Questions
Hi-My name is XXXX-I am on a 50mcg duragesic patch-I was initially on a generic version and when I had my script filled for the 4th time is was a different generic company-the first three were Sandoz (no problems) and the 4th was Mallincrodt. My script read to apply a new patch every 72 hours-When I applied the first Mallincrodt patch my bones started to ache really bad about 10-12 hours after application and continued to ache (Inside my bones in the center of the bones in my limbs-not like any pain I had ever had before it was not typical joint pain that I sometimes felt in my knees or shoulders). I was in bed for the three full days of that patch and percocet didn't help this aching feeling. I went back to my prescription to check the dose and make sure nothing had changed. I noticed it was the brand name that was different. I realized then that I could not use that brand of the generic (Mallinckrodt) and so my doctor began to write DAW in the box so since then I have only had the brand name and have been fine up until about 1 week or so. Now I am getting the terrible aching in my bones about 36 hours into a new patch, it is sporatic (No constant like with the generic patch) but it really hurts and makes it really hard to move-I have that until about 12 hours into the first day of a new patch and then I am good again until about 36 hours into the new patch so I have roughly 24 good hours with no aching. Is this normal? I am wondering if this may mean my dose may need to be adjusted? I have been on 50mcg since February of 2013
Posted Tue, 24 Dec 2013 in General Health
Answered by Dr. Vaibhav Gandhi 2 hours later
Brief Answer: I will advise for epidural spine injection. Detailed Answer: Hello I have studied your case. Yes you may need dose adjustment so that you remain pain free for longer duration. I will advise for epidural spine injection to reduce dependency on opiod medication. Look for any facet arthropathy in your MRI spine. Later on follow rehabilitation and physiotherapy. I will advise to check your vit B12 and vit D3 level. Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries. Wishing you good health. Take care.
Above answer was peer-reviewed by
Follow-up: What is the best treatment for spinal stenosis and severe disc herniation? 3 days later
Hi Dr Gandhi- Thank you for the response.I am sorry I didn't have a chance to review your message sooner. I was waiting for a text message on my phone notifying me that I had received a response but I never received that so I just came and checked the site and was happily surprised to find that I did have your response waiting for me! Thank you for your time and the response. I am still questioning whether or not this terrible aching inside my bones is from the duragesic patch wearing off or if it's because there is not enough medication in my system to actually treat the pain or if my system is just used to the medication and thus I am immune to it or something and it just isn't working for me anymore. I am a am a very complicated case-I recently had all of my blood levels checked and I was Low for Vitamin D only and was instructed and have begun 1000 units a day of Vit D. Would the vitamin D deficiency cause the terrible aching in my bones? Is it possible that once my Vit D levels are up this awful aching will stop?? All other blood levels were within normal range. I requested a copy of most of my blood work results and do have it if you are interested in any specific levels. Yesterday I had my 6th RFA (Radio Frequency Ablation) of L S1-S4. This procedure provides me with some good pain relief of the severe nerve pain that I have in my Left leg from my hip to the top of my foot. Each RFA procedure gives me about 4-6mts of relief. All of my pain started to return from the January 2013 RFA in July 2013 but it has taken until yesterday to get necessary approvals and diagnostic testing completed and paperwork filed. Workers Compensation has 30 days to approve or deny the request and with the RFA they will never approve that procedure unless I receive diagnostic injections and about 30days later at my next appointment I report that the diagnostic injections provided me with approximately 8 hours of good relief. Then the doctors office within a couple weeks sends that report to Work Comp and they have up to 30days again to approve the RFA procedure-Then once it is approved I am sometimes required (depending on the length of time it has been since my last exam) to go in for an appointment and an exam prior to the RFA procedure. Once that sequence of events has occurred then I am scheduled for the RFA and it is sometimes up to a month or longer before I get onto the surgery schedule. This entire sequence can take anywhere from 3-6 months which means I have severe nerve pain in my left leg for anywhere between 3-6 months after the last RFA has stopped working and before the next RFA is completed. I have not previously needed RFA on the R side but as of the past few months I have had a significant amount of nerve pain in my R leg and am now considering RFA on the Right side -same area L1-L4. I have been putting off this process because I am expecting that it will only provide me 4-6months of relief and then will likely have to