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chronic low back pain can't seem to get a diagnosis

jeremy54235jjeremy54235 Posts: 46
edited 06/11/2012 - 7:45 AM in Lower Back Pain
Ok...I am a 33 year old male. I started having low back pain at age 16 for which i started chiropractic care and continued for about 10 years never seemed to help the pain problem i went in for so i got fed up and quit. Over the past few years my pain level increased significantly. I can't sit,stand, or lay down for very long. When i wake up in the morning i am so stiff i can't really bend and that can stick with me for up to 6 hours. I also did physical therapy, they told me they tried everything they could and to seek other treatment. My family dr sent me to pain management he did a steroid injection which helped for about 2 days. Then he tried a nerve block, i didn't get any relief from that. He then told me he didn't know what else to do for me and told me i may just have to take pills for pain the rest of my life and gave me vicodin. Not willing to exept that i saw my family dr again and she had blood work done and per one of the results sent me to a rheumatologist. He thought my syptoms sounded like ankylosing spondylitis and put me on prednisone for a week. Which didn't help so he said he didn't know what to do for me. Back to family dr and she sent me to see a neuro surgeon, He said i had quite a bit of arthritis in at least 3 joints that he could see in the mri said possible more. He said the arthritis was not off the charts but much more than he would like to see in somebody my age. He also said the only thing he could think of that may help was to do a fusion, but being at least 3 levels in a row he said he would not do it. That my other joints would wear out fast from taking the extra movement and strain if it was successful. Neuro then told me to try another round of facet injections and sent me to see a different pain dr. Which did the facet injection had pretty good relief for about 4 days. He then did rfa(radio frequency ablation) which i had no relief. Another dead end told me he didn't know what else he could do for me. I have been laid off since last october and am in to much pain to go back to work if they call me back. I don't know what else to do everything turns into a dead end for me. The last pain dr i saw said he would never increase the strength of my pain meds or change it to anything else. Which i only have vicodin which helps some but only for a couple hours and can only take 3 a day. I have a 17 month old son i can hardly play with because i hurt so bad all the time. Please comment any info or feedback you may have. Thank you and sorry this post is so long.


  • So sorry that your having this much trouble. Did your MRI mention anymore problems other than arthritis? It's sad that your pain management doctor will not try to manage your pain. I wouldn't give up and keep seaching for someone to help....
  • Sorry to hear but hope you get another PM Dr. and Ortho or Neurosurgeons opinion. Are you applying for disability? I was thinking after so many referrals to next see a Rheumatoid Dr. for the arthritis and DDD in my lower back. It's rough to deal with this when you're so young and have a young child. hopefully you'll get your pain managed better soon for you. 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
  • You can give Prolotherapy injections a shot, it is safe, effective and has helped me a lot.
    If you Google "Prolotherapy" you will find more info. Also I recommend reading Healing Back and Joint Injuries by J Valdez.

  • Hi Jeremy,

    Your current pain management doctor is NOT managing your pain. It sounds like you've tried at least one other PM doc but maybe you need to keep looking. I would hope that a PM doctor would be able to help yous seek out a diagnosis for your pain as well as helping you with pain relief in the process.

    2009 Foraminotomy C6-72010 PLIF L4-S1Multi RFA's, cervical inj, lumbar injLaminectomy L3-4 and fusion w/internal fixation T10-L4 July 17Fusion C2-C5 yet to be scheduled
  • I have not filed for disability but my wife keeps bringing it up to me. I was just hoping there was something they could do to get me feeling good enough to work. Also the last pain dr i saw would not even give me any restrictions so i just figure i would be denied anyways. guess he has never seen me in so much pain i can barely move, or when i just lay on the floor in pain cause i can't actually play with my son. I won't even go grocery shopping anymore cause i can't be on my feet that long. But all these Dr's i have seen blow smoke up my you know what.

    MRI showed slight disc degeneration but that's all i was told about it besides the arthritis (which both pain Dr's i have seen say is not much but the neuro surg said just the opposite).
  • How many orthopedic surgeons have you seen? Only one?
  • Nice to seeing you post in this section, but sorry to hear that you're still having problems finding the right solution.

    Have you looked for a fellowhip-trained spine surgeon, it can be either neuro or ortho, but one who only works on spines? I found mine in a spine center where they have surgeons, PT and physios all in one place and they all work together to find the problem, get a diagnosis and then work up a plan of action to take care of the problem. My particular surgeon specializes in botched cervical surgeries and very difficult cervical problems. He's great and worked with the physio in the office when my lumbar problems started, trying injections and such.

