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First Post - Questions About Chronic Right Lower Back / Sciatica

AnonymousUserAAnonymousUser Posts: 49,671

Thank you for taking the time to read my first post.

First, I am a male in my mid-30s.

Since February, I have had what I now consider chronic lower back and sciatica issues. I say chronic because it is literally daily. All the pain is on the right side. It seems as if the problem is around the L4/L5 area, even though the MRI only showed a "mild" disc bulge there. To me there is nothing mild about that pain when it is not managed. My research where I have found pictures of correlations between the lumbar nerve roots and pain location, lead me to believe that my problem is around L4 ( EDITED)

I have done all the conventional treatments from physical therapy to chiropractic , and even acupuncture. I just had my second epidural steriod injection which, like the first one, did not help. The first injection was given between L4/L5, the second one was given between L5/S1.

The only "effective" way I have found to "manage" the pain is taking 400 mg of Advil every single day since February; one 200 mg in the morning, one in the evening. (Occasionally, but not too often, I take Tylenol to mix it up just a little, but it is not as effective as the Advil).

If I don't take the Advil, I cannot function. I can't work, play or do anything productive -- and if I am asked to, I become quite irritable. My mental state can only focus on this pain in my back and radiating pain down my leg to my shin. If I do take the Advil, I can get through the day relatively fine, although I still know something is a bit off.

On top of all this I do have scoliosis, which was only diagnosed after I became a teenager. I have a noticeable shift in my body, although doctors have said I am not an extreme case. My current physical therapist says that my shift may not be structural (i.e., happened when I was born). Instead it may be non-structural that could have occurred over time since I was a teenager due to some other problems I have had with my spine and body. She says that my shift could be corrected, at least some, with some proper physical therapy work.

Here are my questions:

1. I am scheduled to have 3 epidural steroid injections. I have had 2 that were not effective. Is it worth having the 3rd? Like I said, the first was put between L4/L5, the second was put between L5/S1. I thought the placement of these things didn't matter 100% because the medicine was supposed to spread.

2. This has been going on for 6 months, daily now. Literally today I just came up with a concern about nerve damage. What is my risk of nerve damage given that this has not been corrected yet? How do I know if I have nerve damage now? My worry is that if I don't get this fixed soon, which looks like to be from a surgical method given I have tried all other treatments, that I will end up having nerve damage which will make the surgery ineffective.

3. Given that Advil is effective in reducing and managing my pain, would you recommend just continuing that course of action indefinitely (possibly for the rest of my life) as opposed to looking at surgery? Again, my worry is nerve damage and the Advil possibly masking that nerve damage down the line.

4. My worry with Advil long term is the health of my kidneys (and some concern about my stomach). Is it statistically a given that I will have problems if I take Advil daily for years and years on end? Is it better to cycle between the Tyelenol, Advil and maybe Aleve? Is there a big difference between Aleve and Advil?

5. My primary care has finally recommended me to a neurosurgeon on my request. I hope it is not too late. But anyway, at this point would you insist on having surgery to correct this problem? Would you get 2nd and 3rd opinions from different neurosurgeons? Would you choose an orthopedic surgeon over a neurosurgeon? It seems pretty obvious to me that I would need a discectomy.

6. I have had nerve problems off and on for years. It only became chronic since February. One thing about this that scares me a little bit is how I have to carefully get up from certain positions (especially lying on my stomach). Sometimes if I get up the wrong way in order to stand or start walking, my nerve fires and my right leg literally gives out and I have to catch myself on a wall or use all my strength in my left leg to not fall. After that initial firing, though, I can walk normally. Is that something common with this condition that I have? Has anyone experienced that?

I know I have asked a lot of questions, but these have been building in my head for a while now. I appreciate you taking the time to read them, and even more appreciative if you respond.

Thank you.

