Not sure what to do

[dwk]

Over the Thanksgiving holiday I began experiencing tenderness/cramping in my lower back. In the course of two hours it developed into the worst pain I've ever experienced -- I'd be on the floor in a fetal position just crying in pain. I tried the rest, take the otc meds but nothing helped. 2:00 that night I wake my wife and say we need to go to the ER. It's a holiday weekend, so everyone understaff -- decided to send me home on some stronger drugs and see if I can make it through the weekend.

I'm popping pills like candy -- and getting worst. Again, I wake my wife and say we need to go back to the ER. This time I get an MR -- two herniated discs in my lumbar region with cord compression. Change the meds and we're heading back home. things only get worst, on the 3rd night it's back to the ER - I get some IV drugs, they work pretty well maybe I'm mellowed, but the problem is still there. It seems the staff covering for my surgeon -- they don't know me and are relucant to be too aggressive. Besides I have some other contributing medical factors, cardiac stent 9 months ago, sleep apena, a bunch of meds including plavix and asprin... that complicate the care.

I have to refuse to leave and finally get admitted. I have a disc arthogram(?), not a bad test until they find the culprit disc(s). Lumbar fusion L3-L4 with hardware. The spasms are gone but I still have considerable baseline pain.

I'm not stranger to back surgery -- I've have two cervical fusion surgery resulting in being fused from C2-C7. With both of these operations as soon as the surgery was completed I was pain free.

I'm a little concerned that I still still have a significant amount of pain. Again, the spasms are gone but my baseline pain is a "5". I'm being a good patient -- using my walker, wearing my brace and no lifting.

Surgery was a week ago and maybe I'm being a little impatient --I thought I'd be further along. I would describe my pain as muscular and incisional. I've got 5 more weeks of doing nothing and then 6-8 weeks of PT.

Is my experience typical? Or am I trying to rush things thanks.

PS: I will never make fun of anyone with back pain --

dwk

[Alan]

DWK,

Let me first stress, I am not medical person so I don't know if your recovery pain is typical or not, but I can tell you about my own lower back surgery which I had when I was a very fit, soccer playing, 35 year old (over 17 years ago).

I too had a herniated disc, which in fact had fragmented, and I then had a discectomy L4/L5 which involved the soft center of the disc being replaced with fatty tissue, the disc tear being stitched up and the floating fragments removed. I had spoken with several folks who had had the same surgery and they all told me that the surgery and recovery was really painful but well worth it. I never realized how difficult the recovery was going to be and was in total despair at times in the following weeks. I was off work 9 weeks after surgery because I was in so much pain and couldn't even get into a car without real danger of back spasms and severe pain.

I couldn't sit in a chair for at least a month after surgery, the hospital gave me a foam roll-up mattress and I used to lie on it on top of the bed watching TV. During the day I used to go walking as much as I could and went to Physio several times a week. I was so distressed the Dr ordered an MRI with contrast to see if he had missed anything and told me there was a lot of scar tissue but nothing pressing on any nerve roots (I continued to have pain down my left leg for months after the surgery).

I wish you well over the coming weeks. Keep up the meds and the prescribed exercise and advice from your Dr, and hopefully your recovery will progress, albeit slowly.

Exactly four years ago I had back surgery to relieve the excruciating sciatic pain I was having. I had a disc replaced, my spin straightened and fusion. After surgery the sciatic pain was not completely gone. It took almost a year before I could get off of the bed without first thinking about how to do it without hurting my back. I was told it could take from 8 months to a year until I completely recovered but in fact it was almost two years. I have no more sciatic pain but if I try to lift anything over two pounds or if I do any activity that requires bending over for even a short period of time I strain my back.

Now for the irony - my wife had to undergo the same surgery one year ago and because of a very serious post operative infection it will be another 6 months until she is discomfort free (if then).

Feel better DMK.

[Nords]

Quote:

Originally Posted by dwk Surgery was a week ago and maybe I'm being a little impatient --I thought I'd be further along. I would describe my pain as muscular and incisional. I've got 5 more weeks of doing nothing and then 6-8 weeks of PT. Is my experience typical? Or am I trying to rush things thanks. PS: I will never make fun of anyone with back pain

Have you looked at Jolie Bookspan's blog? She's come back from similar injuries and her stretches/exercises/lifestyle advice have helped others with chronic pain.