    I'm thinking that you need to get to the root of the problem and get that fixed, not just get a handle on the pain.

    There's so much more to spine issues than disc problems - there are facet joints, stenosis, spondylosis and spondylolisthesis, among many other things that could be the cause of your pain and I think that finding the right specialist or surgeon(doesn't mean surgery necessarily) would be the road to try.

    I realize you saw a neuro who didn't want to do a 3-lvl fusion, so I really think you need to get as many opinions as you need to from different spine specialists until you find the one that's willing to help you, not just put on a bandaid and send you home. There ARE spine surgeons out there that aren't afraid to do what they need to give you a chance at getting back to a fairly normal life.

    Good luck and please keep us posted. Oh, and you can ask for referrals from the members here (the referrals must be sent to you via PM, but you can ask publicly) and you can use the Find A Doctor function at the top of the page. It'll give you the options of doctors or clinics in your area, so that might be a good place to start. At this point, it might even be a good idea to travel a little ways if you find the right doctor that's willing to help you.

  • Has your doctor suggested a Discogram yet? Maybe your discs have torn open and are leaking. That is what happened to me. I am now facing a MLSF, from L4-S1. No injections helped me, but the Discogram finally diagnosed the cause of my pain. I had no idea I had discs that were leaking.

    I have a terrible amount of pain when I first sit down. I also cannot stand very long now to cook dinner, but if I stand very still, I am ok. It's so odd...
  • I have also tried prolotherapy, and had good results. I still have pain sitting, but I am around 50% better since the prolo.
  • Has any of the doctors you've seen tried you on nerve pain medications? If you have arthritis i'm sure there there must be some kind of nerve involvement there for you to be in such pain and if there is a lot of times just pain meds. won't take the pain away and nerve pain meds. are more successful.
  • I was given a prescription for Gabapentin.It did not seem to help my pain and it made me really dizzy even after taking it for a week or two so i quit taking that.
  • You need to give it longer than a week or two to see if it works and the side effects go away. Did your doctor not tell you that?
  • well i was on a low dose of it for a moth or so. The dose i was on did not seem to reduce my level of pain, but i was able to get some sleep as it made me tired.
    Then they doubled the dosage and said take the higher dose for 3 nites at bedtime, then start taking it morning and night. My follow up appointment was with the pain dr's PA which i didn't care for once so ever and will not see her again.
  • Well, so far you're not moving in the direction of getting more pain control or a diagnosis. What is your goal?

  • I didn't see any mention of suggestions for any types of anti-inflammatory medications....have you tried any at all?

    I was on Vioxx at a time when it could still be prescribed, and it was very helpful to me. When it went off the market, I tried many others and had NO success whatsoever. I happened to mention that fact to a rheumatologist I saw who was also a research doctor at a Canadian university; she immediately put me on Flurbiprofen, which made a difference in my pain levels within 24 hours.

    This doctor also felt I had ankylosing spondylitis, and said that people with AS tend to respond well to this particular anti-inflammatory. When it didn't reduce the pain levels enough, she added Methotrexate, and I am now waiting for approval of Enbrel.

    Something I have found is that it is REALLY important to keep up a good stretching program. I attended two 10-day residential pain clinics in 2007, and we did 30 minutes of stretching every morning and every afternoon. You can not believe how my pain levels changed in each of those 10 days. I did it religiously for almost two years afterwards, then got a bit lazy. I just starting to get back to stretching every day again, as it really does make a difference when you keep the muscles moving so that everything doesn't end up in spasm.

    That's my two bits' worth for today. I hope that you will NOT give up, and will find another rheumatologist who does more than give you a week of prednisone. If ankylosing spondylitis is a possible diagnosis, an MRI would be helpful to look for abnormalities in the SI joints.

    Take care, and good luck.

  • I can not take anti inflammatories do to another condition i have. The pain management Dr gave me some anti inflammatory patches but they just don't stay in place that low down the back. even with tape i can't keep them in place my pants/shorts interfere with them. Now this PM said he can't do anything else for me. So i guess i will try another round of PT and try a chiropractor again. Running out of hope.
    Thanks for the comments.
  • Update: I saw another neurosurgeon yesterday. He noticed a fracture near one of my facet joints. What he showed me you could see plain as day. Can't believe none of the other Dr's that looked at my MRI noticed that. He also said the joint don't look to good, but at least i may be headed in the right direction now. I pretty much gave up but my wife made me an appointment to see this neurosurgeon. Come to find out he is the surgeon for the Green bay Packers.
    He has me going for a CT scan on Wednesday and some other imaging when bending to get a good look at it.
  • Good to hear you finally got a diagnosis. Sorry to hear about your # though and hope you get proper treatment now that the Dr. found it. All the best. 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
  • Nice to hear from you again and especially with good news. Finally finding what's possibly causing the pain is so important and it seems you finally found a good doctor. How the others missed it is beyond me.

