Have severe back pain right below my mid back. Feel hard lumps when pain. Using Butrans pain patch and tramadol for pain. Help?

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Posted on Sat, 28 Sep 2013 in General Health
Question: I have severe back pain right below my mid back almost into my lower back. It is on each side of my spinal cord at the exact same spot. You can feel hard lumps when the pain is very severe as if your knuckles are running over speed bumps on your back. I have had this pain for many, many years but after being in two car accidents in the last 11 months it has progressed aggressively. The pain is so bad that if I am being massaged at an attempt to subside the pain, I literally feel like somebody is sticking a knife in that area when it is gone over. The pain has recently moved to directly on my spine as well as if it feels bruised/tender on a day to day basis but when pushed on even slightly I gasp in pain as it takes my breath away. I received physical therapy after my first accident along with a Butrans pain patch and tramadol for pain which helped tremendously and then following the second accident the pain does not seem to want to go away at all. I hurt sun up to sun down and am only 29 years old along with trying to start a family. The MRI after the first accident came back showing nothing and then the CT scan after the second supposedly showed nothing. I cannot understand how nothing is showing up especially being in this much pain. Please help!
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Answered by Dr. Roopa Hiremath 1 hour later
Brief Answer:
Muscle relaxants, rest to the part.

Detailed Answer:
Hi Mr. XXXXX,

Thank you for posting your query. I have gone through your history and I do understand your concern and the suffering.

In your history you are mentioning that you have had two accidents, and the investigations carried out did not show any problem or deformity in the back or spine.

It would help me greatly if you could elaborate a little more on how and what happened during these two accidents and also if you have them, please upload the reports of the CT scan and MRI. (you can use the upload reports option on the right hand side of your dashboard).

Your symptoms are suggestive of muscular spasm, especially of the paraspinal area (muscles beside the spine). These muscular spasms cause pain which is stabbing type and increased when any movement occurs.

A local application of a rubifacient gel or a pain killer will help relieve the symptoms to great extent. Do not massage very strongly.

Give rest to the part as much as possible. Hot fomentation (hot water bag) on the part will relax the muscles and reduce the pain. Physiotherapy will definitely help.

After the pain has reduced completely, I suggest, you go for a regular exercise regimen which involves body stretches (yoga, Pilates...).

I would also like to mention that wrong posture while sitting, standing and sleeping, an uncomfortable bed and hard pillows can trigger such episodes.

Apart from all this I would also like to suggest you to see a orthopedic surgeon and request a prescription for a good painkiller and muscle relaxant combination and also ask him/her to prescribe the appropriate physiotherapy like SWD(Short wave diathermy), Ultrasonic massage, Massage therapy.

I hope this answers all your concerns. Please do write back if you have further questions or doubts.

Wishing you a speedy recovery.


Warm regards.
Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Roopa Hiremath

Infectious Diseases Specialist

Practicing since :2002

Answered : 877 Questions

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