The Fitness Fixer

[Bigritchie]

I broke my back too, but.........this might be a possibility, it sounds like you may have a kidney stone. If they cannot find anything with your surgery might wanna check that.

When you said fetal position and lower back and utter pain, first thing it made me think of was kidney stone pain.

[Moemg]

If you are not feeling better in a reasonable length of time( and since I've never had back surgery I don't know what that is) I would ask for a referral to a pain doctor .

[Rich_by_the_Bay]

It's very difficult to provide information about this type of situation because the number of individual variables is huge.

Recent research brings into question the value of invasive care (injections, laminectomy (disc removal) and other back surgery for routine low back pain. Much of it is muscular, not spinal, and even the spinal cases often respond as well to conservative care as they do to the routine surgeries. Some think that far too many surgeries for this diagnosis are done.

On the other hand, if a patient has a true cord compression on MRI they are at risk for becoming incontinent (loss of bowel and urinary control) and even paraplegic if things go too far. It is a difficult judgment quite distinct from the pain (which in itself is a huge problem).

So do NOT take other people's well-meaning advice on what to do for back pain based on their personal experience. A kidney stone will light up like a Xmas tree on CT scanning or MRI, so probably not an issue if that was done.

As to recovery time, it is measured in months, not days or weeks. I'd be glad this was gotten to before permanent neurologic damage, and take your time with recovery. Pain management as a separate consultation is sometimes best deferred until a full course of healing has occurred and there remains residual pain which seems permanent and otherwise conventionally untreatable, IMHO. If a patient finds himself getting significantly depressed in the context of chronic pain (beyond situational, understandable levels), that may be an exception requiring pain management or psychiatric care early rather than late.

My signature disclaimer below is rarely more appropriate than when it comes to back pain, so stay in touch with your doctors with any concerns,.

Good luck with and best wishes for your recovery.

[Dawg52]

I'm sorry for all your troubles. My dad had severe pain from rheumatoid arthritis. Late in life he developed severe neck pains that he could not tolerate so he went to a pain management doctor and he put him on morphine. It certainly made the pain more tolerable but his overall quality of life went down. His alertness was numbed and he slept a great portion of the day.

So as Rich said, a pain management doc should be a last resort. It made sense for my Dad being late in life but for someone fairly young, I would put it off as long as possible.

[Moemg]

Quote:

Originally Posted by Dawg52 I'm sorry for all your troubles. My dad had severe pain from rheumatoid arthritis. Late in life he developed severe neck pains that he could not tolerate so he went to a pain management doctor and he put him on morphine. It certainly made the pain more tolerable but his overall quality of life went down. His alertness was numbed and he slept a great portion of the day. So as Rich said, a pain management doc should be a last resort. It made sense for my Dad being late in life but for someone fairly young, I would put it off as long as possible.

Pain management has changed since then .Instead of heavily medicating people they try other interventions first ( such as pain shots which can give great relief ).

[megacorp-firee]

About 2 years ago, I was at a business convention. Walking from meeting to meeting lugging a laptop for a week was the last straw. This is after sitting in my home office for the last 3 or 4 years doing absolutely NOTHING physical (the daily exercise consisted of going out to get the newspaper at the end of the 40 foot driveway and the mail (just outside the front door). So back to the convention ... I was going to dinner with my wife (brought her with as a perk) after a weeks worth of 'conventioning' and as we were waiting for our table it hit me like a ton of bricks. I was crouched down in agony in pain. Someone nearby gave me a couple of advil and by the time dinner arrived I was going ok. I went to the doctor upon arriving home. Pain was in my lower back and was starting to move down the back of my left leg. He said to try a series of back exercises and to see him in 3 weeks. 3 weeks later ... nada ... He sent me for x-rays ... showed a little arthitis, but that was not the cause, ... he said. Try more exercises and see him in 3 weeks. 3 weeks later ... pain was moving down the leg to foot now. He sent me for an MRI ... I have spinal stenosis, a narrowing of the bones in the back that will eventually put pressure on the spinal cord, but he did not think that that was what was causing the pain. So he sent me off to an orthopedic surgeon. OS said yep I had SS, but it should not be causing me this pain yet (maybe in 10 - 15 years ... oh great). He said I was too young to operate. So he sent me to a pain guy. By now, I was getting progressively worse. I could not walk more than 2 blocks without crouching down to ease the pain. It was taking me about 15 minutes to walke the 2 blocks. Pain guy gave me a series of 3 epidural cortisone shots which did nothing to ease the pain, so he sent me to a physical therapist. Initial 'prescription' was to do this for 6 weeks. 14 weeks later, I had stretched my ligaments and nerves, strengthened my back, ab and leg muscles. About halfway through the therapy, I could walk more than 2 blocks without stopping to ease the pain. By the end of the 14 weeks I could walk 1 1/2 miles with a degree of tightness in the back.

