Lower back pain
Discussion
Almost two years ago I crushed 2 discs at work and had 5 months off work recovering. The pain was managed but always there so my specialist suggested cortisone injections which didn't work.
I went back to work and after a few weeks of tramodol I was ok although still taking max dose of tramodol, amitriptine, diclofenac, paracetamol and methocarbomol.
I took care what I did and also changed my car for a 4x4 which has really improved things for almost a year without any issues (also stopped taking everything other than tramodol and amitriptiline) - prior to that I may have had issues but lucky they were during my annual leave or leiu days.
Just recently my back has got worse and the tramodol isn't touching the pain and some days I've been taking more than the maximum dose and even worse over the last two days the pain has been so bad I find myself in an uncomfortable position just to because the pain isn't there.
I'm using muscle rub for the sensation, a tens machine and maximum tramodol plus paracetamol and don't know what else to do. I've not had a day off sick in 20 years other than my time off with my back and not been off since last may.
I went back to my doctor for a medicine review and told him about the increased pain and he had his pen ready with a fit note and suggested oxycodone (I was on that before I returned to work and I'm not allowed to work whilst on such a strong tablet).
Is there anything im missing? I've spoken to my pharmacist and he suggested gabapentim (sp?) but being a drug for epilepsy it cuts off signals to the brain so could affect my ability to think - I'm already short in that area.
I went back to work and after a few weeks of tramodol I was ok although still taking max dose of tramodol, amitriptine, diclofenac, paracetamol and methocarbomol.
I took care what I did and also changed my car for a 4x4 which has really improved things for almost a year without any issues (also stopped taking everything other than tramodol and amitriptiline) - prior to that I may have had issues but lucky they were during my annual leave or leiu days.
Just recently my back has got worse and the tramodol isn't touching the pain and some days I've been taking more than the maximum dose and even worse over the last two days the pain has been so bad I find myself in an uncomfortable position just to because the pain isn't there.
I'm using muscle rub for the sensation, a tens machine and maximum tramodol plus paracetamol and don't know what else to do. I've not had a day off sick in 20 years other than my time off with my back and not been off since last may.
I went back to my doctor for a medicine review and told him about the increased pain and he had his pen ready with a fit note and suggested oxycodone (I was on that before I returned to work and I'm not allowed to work whilst on such a strong tablet).
Is there anything im missing? I've spoken to my pharmacist and he suggested gabapentim (sp?) but being a drug for epilepsy it cuts off signals to the brain so could affect my ability to think - I'm already short in that area.
dreamer75 said:
Sorry to hear that 
Are you seeing a GP, or a specialist/consultant?
I have only been seeing my GP when I have to have a medicine review which is every 3 months. The last I spoke to the consultant was about a year ago after the cortisone injections didn't work. The next stage was pretty extreme so I opted for the drug approach which has been working well until a couple of weeks ago. Are you seeing a GP, or a specialist/consultant?MacGee said:
what is the cause of the pain..why not treat that first!
The cause of the pain is a crushed disc, this puts pressure on one or more nerves. It's not quite as simple as sorting the cause, any surgery on the back is major and, in my opinion, has too many risks attached.
I have one friend that has had a disc replaced which was successful but I also have two friends that have had similar operations which have made matters worse. One of them is now in more pain then before plus their left leg is now twisted inwards which has only happened since the op.
As I said in my initial post I have been pretty good for over a year whilst taking less then prescribed drugs and have only have an odd day of episodes. It's just been the last couple of weeks where it has become much worse.
petemurphy said:
i have an appt at the pain clinic on tues! tramadol makes me feel v high but unfortunately gives me huge headaches on the come down! dont take more than you should go back to docs.
and pilates
pilates
pilates
I might give Pilates a go!! and pilates
pilates
pilates
I know you should never take more then prescribed but when I'm working and the pain is just too much I can take a few too many without realising. That does sound really pathetic but Ill simply think 'oh that hurts, must be tablet time' , next thing a strip of ten has gone.
falkster said:
The cause of the pain is a crushed disc, this puts pressure on one or more nerves.
It's not quite as simple as sorting the cause, any surgery on the back is major and, in my opinion, has too many risks attached.
