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    Includes Expert Content
    Back Pain and Sciatica
    momico posted:
    I have had herniated disks and sciatica pain for two years now. Had a kyphoplasty for a collapsed disk fracture two years ago, it did not take as it should but the sharp pain is gone replace with a dull ache when standing too long but stops when I sit down. After sleeping when I get up I am very stiff and it takes awhile to get a little better. I also have significant nerve damage in my legs which most likely will never be better. Also have osteoporsis which I now find out kyphoplasty is not recommended for people with osteoporsis. (great). I have had epidurals which did not help at all. I have been told by doctors that surgery is my only option. I am 74 years old and do not want surgery since it would be a major surgery. I do not want to gamble on my back at this stage of my life. Yes I am miserable but could be worse after surgery with so much wrong with my back. Help!
    annette030 responded:
    It sounds to me like you have already made up your mind, good for you. You might discuss this with your pcp and see what he thinks. There may be a non-surgical way of dealing with your pain. and stiffness.

    Take care, Annette
    momico replied to annette030's response:
    Thanks Annette for your reply. I am taking Gabapentin prescribed by my pain mgmt. dr. It helps with the sciatica some. I have asked him what else I can do and he said surgery so that is out for me I won't do it unless I get worse. Has stayed pretty much the same for 2 years so I am hopeful that it will not worsen. Anyhow I appreciate your reply and will continue to search for a way to cope.
    annette030 replied to momico's response:
    You might ask your pcp for a referral to a physiatrist or a gerontologist to see what else might help you.

    I have never seen a chronic back pain case where the only option is surgery. Lots of folks, especially older folks, do not want to have surgery. If it has been stable for two years, I bet you have other choices.

    Take care, Annette
    madmiker responded:
    I have similar problems. No osterporsis as far as I know, but plenty of unsolvable pain, especially in the morning. I have found that IB Propine really helps. For me two 500 mg pills a day make a great difference. I am sure more on a timed basis would not hurt as long as you are careful about it. I found that daily strectching as recommended by doctors with or without pain often eliminates pain for the day. If you know what kinds of activities or movements aggravate the pain then stay away from them and/or come up with other ways of doing them-if walking with a numb leg get a walking aide ie a cane or walker. Do as much as possible to get your focus off the pain. Your best bet is to Look to God in prayer for relief if not complete healing. Oh and before I forget I have a small cheap vibrator that heats and vibrates. It is very similar to an ultra sound machine in its effects. While not recoginized by any medical experts as thing to solve pain itr has been a real blessing for relieving muscle cramps caused by the chronic back pain which is most of the pain. My prayers go with you who ever you are . I know that back and leg pain is no fun and can really limit the life style. God bless and please, call on God-he has an unlisted number, but can be reached by prayer. God is the master healer.
    Buffum responded:
    I can appreciate the pain your going through I've been there. Just a thought but maybe you should try a slightly more potent drug, I may be wrong, but I take Neurontin (generic Gabapentin) for nerve damage not for pain relief. But at your age you must be very careful which medication you take because of some of the adverse reactions that come with them, among them is confusion, dizziness, to mention others. but ask your Dr. to try something mild to start, you'll know at what level they start to be effective. Good Luck!! (this is just one additional option that is available, so don't let any one tell you, you don't have other options!!! )
    Hank, (",)
    Thank You.(,)
    cweinbl responded:
    Surgery will very rarely help. I've done it four times and each time I ended up with worse pain. I also learned that spine surgeons are heads over heels above the talent and experience of a neurosurgron or an orthopedic surgeon. That fellowship can make the difference between spending the rest of your life horizontal or returning to a job and family.

    Ask your doctor about Fentanyl Transdermal. These patches reduced my pain by at least 80% for several years, before I finally became tolerant. Fentanyl is the most potent pain medication available, by far. The patches last for 2-3 days. That means near-constant optimal plasma levels. Fentanyl is the best pain medication, by far.