I continue my exercises at home. If I miss more than 4 days I am reminded that I need to do these (in the worse way). I have good days and bad days. When I have a few bad days in a row, I pop a few advil and I'm good for a while. Oh yeah, a side effect of the exercises is that I almost have 1/2 a can to a 6 pack (lost a bunch of the beer belly I had). Lost some weight (which I have found is a major contributor to the pain) and inches. I THINK I am getting progressively although slowly better. I tell this story to reinforce what everyone is saying here. It will take a long time. I suggest you make yourself as comfortable (pain pills, seat cushions, or the occasional 3 fingers of scotch to get yourself through this.
All the doctors in one fashion or another did say I would have good days and bad days. They were accurate.

Good luck with your pain ... and hang in there.
Growing old is a b*tch, but the alternative is worse

[Shredder]

Quote:

Originally Posted by dwk I'm not stranger to back surgery -- I've have two cervical fusion surgery resulting in being fused from C2-C7. With both of these operations as soon as the surgery was completed I was pain free. I'm a little concerned that I still still have a significant amount of pain. Again, the spasms are gone but my baseline pain is a "5". I'm being a good patient -- using my walker, wearing my brace and no lifting. Surgery was a week ago and maybe I'm being a little impatient --I thought I'd be further along. I would describe my pain as muscular and incisional. I've got 5 more weeks of doing nothing and then 6-8 weeks of PT. Is my experience typical? Or am I trying to rush things thanks. PS: I will never make fun of anyone with back pain -- dwk

Sounds like you may just need more time. I had two disc "trims" that were in and out in a day or two, back to work after 3-4 weeks, then in 04 I had fusion on L4 5 & 6, I was in the hospital 5 days, in a plastic shell type brace for 6 weeks, going for short walks in 8 weeks and PT, but did not feel "good" or even "normal" for at least one year. Still have spasms from time to time. Best thing for me was to get as much exersise as possible, try and keep the weight down (it's hard). If your pain now is muscular you should be OK, just take it easy, but do move. It will be hard to know when you do too much for a while but your body will tell you. You really can't compare one surgery to another, or mine to yours. Your condition does sound somewhat normal though. good luck.....Shredder

[Shredder]

Quote:

Originally Posted by Moemg Pain management has changed since then .Instead of heavily medicating people they try other interventions first ( such as pain shots which can give great relief ).

I'm not sure how much value those pain management shots have. My wife and three or four friends went though a series of them. None had long term relief. Three had surgery eventually. I noticed the pain management office has grown in the past few years, the business must have at least quadtrupled. While waiting for my wife I talked to a lot of other patients family in the waiting room, and can't say I heard any that had long term success. None I talked to, were told to try PT, or anything else, just do the shots. I do believe PT is helpfull, when you have a good therapist, or exersise on your own. I am doubting the value of the whole pain mangement thing, at least the one I'm familier with.....Shredder

[megacorp-firee]

Quote:

