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Suggest Treatment For Severe Lower Back Pain
Question: I am asking this question on behalf of my wife XXXXXXX who has suffered with lower back pain for many years. It would seem that her doctors are saying there is nothing further that can be done except pain management of Paracetamol and Ibuprofen.
Brief Answer:
Combination of medications +physiotherapy are more indicated than surgery
Detailed Answer:
Hello XXXXXXX
I carefully read your question and the letters attached and I understand your concern related to your wife's complaints.
Back pain is very common and sometimes it might be devastating as it might prevent the patients to have their daily activities and take care of common needs they have. Most of the times the pain is not due to serious causes, 90% are due to muscular strain, disc prolapse and nerve root compression.
It is obvious by the MRI that your wife has some compression at the root of one of the nerves that cause her to have sciatica pain down her leg.
MRI does not confirm presence of cauda equina which is a good new as Cauda equina is a medical emergency that needs urgent surgical treatment and does not seem to be the case with your wife.
As I read in the letter your wife has been taking a good medical care and she has had symptom relieve with the steroid injections but unfortunately the effect did not last long.
The doctor also has recommended physiotherapy. This is a very important part of the treatment for back pain and I would strongly suggest it.
It is good news that pain is better and it shows that very likely the numbness will soon feel better also.
There are also some medications that can help with nerve pain like Gabapentine but I would not take them without talking with your doctor.
So to conclude I would recommend:
1. take Ibuprofen and paracetamol for pain, after food so not to hurt the stomach (paracetamol alone is not found effective in back pain in studies)
2. Local warm comresses might help to relax the muscles and improve the pain (some patients might feel a better effect with local cold compresses)
3. weight reduction is helpful with many articulation pains and especially with back pain
4. physiotherapy is very helpful to strengthen the back muscles and prevent pain and furhter damage- I would strongly suggest to speak with a good physiotherapist for this.
5, Try to be active as much as you can and the pain allows it- bed rest is not good for back pain, it increases the number of days in pain
6. Speak with your doctor on Gabapentine and if he thinks it would be good in your case
7. The doctor has written in letter 2 that if all the measures do not help with pain, he would consider surgery so if you see that all the above are not helping you might need to speak with your doctor on relation to this. The reason he did not do the surgery in the first place is because you did not try yet many treatment options so now if all the treatment options are utilized and not helpful, then you will need to bring this back into discussion with your doctor.
On the other hand, literature does not show more benefit with surgery compared to pain killers and physiotherapy unless there is cauda equina that surgery is needed (so the suspected cauda equina should be evaluated further). So your doctor will need to balance well the benefits and the risks of the surgery before he decides in favor to surgical treatment.
I hope this answers to your question and is helpful to you. Feel free t oget back to me in case you have any further queries
Kind Regards,
Dr Antoneta Zotaj
Combination of medications +physiotherapy are more indicated than surgery
Detailed Answer:
Hello XXXXXXX
I carefully read your question and the letters attached and I understand your concern related to your wife's complaints.
Back pain is very common and sometimes it might be devastating as it might prevent the patients to have their daily activities and take care of common needs they have. Most of the times the pain is not due to serious causes, 90% are due to muscular strain, disc prolapse and nerve root compression.
It is obvious by the MRI that your wife has some compression at the root of one of the nerves that cause her to have sciatica pain down her leg.
MRI does not confirm presence of cauda equina which is a good new as Cauda equina is a medical emergency that needs urgent surgical treatment and does not seem to be the case with your wife.
As I read in the letter your wife has been taking a good medical care and she has had symptom relieve with the steroid injections but unfortunately the effect did not last long.
The doctor also has recommended physiotherapy. This is a very important part of the treatment for back pain and I would strongly suggest it.
It is good news that pain is better and it shows that very likely the numbness will soon feel better also.
There are also some medications that can help with nerve pain like Gabapentine but I would not take them without talking with your doctor.
So to conclude I would recommend:
1. take Ibuprofen and paracetamol for pain, after food so not to hurt the stomach (paracetamol alone is not found effective in back pain in studies)
2. Local warm comresses might help to relax the muscles and improve the pain (some patients might feel a better effect with local cold compresses)
3. weight reduction is helpful with many articulation pains and especially with back pain
4. physiotherapy is very helpful to strengthen the back muscles and prevent pain and furhter damage- I would strongly suggest to speak with a good physiotherapist for this.