    You should also try the numerous options available at a comprehensive pain management program. Just be certain that it is not an "injection mill." There are physicians masquerading as pain management clinics, but they only offer injections. They convince patients that repeat injections will help. They do not. If an injection fails, it is very likely that all future injections will fail. Don't fall for that trap. A true pain management program will offer treatments like corset, brace, TENS, traction, acupuncture, biofeedback, physical therapy, kinesiotherapy, injection of steroids and anesthetics, non-steroidal anti-inflammatories, cortisone, rhyzotomy (radio frequency denervation), spinal cord stimulator, intrathecal infusion pump, off-label medications (anti-depressants, anti-convulsants), combination of long-acting pain medication with breakthrough meds, counseling, hypnosis and meditation. Often the use of all of these combined will be more efficacious then any of them used alone.

    Surgery is usually not the best solution. Each operation creates fibrosis (scar tissue) which can impinge spinal nerve roots, making your pain worse than ever. Try all options first, including Fentanyl Transdermal. This one medication added 9 wonderful years to my career. Before you are cut open, be sure that all other options have been exhausted. Get second and third opinion from spine surgeons. A spine surgeon is way more talented and experienced than a neurosurgeon or orthopedic surgeon. Trust your health to the very best talent available. Spine surgeons can often be located at or near teaching hospitals.

    Here is the best research:

    Good luck!
    momico replied to cweinbl's response:
    Thank you so much for all the information it give me hope that there are other options besides surgery. I will as my Pain Management Doctor about some of these. I have just got so discouraged tho and am trying hard to keep a positive attitude. I really appreciate you comments
    Thanks Again
    momico replied to annette030's response:

    I appreciate your support and suggestions. Nice to have someone that cares.

    Thank you so much I don't feel so alone now.

    momico replied to madmiker's response:

    Nice to hear from you. I appreciate your thoughts and suggestions. I will definitely try some of them. I guess I just have to hope that I will fine something that will help. I do pray to God every day asking for help.

    Thanks so much,
    momico replied to Buffum's response:

    I tolerate the Gabapentin pretty good. It does make me sleepy late in the afternoon. I take it four times a day 300 MG. I also take ibuprofin some times but try to not take it too often.

    The Gabapentin really does not take the pain away it just makes me more relaxed. At least that is the way I feel. I have been awakened in the middle of the night with terrible leg pain. So I just get up and wait until I can take another Gabapentin and it does help somewhat.

    You are encouraging to me and I feel better just reading your comment. I appreciate the pep talk.

    annette030 replied to momico's response:
    Talk to your doctor about the best way to take gabapentin.

    I refused to take it for a long time because I had heard it was very sedating. My internist who manages all my meds, told me that her patients and other medical reports said that taking it once a day worked just as well. I agreed to give it a try, and have always taken it once a day after supper, a few hours before bedtime. I have been on it for well over ten years now. That way I don't get any sedation except while I am asleep, which is fine with me.

    Night time leg pains may be due to something else, discuss them with your doctor also.

    Take care, Annette
    Peter Abaci, MD responded:
    For many, growing older can mean developing lower back pain problems. Age-related changes can put extra stress and strain on the nerves as well as the joints and discs that help hold up the spine. This can become a source of pain and stiffness in the low back and also lead to radiating pain down the legs.

    Another way of combating these age-related changes is to work on boosting the support provided to your spine. What I mean by that is increasing the strength of the muscles that support your spine and pelvis. This can be done in different ways, including physical rehabilitation and even by walking. As an example, one approach that I have had a lot of success with over the years is getting my patients involved in Pilates. Pilates is a form of rehabilitation exercise that can be wonderful for back health and studies also show benefit with osteoporosis.

    Outcome studies typically find aggressive rehabilitation to be as good or better than more risky surgeries in treating back pain.
    momico replied to Peter Abaci, MD's response:
    Dr. Abaci thanks for the information. It makes me feel a lot better knowing what I though about surgery and building strength of the back muscles is right.

    You have given me more info than the doctors I have seen. They are not very informative even when I press them about things.

    One last question, will nerves in legs maybe regenerate over time? I asked my pain and he shook his head yes.

    Peter Abaci, MD replied to momico's response:

    Generally speaking, in some cases nerves can regenerate over time. This can take many months or longer. As the nerves that extend from the back down to the bottom of the leg are among the longest in the body, changes here can take the longest to complete. I'm so glad that you have found this discussion helpful. Best of luck.

    Featuring Experts

    Peter Abaci, MD , is certified in anesthesia and pain management by the American Board of Anesthesiology. Dr. Abaci received his undergraduate educat...More

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