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Suggest treatment for severe back pain

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Dr. Ajay Panwar

Neurologist

Practicing since :2007

Answered : 1714 Questions

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Posted on Thu, 10 Sep 2015 in Brain and Spine
Question: Hi Doc,

I am 34 years old and at the age of 24, I got problem with l4-l5 disc. 10years back did MRI scan and attaching report of the same.

At age 24, weight was 79-81 KG at the height of 5'10". I reduced (within 6 month)weight to 74kg by walking, yoga for back pain and life was normal for another 4-5 years.

10 years back I have to doc at Lilavati hospital at XXXXXXX and doc suggested to go through physiotherapy and exercise routine and said that this will be there with life time so with exercise ,yoga and weight in check will keep away the problem.

One more doc (Toshi Orthopadic Center - attached), we shown at the same time and he suggested to go for disc replacement and said within one month of time you will lead normal life. With different opinion from different doc we were confused at that time. Writing this to give you background.

Recent time back pain has became severe and more frequent. Current weight is 86KG.
Again have loose confidence as there is always fear that disc will come out press nerve and thacal sac. Pain is severe when it happens and movement become difficult. Recently 15 days back - I took 4 days leave with 2 days bed rest and 2 days little exercise. Currently I am recovering but improvement is slow. Whenever the pain is high or there is visible inflammation I do take vovran 100SR 2 times a day and once pain stops I stop taking it.

I need advise which can help to reduce the pain first. Second what would be the permanent solution to this?

One more important point, I do have gastric problem and specially in intenstine and do flatulence frequently (12-15 time a day). One observation is that whenever I have gastric problem I do feel pain in back severe and muscle control is tough.

Currently I reside at XXXXXXX

doctor
Answered by Dr. Ajay Panwar 31 minutes later
Brief Answer:
If medicines and physiotherapy does not help,surgery is the option.

Detailed Answer:
Hi XXXXXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

I have gone through your MRI report and medical prescription.
You have L4-L5 disc herniation with L5 nerve root compression in MRI report you attached(done in 2006).
On basis of this MRI report and your current symptomatology,the treatment protocol is straightforward:
Symptoms should be managed with the help of medicines and regular physiotherapy exercises.If the symptoms do not improve or worsen within a couple of months of regular medicines with exercises,surgery is the option.However,I would like to mention here that spinal exercises with proper technique and dedication will be the key to improvement.They have a more important role to play than medicines.Consult a truly expert physiotherapist.

One liner-If your symptoms make your life hell,you are not able to do your daily routine yourself because of symptoms and those symptoms are not responding to medicines and exercises,only then you should go for surgery.

Besides,please get a latest MRI of L-S spine to have a better view of the existing pathology.

Your gastric problem seems to be unrelated,though it may have been aggaravating the back pain.I suggest you to please consult a physician for the same.

Regarding medicines,the medicines as mentioned in your prescription are ok.In addition,a pregabalin/methylcobalamin combination may help.Also,one of the antineuralgics-either amitriptyline or duloxetine may be started.Along with,calcium and vitamin D supplementation should also be taken.

Hope that I have answered your query.If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review as your rating will be of help to me.

Please get back to me after getting the latest MRI done.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ajay Panwar 1 hour later
Hi Dr. XXXXXXX
Thanks for detailed response.
I will get back to you after latest LS spine MRI.
Meanwhile, I would like to understand about the medicine you suggested and dosages / time ( once - twice - thrice etc.) If you can share proper prescription with medicine and dosages, it will really helpful.
doctor
Answered by Dr. Ajay Panwar 3 hours later
Brief Answer:
As follows:

Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.

A typical prescription would be like this:
1)Tab.Pregabalin 75 once a day,in the morning.
2)Tab.Etoshine-MR(Etoricoxib) 1 tab twice a day for 7 days(after meals).
3)Tab. Symbal 30 mg once a day(morning)
4)Tab.Shelcal-CT once a day
5)Tab Neurobion forte twice a day.

With regular spinal exercises

PLEASE TAKE ALL MEDICINES UNDER THE GUIDANCE OF A PHYSICIAN ONLY.

Hope that I have answered your query.If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review as your rating will be of help to me.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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