I have one friend that has had a disc replaced which was successful but I also have two friends that have had similar operations which have made matters worse. One of them is now in more pain then before plus their left leg is now twisted inwards which has only happened since the op.
As I said in my initial post I have been pretty good for over a year whilst taking less then prescribed drugs and have only have an odd day of episodes. It's just been the last couple of weeks where it has become much worse.
i always notice it when it turns cold - usually gets better again - for all the drugs etc nothing beats a hot water bottleIt's not quite as simple as sorting the cause, any surgery on the back is major and, in my opinion, has too many risks attached.
I have one friend that has had a disc replaced which was successful but I also have two friends that have had similar operations which have made matters worse. One of them is now in more pain then before plus their left leg is now twisted inwards which has only happened since the op.
As I said in my initial post I have been pretty good for over a year whilst taking less then prescribed drugs and have only have an odd day of episodes. It's just been the last couple of weeks where it has become much worse.
and pilates
did i mention pilates..
Have you had an MRI etc? I certainly wouldn't be starting any additional physical activity until you know what state the disc is in - if it's herniated all the pilates and posh stretching in the world will only make it worse, from my OH's experience, and to a lesser extent my own. If there's no disc there..well... it's obvious really.
My OH has degenerative disc disease, and is currently recovering from having neck fusion (sounds jazzy
), and needs her lower back doing next year, I've had lower back done and it's been great - still feel it a bit in the winter or when doing heavy lifting, but it's a damn sight better than a bad back year round for the rest of my days. She's a yoga and pilates nut, or rather was, so if there was any scope for it to help her, she'd be doing it, but unless you know what the score is with the disc....
As for the OH, she gets cortisone (and something else I forget the name of) injections every few months which for the large part negates use of pills, still some discomfort though, especially in the run up to her next round of shots. If the surgery is suitable for you, I'd give serious consideration to it - it's come a long way in recent years apparently, and her post-op recovery seems to be going perfectly. Certainly appeals to me more than being stuck on opioids like tramadol for prolonged periods.
My OH has degenerative disc disease, and is currently recovering from having neck fusion (sounds jazzy
), and needs her lower back doing next year, I've had lower back done and it's been great - still feel it a bit in the winter or when doing heavy lifting, but it's a damn sight better than a bad back year round for the rest of my days. She's a yoga and pilates nut, or rather was, so if there was any scope for it to help her, she'd be doing it, but unless you know what the score is with the disc....As for the OH, she gets cortisone (and something else I forget the name of) injections every few months which for the large part negates use of pills, still some discomfort though, especially in the run up to her next round of shots. If the surgery is suitable for you, I'd give serious consideration to it - it's come a long way in recent years apparently, and her post-op recovery seems to be going perfectly. Certainly appeals to me more than being stuck on opioids like tramadol for prolonged periods.
OP,
A relative had something similar - commonly called a slipped disk, but it's not. He tried everything, then as a last resort tried accupuncture. It took him over a year of pain to try it, on the basis it was quackery. 3 weeks of sessions, and the spasms stopped, pain reduced etc etc. Once the muscles stopped spasming all the time, he did escersise to strengthen other bits and has been better since.
A relative had something similar - commonly called a slipped disk, but it's not. He tried everything, then as a last resort tried accupuncture. It took him over a year of pain to try it, on the basis it was quackery. 3 weeks of sessions, and the spasms stopped, pain reduced etc etc. Once the muscles stopped spasming all the time, he did escersise to strengthen other bits and has been better since.
Stu R said:
Have you had an MRI etc? I certainly wouldn't be starting any additional physical activity until you know what state the disc is in - if it's herniated all the posh stretching in the world will only make it worse, from my OH's experience, and to a lesser extent my own.
My OH has degenerative disc disease, and is currently recovering from having neck fusion (sounds jazzy ), and needs her lower back doing next year, I've had lower back done and it's been great - still feel it a bit in the winter or when doing heavy lifting, but it's a damn sight better than a bad back year round for the rest of my days.
As for the OH, she gets cortisone (and something else I forget the name of) injections every few months which for the large part negates use of pills, still some discomfort though, especially in the run up to her next round of shots. If the surgery is suitable for you, I'd give serious consideration to it - it's come a long way in recent years apparently, and her post-op recovery seems to be going perfectly. Certainly appeals to me more than being stuck on opioids like tramadol for prolonged periods.
