quote:

a guy not quick to suggest surgery unless needed.

_________________________________________________________________
And that is exactly the kind of "specialist that you need to be seeing.

Well had my appointment today with the neurosurgeon and he seriously recommended surgery. Not what I wanted to hear, bur I am thinking on it and will probably go ahead with scheduling it. Ugh!

I’ve had low back pain for years. Did physical therapy, injections, steroids, chiro... with minimal success. Went to neurosurgeon after MRI. He told me I needed surgery and I would know when it was time. Fast forward a couple of years when I could only crawl not walk (seriously). I knew it was time. Herniated disk had pressed sciatic nerve flat. Discectomy surgery and I was walking the next day. I’m probably 95% healed. Wish I hadn’t waited so long.

quote:

Originally posted by ruger357:
I’ve had low back pain for years. Did physical therapy, injections, steroids, chiro... with minimal success. Went to neurosurgeon after MRI. He told me I needed surgery and I would know when it was time. Fast forward a couple of years when I could only crawl not walk (seriously). I knew it was time. Herniated disk had pressed sciatic nerve flat. Discectomy surgery and I was walking the next day. I’m probably 95% healed. Wish I hadn’t waited so long.

I will be having micro diseconomy surgery on 5/31/22. I hope it fixes this.

Things sure have changed since my last surgeries. Before you just showed up, answered a few questions, and had surgery. With this surgery I had to provide almost every doctor I have see so they can get medical records. I then will have a phone interview with a nurse within a week. Next week I have a “surgery clearance” exam to do an EKG, X-rays, and all kinds of blood labs, and then an interview with a doctor. Geez! I am sure this is to protect themselves, make sure the surgery is safe, but also to make money.

quote:

Originally posted by StorminNormin:
Things sure have changed since my last surgeries. Before you just showed up, answered a few questions, and had surgery. With this surgery I had to provide almost every doctor I have see so they can get medical records. I then will have a phone interview with a nurse within a week. Next week I have a “surgery clearance” exam to do an EKG, X-rays, and all kinds of blood labs, and then an interview with a doctor. Geez! I am sure this is to protect themselves, make sure the surgery is safe, but also to make money.

Mrs. Flash went through all of that prior to her two back surgeries a few years ago. They even did a video of her being verbally prepped for the surgery and she goes and looks at it once in a while.

I have had back pain, but it is muscle spasms, not originating in the nerves.

Good luck.

quote:

Originally posted by jhe888:
I have had back pain, but it is muscle spasms, not originating in the nerves.

Good luck.

Not playing Dr. here… But,… Sciatic nerve problems stemming from constricted spinal tubes express themselves as muscular pain in your hip (paraformis?) IT bands (outer thigh) and shin splints in greatly varying degrees.

They all feel muscular, but the problem could easily/likely be spinal.

Lower Back Pain: NSAID + Muscle Relaxant No Better Than NSAID + Placebo

link: https://www.medscape.com/viewarticle/940470

Patients with lower back pain prescribed skeletal muscle relaxants in addition to NSAIDs report the same outcomes as placebo plus NSAIDs, new research shows.

"Combining a skeletal muscle relaxant with an NSAID does not confer any additional benefit," Lorena Abril, MD, Montefiore Medical Center, New York City, told Medscape Medical News in an interview following her abstract presentation at the annual American College of Emergency Physicians (ACEP) online congress.

There are 2.6 million visits to emergency departments in the US annually for lower back pain, Abril said in her presentation. One third of patients report persistent back pain and 1 in 5 report limitations in activity, she explained.

Acute lower back pain "is generally considered a condition with a favorable prognosis, regardless of treatment," Abril said. The current American College of Physicians guideline for noninvasive treatment of acute, subacute and chronic low back pain (LBP), published in 2017, recommends that if a pharmacologic treatment is desired, NSAIDs or skeletal muscle relaxants (SMRs) should be used. But "no pharmacological treatment…has been shown to provide a moderate or large effect on pain or function in patients with acute low back pain," Abril said.

To see if SMRs improved prognosis at 1 week after discharge from hospital, investigators enrolled 889 patients with lower back pain from the emergency department into a randomized, placebo-controlled trial. Patient mean age was 39; 56% were female, 44% male.

