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Dr. Andrew Rynne

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Exp 50 years

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How can body pain be treated post accident despite taking pain killers?

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Dr. Ishu Bishnoi

Neurologist, Surgical

Practicing since :2007

Answered : 830 Questions

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Posted on Fri, 20 Apr 2018 in Brain and Spine
Question: A friend was involved in an auto accident and had to undergo some operation on her neck. After that surgery, she has been in constant pain and has to take pain killers and muscle relaxers very single day which makes it very uncomfortable and dizzy sometimes. We are now looking for a second opinion on what needs to be done next to relieve her of all this discomfort. When on cardio workout machines, her toes become numb. Is this something you or your network can help with? We have MRI and X-Ray images that we can upload for analysis.

An attempt to upload the images in a zipped file returned the following error: "413 Request Entity Too Large". Please let me know if there is another way for us to send you these images, for example through the Cloud services (iCloud or Google Drive).
doctor
Answered by Dr. Ishu Bishnoi 2 hours later
Brief Answer:
Need more information and how to send images

Detailed Answer:
Hi Oxxxxxxx, thanks for asking from HCM.


I can understand your concern. Spinal cord damage and nerve compression can cause constant pain in body. It can be confirmed by checking MRI of damaged spine area. As you are not able to download it, please take help from HCM customer care. You can call them and send your images to them.
Or you can make a video of it, upload it on youtube and send me the link. These two methods can be used to send the images.

I also need more information about

- What procedure was done?
- Is there any focal deficit?
- When was she operated?
- What is her age and general physical condition?

I need these answers to conclude better. Hope you will understand my point.
If you have any doubts, do let me know.
Thanks. Take care
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ishu Bishnoi 28 minutes later
Thanks for your quick response. I believe that in the rush to get back to me, you skipped the profile and were not able to see her age. I have provided it there.

She is in great shape apart from the constant pain. She cannot stand for long periods of time. She is very athletic normally but this issue is slowing her down a bit. She would like to work out to maintain her health but she feels dizzy because of the medicines.

She is out now but she will be back tomorrow then we can provide all the information you need to help. I hope by that time I will have found a way to upload the images too.

Thank you.

She called and now I have some update:
-They did disc replacement C5.
-She is taking Lyrica muscle relaxer and she has shooting pains in her arms and fingers.
-Her neck is not flexible when going back.
-She recently stopped taking the muscle relaxer because it makes her feel sick and now the pain is worse. It is there now even when she is moving her head forward.


I reached out to Customer Service and they advised that I send the attachment via your attachments email and it prompted me to send with MailDrop which will keep it in the Cloud for the next 30 days.

It is a zipped file, XXXXXXX zip, and you can easily unzip it with WinZip once you have retrieved it from the Cloud.

Please let me know if you need any more information to help with the analysis.

Thank you.

Otswila.
doctor
Answered by Dr. Ishu Bishnoi 22 hours later
Brief Answer:
Probable diagnosis of pain and how to approach

Detailed Answer:
Hi Ostwila, welcome back.


Thank you for providing me the reports and answers. She had undergone C5 discoidectomy for cervical disc herniation and cord/nerve compression. In most patients, it relieves pain and nerve damage features. But sometimes, there will be no relief due to

- Incomplete disc removal - It leads to persistence of nerve and/or cord compression. The symptoms are similar to past symptoms. It can be checked by re MRI of cervical spine.

- Migration of graft which has been put at discoidectomy site. It can cause compression. NCCT cervical spine can confirm it.

- Cervical disc disease at another level either above it or below it. After removing one disc, the chances of disc herniation at another level increases. If patient does not follow precautions, disc herniation can occur at different level and cause pain.

- Painful peripheral neuropathy due to trauma. It can be suspected if MRI/CT cervical spine are normal, but there is nerve damage and pain. The nerve damage can be checked by nerve conduction velocity of axillary/musculcutaneous/median and ulnar nerves.

