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    What causes constant pain in lumbar region despite taking medication?

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Posted on Wed, 1 Jun 2016 in Bones, Muscles and Joints
Question: Not sure if you can. I have severe DDD in the lumbar area causing great discomfort. Prednisone and I do not get along. What would you do if you had this condition. Would you elect surgery or chiropractor?
doctor
Answered by Dr. Vivek Chail 37 minutes later
Brief Answer:
Please try conservative management options for few months

Detailed Answer:
Hi,
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

1. Being a radiologist I come across many patients who have problems similar to yours and the have to make a choice between getting treated by physiotherapy, medicines and injections on one hand and surgery on the other.

2. In my experience a mild disc problem can be treated with physiothearapy to start with. In the first few months, mild over the counter pain relief and physiotherapy is recommended and the response to treatment can be evaluated for 6 months.

3. If you do not get relief after 6 months and the pain is worsening then injection steroids and nerve pain relief medicine is prescribed.

4. Should there be significant pain even after the measures discussed then it might be tome for high potency pain relief like opioids and ssurgery. This is recommended only if there is no relief after 12 months of regular treatment by other methods.

5. Surgery is of many types and now laser disc surgery is being done and it is minimally invasive with few complication. However it is to be remembered that 20 percent patients can get good relief after surgery. In the remaining patients going for surgery, 40 percent will have the same level of pain and discomfort and 40 percent will have worsening of symptoms after surgery.

6. In conclusion, the treatment choices are customised and a duration of 12 months should be allowed to know if treatment with medicines and physiotherapy can be made to work for you. However, if the disc problem is acute and significant then patients are directly recommended surgery.

7. If possible then please upload the entire DVD containing your MRI images and send me the download link. Alternatively you can upload a copy of your report so that I can understand your situation accurately and discuss in detail.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 28 minutes later
we have disc but unsure how to send to you.
doctor
Answered by Dr. Vivek Chail 22 minutes later
Brief Answer:
Please upload entire DVD to file sharing facility and send ownload link

Detailed Answer:
Hi,
Thanks for writing back with an update.

1. Many of my patients send DVD pictures through file sharing facility. I request you to please upload the entire DVD to a file sharing facility like Dropbox or google drive and send me the download link. I will see your pictures on my work station.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail 9 hours later
https://www.dropbox.com/sh/196ksus2ik1i9vh/AAB6aRA9-n6XRvGXAQEht2j4a?dl=0

Hello Dr. Chail, Please see MRI files regarding our current discussions. Thank you, XXXXXXX
doctor
Answered by Dr. Vivek Chail 5 hours later
Brief Answer:
Please discuss non steroidal medical management with your doctor

Detailed Answer:
Hi,
Thanks for writing back with an update.

1. Having gone through your MRI scan we find that there are disc changes at multiple levels and probably the poain is nore worse on the left side. There is no indication of any emergency surgery, however it is important to evaluate the pain you are having when planning an elective surgery.

2. In my opinion you can discuss non steroidal treatment options in the beginnung and follow up for fgew months. If there is continuous worsening after 6 to 12 months then you can plan surgery.

3. I stress more on non surgical treatment because surgey should be the last option when there is unbearable pain after trying every form of non surgical treatment available to you. Surgical outcomes for low back surgery varies greatly in the population.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6708 Questions

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