All patients completed the Roland-Morris Disability Questionnaire (RMDQ) before leaving the hospital and again after 1 week follow-up. Abril explained that RMDQ has been shown to correlate well with other tests that measure physical disability, including the Quebec Back Pain Disability Scale, the Oswestry Low Back Disability Questionnaire (ODI), and the physical subscales of the Sickness Impact Profile, among others.

In the initial RMDQ performed with patients, the median score overall was 18, (ranging from 16 to 22) on a 24-point scale.

On discharge, patients were prescribed 1 of 7 skeletal muscle relaxants (SKMs — baclofen, metaxalone, tizanidine, diazepam, orphenadrine, methocarbamol, or cyclobenzaprine) or placebo in addition to an NSAID such as naproxen or ibuprofen.

At 1-week follow-up, 858 (96.5%) patients completed a second RMDQ. Although all scores were improved, researchers found no significant difference in RMDQ scores between patients receiving placebo or any of the SKMs. "The between-group differences failed to achieve clinical differences. In fact, placebo was superior to methocarbamol with a mean difference of 2.4," said Abril.

Table. 1-week Roland-Morris Disability Questionnaire score per muscle relaxant.

Skeletal Muscle Relaxant RMDQ score at 1 week
Placebo 10.5
Baclofen 10.6
Metaxalone 10.3
Tizanidine 11.5
Diazepam 11.1
Orphenadrine 9.5
Methocarbamol 8.1
Cyclobenzaprine 10.1

As investigators continue to research the appropriate use of muscle relaxants as part of a multimodal approach to low back pain in the ED, the evidence continues to show these medications have a limited role," Alexis LaPietra, DO, of St. Joseph's University Medical Center, Paterson, New Jersey, told Medscape Medical News. LaPietra was not involved in the study.

"Even when they analyzed subtle differences in sex, age, and baseline severity, they had consistent findings that none of the traditionally used muscle relaxants add much benefit to the recommended analgesic regimen," LaPietra added. "More pain research is need to equip clinicians with up-to-date, evidence-based concepts to help manage the complex, disabling, but very common complaint of low back pain in the ED."

Abril said her team is considering studies of other medications for patients presenting to the ED. Because poor pain and functional outcomes persist beyond the hospital visit for patients with acute musculoskeletal LBP, and because research shows topical NSAIDS might be more effective than oral NSAIDS, "we are currently designing a clinical trial to test the effectiveness of topical diclofenac in patients presenting to the ED primarily for management of nontraumatic, nonradicular musculoskeletal LBP," she said.

Nonpharmacologic treatment, including superficial heat, massage, acupuncture, or spinal manipulation, is initially recommended for most patients with acute or subacute low back pain, Abril said. "This is an interesting and important topic for future research, starting with the need for validated, properly described and standardized methods of measuring and reporting clinical outcomes, which is a major limitation of the literature."

"Finding a solution," she added, "is a challenge that we hope can be solved soon."

What do you prescribe for your patients with back pain? Tell us in the comments.

American College of Emergency Physicians (ACEP) 2020: Abstract 15. Presented October 24, 2020.

Ingrid Hein is a freelance health and technology reporter based in Hudson, Quebec.

quote:

Originally posted by SIGnified:

quote:

Originally posted by jhe888:
I have had back pain, but it is muscle spasms, not originating in the nerves.

Good luck.

Not playing Dr. here… But,… Sciatic nerve problems stemming from constricted spinal tubes express themselves as muscular pain in your hip (paraformis?) IT bands (outer thigh) and shin splints in greatly varying degrees.

They all feel muscular, but the problem could easily/likely be spinal.

No question. I thought mine were muscular as that is how they felt. The doctor did a wonderful job at taking time to show me differences in my last two MRIs to show exactly what the problem is and how it has changed. Cartilage has broken off and is pressing on the sciatic nerve causing my pain.

