Chronic Pain: Dealing With Back and Neck Pain (cont.)

wiredone1_lycos: Do you feel that nerve damage problems such as bilateral radiculopathy in both legs and feet should be treated by an ortho, neurosurgeon, or a
pain doctor? I had ALIF L5-S1 that has left me with this (done by ortho). My ortho says he can do nothing more for me and I am only 30.

Heary: Again, this is a somewhat common problem. Radiculopathy is the term used to describe pain related to a nerve route. This will be best treated by a physician comfortable dealing with nerve root problems. In some communities this expert may be the neurosurgeon, and in others it may be the orthopedic surgeon. Every community is different and individualized. As far as a pain specialist, these are ordinarily doctors who treat pain but do not perform surgery. Most pain specialists are anesthesia doctors. My advice is if you are only 30 years old and have severe leg troubles, a second opinion would be in order. Since surgery has already been performed, get the second opinion from a good spine surgeon. This surgeon could be an orthopedic surgeon or neurosurgeon. Due to my training, I am a little biased towards neurosurgeons.

mountainman7777_webmd: I had surgery last week due to a pinched nerve in area 15 and still have some feeling in one buttock and slight numbness across top of my right foot. Is this normal, and will it get better or did they not take enough out? Also, I'm having leg cramps in my shin area, and fluctuations, like it's more nerve controlling, and that seems to be causing the cramps. Thanks.

Heary: With having undergone surgery only one week ago, these are very common problems. Often when a herniated disc is removed the nerve root must be manipulated in order to remove the bad portion of the disc. This nerve manipulation, however gentle, can lead to symptoms of pain, weakness, or numbness which may take a few weeks to resolve. If there are any specific concerns that something may be wrong (doesn't sound like the case here), you could contact the operating surgeon and be seen.

wiredone1_lycos: I will be having steroid nerve blocks done by a new pain doctor. What is the success rate with these?

Heary: Steroid injections have very variable results. Some patients derive benefit for months at a time; whereas others may only receive benefit for only a few days. Some do not receive any benefit at all. It is very hard to predict which patients will have a positive response to steroid injections. As a general rule, if the injections are performed by a skilled specialist, they are quite safe with very little risk.

wiredone1_lycos: I had an MRI show straightening of the cervical spine. Could this cause cervical radiculopathy? The doctor also noted I have hyperreflexia.

Heary: Straightening of the cervical spine can often occur from a cervical sprain. This may just be a temporary muscle problem or it may be a more longstanding problem. More important than the straightening of the spine is whether there is any nerve root or spinal cord compression. This can be determined on the MRI and correlated with the patient's physical exam. Hyperreflexia means the flexes are overly reactive, which can be a sign of spinal cord compression. This requires a detailed neurological exam to determine if there are other signs of spinal cord compression, as well as a review of the MRI by an expert.

cubs629_webmd: I recently hurt my back playing tennis. I experienced a sharp pain down my leg and a pain in my lower back. I was given an anti-inflammatory and went through physical therapy. My back is still sore and I'm told to continue to stretch and exercise. Will that hurt my back more?

Heary: This is an interesting and difficult problem. Years ago if someone had a herniated disc they were put to bed rest for 6 weeks. It is now very clear that this is not the best way to treat a disc herniation. What this patient is describing may be a herniated or bulging disc causing nerve root irritation. Nowadays we normally recommend that the patient allow the nerve to "cool off:" which may take one, possibly two weeks. After this cooling off period, it is reasonable to begin an exercise program. As a general rule, this will not hurt the back any more. The regular program of abdominal and back exercising is advisable for this patient and [for] almost all people to keep their back conditioning in its best shape possible.

doda711_msn: I have had neck, arm, and shoulder pain since my cervical surgery a year and a half ago. I am now considered a chronic pain patient. I am told that I will be on pain meds forever. I also have small lumps within the muscles that cause me a lot of pain. Do you think that this problem will ever get better?

Heary: This is a hard question to answer with certainty. One thing I can recommend to any patient who has had surgery more than one year ago and continues to have problems is to have a re-evaluation by a spine surgeon. I strongly recommend the first re-evaluation be performed by the individual who performed the initial surgery. However, if the operating surgeon says there is nothing to do, it is advisable to get a second opinion from a different surgeon, since all spine surgeons do not agree on whether something can be done or not.

Moderator: Member question: I have very little curve in my neck. The muscle the runs from the back of the neck to the chest (where the Vulcan death grip would be placed) becomes inflamed and spasms. This causes pain with arm movement and also triggers migraines. Swimming and massage have helped, but what else can I do?

Heary: The first thing is to get an evaluation by the general family doctor. There is a very good chance that at least X-rays, and probably an MRI, will be performed to eliminate the possibility of a surgically correctible cause of the symptoms. If there are no surgically correctible causes then the problem may be muscular, which would be best treated by a physiatric doctor. If the symptoms are related to a cervical spine abnormality, then an experienced spine surgeon is the best doctor to see.

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