Originally Posted by Shredder Sounds like you may just need more time. I had two disc "trims" that were in and out in a day or two, back to work after 3-4 weeks, then in 04 I had fusion on L4 5 & 6, I was in the hospital 5 days, in a plastic shell type brace for 6 weeks, going for short walks in 8 weeks and PT, but did not feel "good" or even "normal" for at least one year. Still have spasms from time to time. Best thing for me was to get as much exersise as possible, try and keep the weight down (it's hard). If your pain now is muscular you should be OK, just take it easy, but do move. It will be hard to know when you do too much for a while but your body will tell you. You really can't compare one surgery to another, or mine to yours. Your condition does sound somewhat normal though. good luck.....Shredder

Agreed on the exercise I CAN'T EMPHASIZE THAT ENOUGH... and keeping the weight down... also 200% AGREEMENT

[FinanceDude]

My 4-step program for 2008:

1)Regular visits to chiropractor

2)Liberal use of "thumper" (percussion massager)

3)Stretch everyday

4)Lose 20 pounds

[tightasadrum]

We had a pain management office across from our office for a couple of years. The roughest looking bunch of patients I've ever observed. People would show up at odd times when the office was closed looking for, what to me looked like, a fix. I would never go to a pain clinic for help. I've had a long time back problem, but never surgery. Dealing with my pain requires constant effort, mostly with exercise. So far, so good. But several doctors have predicted increasing level of problems. So it goes.

[Shredder]

One thing I forgot to mention, hydration. The disc is tissue, being a little under hydrated takes moisture from tissue, and leaves them a little less elastic. I notice my back getting stiff if I go a while without water for a time. I'm sure that's the muscle, most of the time not disc, but still hydration is very important, along with the previously mentioned exersise and diet........Shredder

[FinanceDude]

Quote:

Originally Posted by Shredder One thing I forgot to mention, hydration. The disc is tissue, being a little under hydrated takes moisture from tissue, and leaves them a little less elastic. I notice my back getting stiff if I go a while without water for a time. I'm sure that's the muscle, most of the time not disc, but still hydration is very important, along with the previously mentioned exersise and diet........Shredder

Good point.more water!!!

[megacorp-firee]

Quote:

Originally Posted by tightasadrum But several doctors have predicted increasing level of problems. So it goes.

Why is that?

[Buckeye]

1990 was a year with such continuous, bad back pain, I really don't remember much of it. I didn't take anything for the pain to keep me motivated to fix it (stretching, chiros, osteos, massage, accupunture, surgery not an option in my mind). After about a year, it reduced to moderate+ chronic pain (low back and everything down the leg into the foot) for the next 10 years until I finally found a chiro in Winter Park, FL that "fixed" it. About three weeks after he started treating me, I cried the day he moved the pain to the "other" side of my lower back. Later it was completely absent for long periods of time.

I walked Epcot for 9 hours in sandals the day after this Christmas. My neck was a little stiff but NO lower back pain. I still see a local chiro in the small town I work in about once a month for a "tune up."

[Shredder]

Quote:

Originally Posted by Buckeye 1990 was a year with such continuous, bad back pain, I really don't remember much of it. I didn't take anything for the pain to keep me motivated to fix it (stretching, chiros, osteos, massage, accupunture, surgery not an option in my mind). After about a year, it reduced to moderate+ chronic pain (low back and everything down the leg into the foot) for the next 10 years until I finally found a chiro in Winter Park, FL that "fixed" it. About three weeks after he started treating me, I cried the day he moved the pain to the "other" side of my lower back. Later it was completely absent for long periods of time. I walked Epcot for 9 hours in sandals the day after this Christmas. My neck was a little stiff but NO lower back pain. I still see a local chiro in the small town I work in about once a month for a "tune up."

Sometimes waiting/hoping can be no good. I went though pretty much the same thing in 1991. It took about a year to feel any good, and still on occasions it flared up. Skip to 1998 I finally had a disc trim then another, and even then it did not help all the leg pain, doc said my nerve was permanetly damaged by waiting so long. MRI's show it is flat instead of round. Then in 04 3 level fusion on lumbar. Now I can't feel my left leg from the calf down, or much of right foot. I think it could have been avoided if I got more aggressive earlier. Like Rich in Tampa said everyone is different, see a doc you trust. They keep coming up with new things too, now you can get disc replacement, that was not available went I needed treatment, big improvment over fusion.........Shredder