Normin - according to what you said on the 17th, you were supposed to have had surgery yesterday. Did you? What gives? How's it going? Are you recovering OK? Pls give us a heads up...... Fred

quote:

Originally posted by jtedescucci:
Normin - according to what you said on the 17th, you were supposed to have had surgery yesterday. Did you? What gives? How's it going? Are you recovering OK? Pls give us a heads up...... Fred

Yes, I had a microdisectomy on the L5-S1 yesterday and am lying in the hospital bed right now recovering. They had me stay overnight and I should get out today. Surgeon said the surgery went well and I should no longer have pain from that joint. Right now I just have a good amount of pain from the surgery. My lower leg still has numbness but they said it is probably due to swelling and should go away. Thanks for asking!

Normin, glad the surgery was successful. I hope you get total pain relief from it. Heal up fast my friend.

Mine was also L5S1. It took a while for the numbness to go away. Do the physical therapy and stretching they recommend. I hope yours is as successful as mine was.

Hope recovery goes well for you! If PT is prescribed, do it!

quote:

Originally posted by Fly-Sig:
Pain in the buttocks could be the piriformis muscle or the sciatic nerve, ...

I aggravated one, the other, or both of them years ago, moving something heavy using poor form. I've had to fight sciatica ever since. What has generally kept it at bay, for me, is crunches, to keep the abdominal muscles strong, and regular stretching of the hamstrings.

But lately I've experienced fairly persistent lower-back discomfort. Not really "pain," per se, just a kind of low-level soreness or discomfort.

In the process of building my own home gym I've been researching equipment priorities. One of the things that was on the list, but way down there, was a back hyperextension bench. Doing some research, today, that all changed. It turns out what I'm experiencing may well be relieved by doing back hyperextensions. I never had this problem while I was still working out regularly, and back hyperextensions were part of shoulders, back, and biceps day.

So a back hyperextension bench is now next on the list. "Next" as in "sooner, rather than later."

This, of course, is nowhere near what StorminNorman has experienced. Just thought I'd tag along on an existing "back problems" thread, rather than start a new one.

Speaking of which: How's your back these days, SN?

Overall I am doing very good. I seriously need to start on strengthening my core to prevent anything else. I am back to taking on a lot of home projects and if I do too much I am feeling aching right on my lower spine and a few time getting that slight stab in my buttocks. I am still numb on my right leg from my mid-calf to the bottom of my foot. The numbness seems to be improving at a very slow rate, but at least it is improving.

quote:

Originally posted by StorminNormin:
Overall I am doing very good.

That's good to hear As a fellow kinda-sufferer I can surely appreciate back pain/troubles are no fun.

quote:

Originally posted by StorminNormin:
I seriously need to start on strengthening my core to prevent anything else.

I highly recommend doing so. Sooner, rather than later. You don't want to be back where you were again. "An ounce of prevention..." Every time I start slacking off I remind myself what it was like when I could barely move.

I've long counseled hamstring stretches and abdominal crunches to prevent/relieve lower back issues. Upon my recent research I'll add back hyperextensions. Of course: Depending upon the nature of existing problems, if any, and ability.

The stretches and abs don't require anything special. For back hypers you need a back hyper bench or Roman chair. I'll be meeting with someone next week to acquire a back hyper bench.

quote:

Originally posted by StorminNormin:
I am back to taking on a lot of home projects ...

I'm getting ready to do the same. Before I can do that I need to get a bit more fit, lest I injure myself.

I explained this to my wife, just yesterday, when she was grousing about my wanting to acquire another bit of fitness gear. "Honey, I need to do this so I don't injure myself doing the things I need and want to do."

There's a guy I follow on Twitter: Dan Go @FitFounder. He posts regular common-sense and easy things to do for a healthier mind and body. He recently tweeted "I workout, sleep and eat healthy so my 80 year old self can thank me later."

Glad you are on the mend. I was born with Spondylolisthesis. It wasn’t a big issue until I injured my back in 2019. I was stuck in a recliner taking narcotics for a year due to the Covid 19 ‘non essential’ surgery ban in the hospitals. I finally had spinal fusion done in June of 2020.

Recovery was 9 months. It was life changing in every way. No pain, 50 pound weigh limit.

I hope you have the same results. Follow your surgeon’s instructions to the letter.