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What is the treatment for severe chronic lower back pain?

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General Surgeon
Practicing since : 2008
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I find myself in a very difficult situation. My wife has a chronic lower back paid which is pretty severe and I believe there is something wrong because of which she has the pain. This started in March 2013 and we went to see an orthopedic surgeon. He asked for an Xray, which did not show anything, he asked for a MRI of the lumber spine, it was done, still no results, the report came out clean. The doctor said nothing to worry. We went to a second orthopedic doctor who also said the same thing, yet my wife is in severe pain and she is having to live and work with it every day. I do not know who to see and what to do. Her sister has Spinal Tuberculosis, could she be also affected with that? or could it be some problem with her kidney? She has already been diagnosed of Hiatus Hernia and underwent a treatment for that. Could there be some issues with her colon? Please suggest which doctor or specialist should we see now?, so my case was closed. I asked the above question and below is the reply which I received. I was late in replying to the doctor so my case was closed. My wife has already undergone a pelvis usg once usg of the lower abdomen another time, both times it came out clean. So based on the below answer what should I do now? Who should I consult, can you refer me someone in Hyderabad who can help? My wife has severe paid from lower back that extends to her legs and feet. Brief Answer: See a general surgeon Detailed Answer: Hi Thanks for posting your query on HealthcareMagic. Yes, if back pain is present, then a cause would also be there. Now it is not easy to find cause when MRI came back negative. I would like to answer you specific questions: I do not know who to see and what to do. A. See a general surgeon Her sister has Spinal Tuberculosis, could she be also affected with that? A. Yes it is possible. Can do PPD or Montoux test to start with. or could it be some problem with her kidney? A. Yes kidney problems can be an issue. Can get a urine analysis and an ultrasound abdomen to check. She has already been diagnosed of Hiatus Hernia and underwent a treatment for that. Could there be some issues with her colon? A. Yes colon can be affected. Let us first do an ultrasound of an abdomen. Hope it helps. Let me know if you have further queries.
Posted Thu, 13 Mar 2014 in Abdominal Pain
 
 
Answered by Dr. Ashish Verma 1 hour later
Brief Answer: need a few more details Detailed Answer: Hi, Thanks for writing to HCM. This is Dr. Ashish Verma, a general surgeon, answering to your query. First, a little background information...there are various causes of chronic lower back ache...it can be due to incorrect posture, diseases of spine, kidney, ovaries, uterus, colon and retroperitonium. If mri of lumbar spine is clean... then spinal diseases including spinal tuberculosis is ruled out. Normal usg rules out kidney, uterus and ovarian causes. Also, hiatus hernia does not causes low back ache. Now, as you told that the pain also goes down to the legs and feet...so it appears more like a siatica...but to say that for sure...I will need answers to a few more questions... 1- what type of pain is there in the legs...is it burning like or pricking like or cramp like? 2- what activities increase the pain in back and legs and doing what decreases it? 3 - are her bowel and bladder motions normal? Waiting for your reply, to help you to ease the pain of your wife. Dr. Ashish Verma
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Follow-up: What is the treatment for severe chronic lower back pain? 2 hours later
Hello Doctor, Thank you so much for your prompt response. Please see the answer to the questions you asked above: 1) Cramp like 2) Standing for long hours, bending, climbing stairs, lifting heavy things, walking for long distances increases the pain. There is nothing that decreases the pain. She tried hot water therapy, using heating pads, etc, with no result. 3) The bowel motions are not normal, she has constipation at times, Bladder motions are normal. Please let me know what to do next and if we need to see any specific type of doctor and if you can refer anyone in Hyderabad.
 