Yes, I had an MRI last year and my consultant did say I would have episodes which can be controlled by drugs. He would only consider operating if it got worse (which up until last two weeks it hasn't). My OH has degenerative disc disease, and is currently recovering from having neck fusion (sounds jazzy
), and needs her lower back doing next year, I've had lower back done and it's been great - still feel it a bit in the winter or when doing heavy lifting, but it's a damn sight better than a bad back year round for the rest of my days. As for the OH, she gets cortisone (and something else I forget the name of) injections every few months which for the large part negates use of pills, still some discomfort though, especially in the run up to her next round of shots. If the surgery is suitable for you, I'd give serious consideration to it - it's come a long way in recent years apparently, and her post-op recovery seems to be going perfectly. Certainly appeals to me more than being stuck on opioids like tramadol for prolonged periods.
The next step after the cortisone injection was to kill the end of the nerve that the disc was touching but in order for me to have that done, they have to poke and prod me without anaesthetic to find the offending nerve. I didn't like the sound of that given the cortisone injection brought a grown man to tears, I would do everything I could to avoid such measures.
I'd be asking about another MRI then, TBH. A lot can change with them in a year - my OH's neck for example, was fine when she had it MRI'd in July 2010, but in Feb 2011 it was knackered. Worth checking the state of play to see if it has worsened. As for killing nerves etc, that sounds pretty harsh! Not a treatment I've had offered before, and probably not one I'd take either!
I love cortisone injections (though I don't get them in the back). My OH is the biggest wimp I know and she gets a track mark of 6 on each side of her spine in one sitting
I think her biggest problem with them is her doctor sees more of her arse than he does of her face. Heaven forbid they see eachother in the street, she'd have to lift up her frock for him to recognise her
Being as it's only got worse a couple of weeks ago, I'd be inclined to say let the doc know, and see if it's just a short term increase in pain. But if it's a permanent increase in pain etc, it's probably worth considering taking the next steps.
I love cortisone injections (though I don't get them in the back). My OH is the biggest wimp I know and she gets a track mark of 6 on each side of her spine in one sitting
I think her biggest problem with them is her doctor sees more of her arse than he does of her face. Heaven forbid they see eachother in the street, she'd have to lift up her frock for him to recognise her
Being as it's only got worse a couple of weeks ago, I'd be inclined to say let the doc know, and see if it's just a short term increase in pain. But if it's a permanent increase in pain etc, it's probably worth considering taking the next steps.
Osteopath for gentle manipulation might be an option or the Alexander Technique (classes or 1 to 1).
I had emergency surgery on 2 "leaking" discs 8 years ago - the discs trapped the sciatic nerve leading initially to referred pain in the calf and then loss of feeling in the lower leg. It was top end disk skim or remove and put cages in. Opted for the former. Fantastic surgeon (NHS) and down to my GP and his "old boy network".
I know there are risks with surgery (something like 1 in 10,000 of paralysis), but I had no option at the time and it worked for me. Still get pains and problems occasionally, but maintenance from the Osteo every 4-6 weeks topped up with some of the meds you have and I've been back in a sports car for a few years now.
Strengthening stomach muscles also supports the back, so daily sit ups when I don't have pain is a must.
Look at the alternative medicine routes if you really don't want surgery.
I had emergency surgery on 2 "leaking" discs 8 years ago - the discs trapped the sciatic nerve leading initially to referred pain in the calf and then loss of feeling in the lower leg. It was top end disk skim or remove and put cages in. Opted for the former. Fantastic surgeon (NHS) and down to my GP and his "old boy network".
I know there are risks with surgery (something like 1 in 10,000 of paralysis), but I had no option at the time and it worked for me. Still get pains and problems occasionally, but maintenance from the Osteo every 4-6 weeks topped up with some of the meds you have and I've been back in a sports car for a few years now.
Strengthening stomach muscles also supports the back, so daily sit ups when I don't have pain is a must.
Look at the alternative medicine routes if you really don't want surgery.
Perhaps you need a repeat MRI to see if things have changed - either way it sounds like it's time to go back to the consultant.
