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

Moderator: Member question: I'm 52 and have had lower back pain since 1997. I've tried everything. I'm ready to try epidurals. Then pain medicine or microscopic surgery. What do you recommend?

Heary: As a general rule it's best to attempt to avoid surgery. We refer to conservative therapy as any nonoperative treatment regimens. For the low back, this ordinarily begins with a back and exercise program, which is done at home as a patient or in a formal physical therapy program. In addition, it is important to maintain as close to an ideal body weight as possible, since being overweight can worsen back problems. Other treatments which in general are quite safe and worth looking into could include epidural injections. There are also positive reports from patients who have received treatment via chiropractic, acupuncture, or biofeedback. It is not always possible to explain why a person has a good result, but if any of these modalities are able to help one avoid surgery, this is in their best interest. Most patients will regret rushing to spine surgery. If none of these assorted conservative methods are successful it is reasonable to consider surgery.

Moderator: Member question: I had x-rays of the lumbar spine and it showed "marked degenerative intervertebral disc space narrowing at the L5-S1 level with moderate anterior subluxation of L5 on S1. There may as well be pars interarticularis defect at this level." What does this last sentence mean in laymen's terms? I also have osteoporosis in region L-2 - L4 (-3.2 compared to young adult). Is it OK to have chiropractic adjustments when one's bones are osteoporosis? I am a female, age 66.

Heary: The L5 S1 slippage is referred to as spondylolisthesis. This is most commonly seen at the L5 S1 level and can be associated with pain. It's an abnormality found in 5% of all people in the U.S. If there are symptoms related to this problem they are most often treated with a spinal fusion procedure. The pars defect refers to an absence of bone in the low back. There should normally be a complete ring of bones around the nerves in the lower spine, and the pars defect means the ring is not complete. As far as chiropractic manipulation with osteoporosis, this is best addressed with the chiropractor directly. There is some increased risk of complications with manipulation in this case. A value of minus 3.2 is quite low and should cause you to see your medical doctor to determine if there are any medications which may be used to help increase your bone density.

wiredone1_lycos: How successful are spinal cord stimulators in reducing leg pain symptoms compared to opiod and antispasmodic medications?

Heary: Unfortunately, all of these topics are for patients with severe spinal problems. They are usually utilized after patients have failed surgical intervention. Spinal cord stimulators, morphine pumps, and baclofen pumps are all utilized when people are having significant back pain that is not treatable with spine surgery. The most important point to remember is to confirm that spine surgery will not be helpful. Just because a single surgeon does not feel spine surgery is indicated, not every surgeon will agree. In general, if the problem can be corrected with spine surgery, then the results will be better than if a stimulator or a pump is necessary. As far as comparing spinal cord stimulators with morphine pumps, it depends on the specific problem treated and the doctor implanting these pieces of equipment.

gailmom42_webmd: Why is it that I have two herniated discs and some stenosis yet the doctor says this is quite common although I suffer from pain?

Heary: The doctor is correct. This is very common, and many patients don't understand that because you have two herniated discs and some stenosis it doesn't mean that those abnormalities are causing your pain. This is a good example of why a spine specialist (neurosurgeon or othopaedic spine surgeon) should determine whether the herniated discs and stenosis are causing your problems. Unfortunately, many general practice doctors do not have the training to determine if herniated discs or stenosis is causing the pain. It is important the doctor you are referring to be a spine specialist. Just to repeat, spine specialists are generally neurosurgeons or orthopaedic surgeons. Almost all neurosurgeons perform spine surgery regularly. Approximately one out of five orthopedic surgeons perform spine surgery. The orthopedic surgeons who perform spine surgery have done fellowship training. Most neurosurgeons learn spine surgery during residency training, and as a result, they do not ordinarily do spine fellowships. Any fully trained neurosurgeon or orthopaedic surgeon with a spine fellowship should be able to fully evaluate any spine problems.

babyblue007_webmd: I broke my sacrum bone in a MVA. Will it ever be the same? Been in severe pain for over 2 years.

Heary: Two years is too long a period of time to be in severe pain. I suggest an evaluation by a surgeon comfortable dealing with sacral bone injuries. These are relatively uncommon, and even many spine surgeons might not be comfortable handling these problems. Therefore the patient should ask their specialist if he or she is comfortable treating sacral injuries, and if not, get a referral to a specialist specifically treating sacral injuries.

wiredone1_lycos: Can you tell us if the main web site for the American Association of Neurological Surgeons has a doctor finder for specific states program, and if so what is the web address?

Heary: Yes. The main web site has a region called Find a Neurosurgeon at . Through the Find a Neurosurgeon section, a neurosurgeon in anyone's area can be found. Almost all neurosurgeons treat both back and neck disorders, so a referral to a neurosurgeon means you have been referred to a spine specialist.

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