 
Answered by Dr. Ashish Verma 7 hours later
Brief Answer: can be vitamin deficiency...and constipation Detailed Answer: Hi, Cramp like pain on prolonged walking or standing or doing household work is usually due to vitamin deficiencies... Ask her to eat healty, more of green vegetables and whole cereals...these are also rich in fibers and will help reliev the constipation as well. Also chronic constipation can also cause low back ache...as the loaded colon puts pressure over the back and stretches the nerves in the pelvis... So initially she can take some laxatives to clear her bowel till it can be managed with diet alone. Give her oats and bananas and fresh curds...and food supplements like hi-fiber biscuits and multivitamin capsules having omega 3 and omega 6. Try this for a month or so...it should surely help... I don't think that at this age she is having any serious disease...so relax. Hope, that i have answered to all your queries. If you don't have further queries, you may close this discussion and rate the response. Regards Dr. Ashish Verma
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Follow-up: What is the treatment for severe chronic lower back pain? 52 minutes later
Hello Doctor, She was under laxatives for quite sometime during her treatment of Hiatus Hernia, but it never helped. Even when she had normal bowel movements this back pain was always there, however, the pain extending to the legs and feet have started and taken severe proportions in recent times. She eats a lot of vegetables. She has extreme pain in the bones in her feet as well. Could it be because of overweight? But you need to give me some solutions fro the lower back and leg pains. Could we not see a doctor, take some tests, to make sure nothing is actually wrong? She keeps on telling that it seems after sometime because of this pain I will be crippled and I feel helpless as I have no idea what to do?
 
 
Answered by Dr. Ashish Verma 12 minutes later
Brief Answer: you can see an orthopedic Detailed Answer: Hi, Yes, these pain can be due to overweight...and loosing a few kilos will greatly help. And, you can show her to an orthopedic and get her bone mineral density test done...and he may suggest a few more test depending upon his examination findings. Extra body weight puts lots of pressure over the bones and joints of legs and back...so that could very well be a reason for the pain. Dont loose heart...there is hardly anything that can not be improved if not cured, in this era. Regards Dr. Ashish Verma
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Follow-up: What is the treatment for severe chronic lower back pain? 41 minutes later
Hello Doctor, We have seen an orthopedic surgeon, Dr. Jairamchander Pingle, he hardly showed any interest after the MRI did not show anything. So can you recommend someone in Hyderabad who will take good care and see my wife?
 
 
Answered by Dr. Ashish Verma 6 minutes later
Brief Answer: sorry Detailed Answer: Hi, Sorry, i dont know anyone in Hyderabad. You can show in any medical college.. they have very experienced doctors. Get a bone mineral density done....but its weight reduction that will help her the most. Regards Dr. Ashish Verma
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Follow-up: What is the treatment for severe chronic lower back pain? 22 minutes later
Hi Doctor, She is a school teacher, she runs around the school the entire day, has a lot of physical activity, still does not lose weight. She has thyroid issues but she takes medicines for that, so I am not sure how she can lose weight, she doesnt even have proper time to sleep. Do you think that bariatric surgery would be a good option?
 
 
Answered by Dr. Ashish Verma 7 minutes later
Brief Answer: whats her bmi? Detailed Answer: Hi, Everytime you tell me a new thing... Whn was the last thyroid test done and what was the result. Hypothyroid causes weight gain if not properly controlled. It also causes constipation. That is the root cause of everything in your wife's case. Also for biatric surgery the bmi should be arround 30. Dr. Ashish Verma
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Follow-up: What is the treatment for severe chronic lower back pain? 6 hours later
Hello Doctor, I have attached the last thyroid test report that was done in Aug 2013. Also she is taking Thyrox 75 daily for a long time now. Her BMI is 31.9. Would you know approximately how much can a bariatric surgery cost?
 
 
Answered by Dr. Ashish Verma 16 minutes later
Brief Answer: more than 5 - 10L Detailed Answer: Hi, The thyroid profile looks normal...but its almost 6 months old...so get a new one done...but this time get 'free T3', 'free T4' and TSH and show to and endocrinologist for further management. Also see a bariatric surgeon....surgery will cost an upward of 5-10 lacs...depending upon the center... Dr. Ashish Verma
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