I started with bulging discs, osteo made it worse (before I had diagnosis), eventually L4/5 herniated and was operated on last year. That made things better for a while but now it's degenerated to the point there's only 1mm or so left, and I'm looking at disc replacement early next year.
Throughout the last few years I've had physio and done Pilates constantly - although a lot of the associated pain has cleared up (SI joint problems etc.) and undoubtedly my posture and core strength is better, but you can't stop the progress of DDD I guess (Degenerative Disc Disease)
It doesn't sound like popping painkillers randomly (and in excess) is the answer though! At least get an up to date diagnosis of where things are.
And get on Pilates ;-)
I started with bulging discs, osteo made it worse (before I had diagnosis), eventually L4/5 herniated and was operated on last year. That made things better for a while but now it's degenerated to the point there's only 1mm or so left, and I'm looking at disc replacement early next year.
Throughout the last few years I've had physio and done Pilates constantly - although a lot of the associated pain has cleared up (SI joint problems etc.) and undoubtedly my posture and core strength is better, but you can't stop the progress of DDD I guess (Degenerative Disc Disease)
It doesn't sound like popping painkillers randomly (and in excess) is the answer though! At least get an up to date diagnosis of where things are.
And get on Pilates ;-)
OP: You asked about Gabapentin?
I'm on Gabapentin and Amitriptyline at the moment. Both are indeed drugs for other purposes (epilepsy and depression respectively), but have a proven ability to reduce neuropathic pain, which is what I take them for. Your GP would need to prescribe both. You can take both concurrently, or just one or the other. I'm supposed to be dropping the Am. and titrating up the Ga., but I can't handle the pain without the Am., thus me taking both together at the moment until the Ga. dose is high enough. I've not noticed any reduced ability to think - the only thing I've noticed is that Amitriptyline makes me feel very sleepy at doses over 50mg a day. I'm currently ramping up the Gabapentin and am halfway to my full prescribed dose and have no side effects so far.
HTH
I'm on Gabapentin and Amitriptyline at the moment. Both are indeed drugs for other purposes (epilepsy and depression respectively), but have a proven ability to reduce neuropathic pain, which is what I take them for. Your GP would need to prescribe both. You can take both concurrently, or just one or the other. I'm supposed to be dropping the Am. and titrating up the Ga., but I can't handle the pain without the Am., thus me taking both together at the moment until the Ga. dose is high enough. I've not noticed any reduced ability to think - the only thing I've noticed is that Amitriptyline makes me feel very sleepy at doses over 50mg a day. I'm currently ramping up the Gabapentin and am halfway to my full prescribed dose and have no side effects so far.
HTH
Edited by RobM77 on Tuesday 22 November 10:31
RobM77 said:
OP: You asked about Gabapentin?
I'm on Gabapentin and Amitriptyline at the moment. Both are indeed drugs for other purposes (epilepsy and depression respectively), but have a proven ability to reduce neuropathic pain, which is what I take them for. Your GP would need to prescribe both. You can take both concurrently, or just one or the other. I'm supposed to be dropping the Am. and titrating up the Ga., but I can't handle the pain without the Am., thus me taking both together at the moment until the Ga. dose is high enough. I've not noticed any reduced ability to think - the only thing I've noticed is that Amitriptyline makes me feel very sleepy at doses over 50mg a day. I'm currently ramping up the Gabapentin and am halfway to my full prescribed dose and have no side effects so far.
HTH
It was the pharmacist at work that suggested gabapentim but when I spoke to my GP he wasn't too keen on trying it. He did say there were lots of other mixtures and doses we could try before using that. I'm on Gabapentin and Amitriptyline at the moment. Both are indeed drugs for other purposes (epilepsy and depression respectively), but have a proven ability to reduce neuropathic pain, which is what I take them for. Your GP would need to prescribe both. You can take both concurrently, or just one or the other. I'm supposed to be dropping the Am. and titrating up the Ga., but I can't handle the pain without the Am., thus me taking both together at the moment until the Ga. dose is high enough. I've not noticed any reduced ability to think - the only thing I've noticed is that Amitriptyline makes me feel very sleepy at doses over 50mg a day. I'm currently ramping up the Gabapentin and am halfway to my full prescribed dose and have no side effects so far.
HTH
Edited by RobM77 on Tuesday 22 November 10:31
What dose of amitriptiline do you have?
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