have RFA done on alternating the R and L from this point forward. I have also had several nerve blocks in my facet joints and epidural blocks in my neck and shoulders and SIJ injections. The nerve blocks take all of my pain away within 24hours of the block but all of my pain gradually returns within 6-12 days following the block. This is all related to a work injury that Workman's Compensation is responsible for my medical coverage for the injury. Because the epidural and nerve block injections and SIJ injections only last up to 12 days Work Comp will no longer pay for therapeutic injections and will only cover the 8hr diagnostic injections that they require prior to approving the RFA procedure. The RFA provides relief of my nerve pain in my left leg. My doctor has encouraged me to consider RFA in my neck because I have a headache on a daily basis and have ended up in the hospital a few times with migraines (headaches and migraines all are the result of a neck injury) lasting more than 3 days. I have been on several preventative as well as abortive medications for migraines for the past three years with limited success. I have been encouraged to try botox every 8 weeks as a migraine preventative but have not yet agreed to that either. Because of the significant nerve pain in my Left Leg that that follows the RFA procedure in my L lumbar spine for a 7-12 days following the RFA I am terrified of having RFA done in my neck to treat my headaches and migraines because I just cannot imagine how I would possibly deal that type of pain that I get in my leg following the RFA on my L lumbar spine, in my head if I were to have the RFA in my neck as a treatment for headaches and migraines. I appreciate any feedback you can provide. I am still wondering if the severe aching that I have in my bones is related to the Duragesic patch, if the patch is wearing off really quickly or if my body is just used to the duragesic and I may need a different kind of medication or if an increase in the dose would be more appropriate. I was on Kadian extended release morphine for three years and it stopped working and began to significantly contribute to migraines and headaches and that is why I began the duragesic patch. Again any feedback would be very much appreciated! Thank you!!
Follow-up: What is the best treatment for spinal stenosis and severe disc herniation? 21 minutes later
I forgot to add this to my previous response earlier tonight. Also I have done Physical Therapy twice a week for several months, Massage Therapy over 10 visits and Chiropractic weekly for 3 years, I also tried acupuncture about 5-10 visits. Chiropractic and Massage Therapy provided me with the greatest benefits compared to physical therapy, and accupuncture. Accupuncture I found to be relaxing and a pleasant experience but had no lasting effects. Massage and Chiropractic really helped a great deal with my headaches and migraines as well as with my back pain but my Worker's Compensation does not cover Chiropractic or massage (or acupuncture) and my private Excellus Health Insurance will not cover any treatments related to my fall at work (or any of the following areas: head, neck, back, L leg, Left thigh Left Knee). The Massage appointments are $100. a visit and I cannot afford to pay for it and although I am unsure exactly how much Chiropractic visits would cost it was a $40 copay three times a week when I was working and my insurance covered it and so I am sure I cannot afford that either without any insurance coverage. Any additional thoughts or opinions would be greatly appreciated. I was also evaluated by a Psychiatrist to determine if any of my symptoms were psycho somatic. His findings were that all of my pain was physical and not psychosomatic. He did not consider me to be depressed but he did a medication trial of Cymbalta with me-Cymbalta was very helpful and provided me with a lot of pain relief after I had been on it about a week. I was able to significantly decrease percocet but within 2 weeks of the start date of the cymbalta I started to wake up several times a night with nightmares. They got so bad that I had to go off the Cymbalta. I did one more trial of it a few months later and had the same problems-The psychiatrist said that there was nothing more he could do to help me and he referred me back to pain management.
Answered by Dr. Vaibhav Gandhi 4 hours later
Brief Answer: I will advise you then surgical decompression Detailed Answer: Hello, I have studied your case. As you have taken all patterns of conservative therapies for your spine but still having persistent pain, I will advise you then surgical decompression to relive your spinal canal stenosis which will give better relief. Till time you can continue duragesic patch, better not to increase dose. I think your body is dependent on duragesic patch. You can take tramadol which will give some relief. Take neurotropic medication like methylcobalamine daily with it Vit D deficiency can lead to diffuse bone pain which is not of severe variety, you need to continue vitamin D supplement. Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries. Wishing you good health. Take care.
Above answer was peer-reviewed by
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