- Muscle injury during surgery and dural compression can cause pain in neck movements and stiffness. While disc surgery is done, neurosurgeons separate neck muscles to reach till bone. This dissection causes adhesions. After removing disc, the vertebrae (above and below) are fixed. To prevent graft migration, neck rest is advised in initial days. All these manoeuvres can cause neck stiffness. This leads to stiff neck and painful movement. Another reason for neck pain could be compression of dura (a membrane like covering of spinal cord, which is pain sensitive). It can be due to persistence of disc/graft or disc at another level.

Now you can ask her to discuss all these options with her treating spine surgeon. She is quite young to undergo such procedure. Ask her to follow few simple steps till final diagnosis

- Consult a good physiotherapist and gradually start neck exercise. It will improve neck flexibility. Good thing is - most neck movements (right-left or up-down) occur at upper-most cervical spine area. So surgery at C5 level is not going to affect much. She needs to work hard.

- She is on tablet Lyrica, which is a good neuropathic pain reliever drug. If possible, ask her to take not more than 150mg dose in a day. She should avoid cold environment and apply diclofenac gel (which does not cause systemic side effects) over neck. Hot fomentation and neck massage will also relieve pain.

- Ask her to eat green vegetables, fruits, fish, curd and take nerve specific vitamins like B12, folic acid, Benfotamine, Pantothenic acid, Pyridoxine. It will help in recovering nerve damage.

Please let me know the response and her doctor's opinion. If there is any doubt, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ishu Bishnoi 2 hours later
Thank you Dr. Bishnoi.

We shall review this and get back to you if necessary.

Best regards.

Otswila.
doctor
Answered by Dr. Ishu Bishnoi 12 hours later
Brief Answer:
Thank you for the appreciation

Detailed Answer:
Hi Otswila, welcome back.

Thank you very much for the appreciation.
I am looking forward to your query.

Take care.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ishu Bishnoi 38 hours later
She has been taking 150mg of Lycra 3 times a day but since she stopped, she has been having headaches and the pain in the neck has worsened. When she moves her head forward, she has pain in the spine, the upper part of the back going down to the middle. And when she moves her head backward, there is pain in the spine but it extends even further down toward the lower back.

Does this report help narrow down the possible areas for re-examination or further scrutiny to determine the root cause of the problems she is experiencing?

She is already working on getting an appointment with her neurologist for discussion and examination.

Thanks for your help.

Otswila.
doctor
Answered by Dr. Ishu Bishnoi 19 hours later
Brief Answer:
Neck pain cause

Detailed Answer:
Hi Otswila, welcome back.


It is sad that she used to take such high dose of pregabaline (Lycra 450mg/day) for pain relief. It is good that she had stopped taking it. But her pain is disturbing her very much.

The history of pain is suggesting few things

- Pain on neck movement (flexion and extension) are most commonly due to compression of cervical spine nerves and cord anteriorly (flexion pain) and posteriorly (extension pain). It can occur due to disc/bony osteophytes anteriorly and ligament flavum posteriorly. Overall spinal canal stenosis at same level or above-below can cause such symptoms.

- The neck stiffness is due to neck muscle spasm, surgical injury and adhesions, pain.

As she is still waiting for neurologist meeting, you should ask her to follow few steps to get some relief -

- Ask her to apply diclofenac gel, hot fomentation over neck (pain area).

- Avoid cold environment. Ask her to keep her neck covered to keep it warm. Stiffness and neuropathic pain always increase in cold.

- She should take neutron specific multivitamin like B12, folic acid, pantothenic acid, pyridoxine, befotamine. It will help in healing nerve injuries and will provide relief.

- Ask her to do regular neck exercise. But avoid extreme neck movement. Do it under supervision and stop the movement, if she feels severe current like pain. Gradual relief in stiffness can be achieved by it.

- There is no need to completely stop painkiller medication. She can take low dose of pregabaline (75-150mg once a day or on alternate day), Gabapentine (300mg once a day), or combination of Gabapentine+Nortriptyline after prescription.

- She can also try Tablet S-adenosylmethionine. It is given to enhance nerve myelination and helps in healing of nerves. It is supplement medication. I have seen good results with this medication. She can take around 400mg once a day after prescription. It will also help in reducing her depression.

Please send me her new MRI/CT separately, not with previous reports. It will be easy for me to check it. I don't have previous reports with me now. Sorry for the inconvenience.

Hope it will help her. If any doubt, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
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