5, Try to be active as much as you can and the pain allows it- bed rest is not good for back pain, it increases the number of days in pain
6. Speak with your doctor on Gabapentine and if he thinks it would be good in your case
7. The doctor has written in letter 2 that if all the measures do not help with pain, he would consider surgery so if you see that all the above are not helping you might need to speak with your doctor on relation to this. The reason he did not do the surgery in the first place is because you did not try yet many treatment options so now if all the treatment options are utilized and not helpful, then you will need to bring this back into discussion with your doctor.
On the other hand, literature does not show more benefit with surgery compared to pain killers and physiotherapy unless there is cauda equina that surgery is needed (so the suspected cauda equina should be evaluated further). So your doctor will need to balance well the benefits and the risks of the surgery before he decides in favor to surgical treatment.
I hope this answers to your question and is helpful to you. Feel free t oget back to me in case you have any further queries
Kind Regards,
Dr Antoneta Zotaj
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Hi, thank you for your comprehensive reply.
I have discussed this with my wife. She has started the physio and I do think she is getting some benefit. She will be in circumstances for the next month whereby she can increase her attention to the exercises explained by her physio. Losing the weight will not be easy on a cruise ship.
You have echoed what she has been told but the loss of mobility gets her down. She begins to stoop over as the day goes on. She has always had amazing forward flex and can still touch her toes. It is the standing straight which is problematic.
Her next appointment is not due until April for a review. They have said that further injections are pointless as XXXXXXX had told them that the last one only helped for four weeks. I believe that gave them the opportunity to make space for others.
We just think there must be a way in this day and age of easing the joints of the vertebrae where impinging is occurring. One specialist simply explained that Brenda's back is just worn out. We continue to hope.
Kind regards.
I have discussed this with my wife. She has started the physio and I do think she is getting some benefit. She will be in circumstances for the next month whereby she can increase her attention to the exercises explained by her physio. Losing the weight will not be easy on a cruise ship.
You have echoed what she has been told but the loss of mobility gets her down. She begins to stoop over as the day goes on. She has always had amazing forward flex and can still touch her toes. It is the standing straight which is problematic.
Her next appointment is not due until April for a review. They have said that further injections are pointless as XXXXXXX had told them that the last one only helped for four weeks. I believe that gave them the opportunity to make space for others.
We just think there must be a way in this day and age of easing the joints of the vertebrae where impinging is occurring. One specialist simply explained that Brenda's back is just worn out. We continue to hope.
Kind regards.
Brief Answer:
I understand the frustration but still some things might help
Detailed Answer:
Hello XXXXXXX
I understand the frustration you and your wife are feeling with the chronic back pain she is having. It is true that we would expect to have some things to improve the back pain in this day and age we are living now.
Unfortunately sometimes the pain might go on for longer than we expect or would like it to. There are some things that can be done but some patients benefit from those and some do not benefit enough and pain is on and off.
I understand that pain makes it hard to be very active and I am glad that your wife tries as much as she can to be active. This is what I also ment- to be active as much as she can and not have bed rest as bed rest porlongs the back pain problems.
Physiotherapy is found very helpful in back pain. I am encourraged to read that your wife is seing some improvement with it and as I saw in your first message, it has helped to control pain, while numbness might last a little later till the nerve regenerates.
The medication for nerve pain (Gabapentin) might bring a lot of release in Brenda's case.
I also hope and pray that you will be strong and have hope. It is very important how we feel about a medical condition.
Kind regards
Dr Antoneta Zotaj
I understand the frustration but still some things might help
Detailed Answer:
Hello XXXXXXX
I understand the frustration you and your wife are feeling with the chronic back pain she is having. It is true that we would expect to have some things to improve the back pain in this day and age we are living now.
Unfortunately sometimes the pain might go on for longer than we expect or would like it to. There are some things that can be done but some patients benefit from those and some do not benefit enough and pain is on and off.
I understand that pain makes it hard to be very active and I am glad that your wife tries as much as she can to be active. This is what I also ment- to be active as much as she can and not have bed rest as bed rest porlongs the back pain problems.
Physiotherapy is found very helpful in back pain. I am encourraged to read that your wife is seing some improvement with it and as I saw in your first message, it has helped to control pain, while numbness might last a little later till the nerve regenerates.
The medication for nerve pain (Gabapentin) might bring a lot of release in Brenda's case.
I also hope and pray that you will be strong and have hope. It is very important how we feel about a medical condition.
Kind regards
Dr Antoneta Zotaj
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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