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Edited by moderator paulgla


  • I think the NeuroSurgeon or Dr would be the best one to ask about Tylenol and Advil. It should be used long-term with a Dr's recommendation. Never exceed 4 grams of Tylenol in one day and any drug has the potential to cause stomach problems. It's always best to ask your Dr and Pharmacist if you're switching meds unless he recommends them. It's good if you have a 2nd opinion NeuroSurgeon. I've seen 2 Orthos and they refused me surgery so next opinion coming up with a NeuroSurgeon. Hopefully you will see the Specialist in time for any weakness you're having in yur leg and hope you let your Dr know about the weakness. I have similar symptoms with my leg as well as foot numbness. I also can't get up off the floor crouching as my hips and legs don't have the strength. I think some insurance make sure you get the epidurals which should only be 3 in a year and I ended up having 5. Are you on any meds for your nerve pain in your leg? I hear some people can heal on their own yet it's been the same for me 1-1/2 years. It's good to keep asking questions to your Dr especially informing him of your leg weakness. I also think I needed a Micro disectomy but it seems there are alot of people with chronic pain who haven't had surgery yet/if. It's hard to find all the answers from one Dr maybe it's always best to have 2 opinions or 2 or more. After my EmG it seemed there wasn't any rush to have surgery with any Dr. I have. It's only if you have causa equine symtoms that is an urgent run to the ER. I really couldn't say if it was too late but keep going to the Dr and let them know your symptoms and any changes. Best wishes and take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • i so relate to your pain...
    mine also started on the right side.
    first off research has shown that just mild bulging can cause just as much or more pain than major hurniation. having had the mri i would move next to a discogram which gives a better idea of whats happening with the disk.
    i would get a nerve test called EMG to see what damage you have suffered.
    i would find board certified spinal surgeon either orthopedic or neuro or even better an opinion brom both...
    i would talk to dr now about longer acting ibupropin drug like diclofinac instead of over the counter stuff
    dont procede with another shot till surgeon gives direction.
    i have same trouble with leg collapsing and then loosening up. best to hold on to something and bend leg several times before venturing further.
    welcome to this group of pain people and know that whatever happens we are here for you...
  • Thank you Charry for the reply.

    The only meds I do take are ibuprofen. Nothing else extra for my leg.

    Thank you Pete for the reply.

    Would you ask your primary care doctor for the discogram and EMG? Or is that something I should ask my neurosurgeon? Or my pain management doctor that has been giving me the epidurals.

    Does something like diclofinac offer me the ability to possibly only take one pill a day instead of 2 that I have been taking with ibuprofen? That would be nice, but I would hesitate to do that if the side effects of diclofinac are much worse. I am also trying to avoid narcotic drugs as well.


  • Good advice above, and my issues were the same, except they started at 22 or so. I used every OTC meds thought of to try to control it. I never found anything good. I used anger to move, spite to get up in the morning and sarcasm to put myself to bed. [When I was younger - I was not happy with this issue and I had no coping skills to deal with it early on.]

    My experience with Diclofinac was to add wieght to me, about 1.5 lbs per day. Fluid retention. I was on it for about 14 days and then stopped. Once I did, I lost the wieght in 4 days.

    I too, did not want to use narcotics and fought this for years, but after 25 years, there was nothing else that worked. Very low doses of these, controlled my pain well, and now more than 2 years later, I am still on a low dose. I have to be careful not to overdo things and get my pain level back up to the level I was use to. That is the key to it for me. It was 2 years of discussion about narcotics before I was willing to try them.

    I remember they kept wanting me to stretch my hamstring out and every time I did, it caused anothe rpain cycle. Around and round it went, I would pull it and it would just rip the flesh off my leg, that is how it felt. I was not happy about it, now I tell the Dr, the hamstring is going to stay tight and I'll keep stretching my back out and turn as much as I can take, but the ham does nothing and that is how I have dealt with it.

    Your Dr should be able to fill you in on how to sort out the pain control and what to do next.
  • Hi Centurion45. Thanks for the reply.

    I definitely don't want to take anything that makes me gain weight. In 3 weeks I have lost about 7 pounds. I am trying to get to 180 for 6'3". Just 10 more pounds to go. I heard that the less weight on your back, the better. I figured it couldn't hurt to try.

    I don't necessarily mind sticking to the ibuprofen. It would be nice though to only have to take one pill in a 24 hour period rather than 2 or 2 1/2. Ibuprofen has been working (well, whatever working really means, I guess).

    I started going to a new Physical Therapist who I really like and seems really wanting to help and very knowledgeable. But, my last experience with PT makes me cautious that it will help.
  • thats a good question about who and how to approach dr regarding tests. drs like to be in charge. they arent happy when their patients want to take control. one tactful technique might be to ask the surgeon how more information can be attained for your situation. tell him you feel something is seriously wrong and want to know the cause. like i say the spinal surgeon has the most diagnostic knowledge.
    i take one diclofinac 75mg per day. it really helps so in my case one pill works. diclofinac is very popular in europe but for some reason not used a lot in usa.
    i find that 2 500mg tabs of tylenol in the am and 2 in the evening help me. the 2000mgs is well within 4000 max that is recommended per day.....
  • Thanks again Pete. One thing I have always been confused about is if taking doses of medicine like ibuprofen is cumulative with respect to your long term health.

    Here is what I mean. Let's say I take 2 200mg tablets of ibuprofen every day for a year. That is well within the daily dose limits by a long shot. Does each day of use build upon the previous day of use, or does your body start over each new day.

    In other words, will someone who takes 3000mg of ibuprofen (way above the recommended dose) every day for 3 weeks, but then quits, have done less or more damage to his body than someone who has taken 400mg of ibuprofen every day for one year.

    You understand what I mean?
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