    Thanks for the update and please keep us posted on your new tests.

    Take care,
  • Great! I am glad you finally got the diagnosis!
  • I have 2 compressed discs - L3/L4 and L4/L5. They bulge on a regular basis and the pain is constant. I have been to 3 chiropractors and tried many different therapies and treatments, including spinal decompression.

    None of these seemed to have any lasting pain relief, until I discovered Class 4 Cold Laser Therapy. Within 4 treatments my pain was reduced by 75 percent!

    I am now 2 months into treatment and my back feels almost like I never had an injury at all.

    It is a relatively new treatment, so there may not be a doctor in your area with this laser. There are only 2 near me here in FL.

    The laser is manufactured by a company called Avicenna, and their website is: Contact OP via PM for URL

    My Doctors website is here: Contact OP via PM for URL

    He has several very informative video's on his site.

    Your condition sounds pretty severe, but it has worked for a lot of his patients with major problems.

    This is the best thing I have found for pain relief and I just wanted to let everyone know.

    URL's Removed

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  • I'm so glad to hear that someone took a closer look at your MRI. I just had a very similar thing happen; I had a visit with my rheumatologist who reviewed my MRI reports to see if there was any mention of SI joint irregularities, and the report said there were NO irregularities. The rheumatologist called the MRI up on his computer and zoomed in to take a look himself. What he saw was a very obvious change, on both sides. I find this very discouraging when we, as patients, take the steps we do to get answers, and find ourselves left in the dust because somebody, be it a radiologist or whomever else is responsible for interpreting the reports, doesn't take the time to properly read the x-ray or scan.

    Good luck, Jeremy - I hope this new NS will do his/her best to help you get rid of some of that pain so you can enjoy life with your little guy.

  • Did not end up being a pars defect like he had thought. Said bulging disc agitating nerves, and the joint or disc (not sure what he meant) is moving and should not be. He said the only thing that could be done is a fusing to stabilize the joint. With me being 33 he did not recommend getting the surgery said the cure would be worse than the fix.

    I got a copy of his dictation. It says He is in the opinion that changes are identified at the L4-5, potentially L5-S1 level, that could be the etiology of my symptoms. Clearly on dynamic studies, abnormal motion is occurring. Then goes on to say he encouraged me to not undergo any surgical intervention.

    No significant radiculopathic component on examination. Strength is maintained of the lower extremities at 5/5 relatively at this point with upper extremity strength maintained. Normal reflexes and sensation. Gait is slightly anthropoid and antalgic.

    Not sure what gait is slightly anthropoid and antalgic means?
  • Jeremy,

    If this helps....Since it references your gait - walk -

    Antalgic: A limp adopted so as to avoid pain on weight-bearing structures, characterized by a very short stance phase.

    You probably won't like the next definition for anthropoid. It is to parallel a pictorial description, okay?

    Anthropoid: Resembling or characteristic of an ape; apelike. (walk)

    I guess your style of walk is the only outward thing he sees' odd. You have some instability, but from what you are posting, it isn't enough now to be of risk? 33 is young. Your strength is good, no other neurological issues. I hope that continues for you. And now you at least know what is going on down there. I hope you continue to be able to control it and keep you out of surgery. :) Please keep us posted. *HUG*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I guess that explains one way they tell when someone is really hurting or not! So glad that they are getting to the bottom of your pain.
  • You may be able to use Prolotherapy to stabilize the joint instead of fusing. Prolo is safe and effective and is used mostly by Sports Medicine doctors.

  • I wish I was a doctor because it always ticks me off when one says that someone is too young for spine surgery. It seems like common sense that the younger you are, the more easily you'll heal and fuse, and therefore is a good time to get your spine fixed.

    But this is coming from someone who's not a doctor and I guess they have their reasons considering that it's been said so many times here. I guess that being in your late 40s or older is a blessing when it comes to spine surgery because someone is actually willing to take the risk of surgery and give you the opportunity for relief. It seems only young people get surgery if they have a traumatic injury of some sort and it becomes emergent.

    So that's just me blowing off steam after so many years of hearing that "you're too young for surgery". What the heck is a youngun supposed to do? Wait 10 years or more until they deem you old enough?

    I hope you can find a conservative measure that works for you until you "grow up" and can have corrective surgery.

    Sorry for the negative attitude...I've just heard it too many times and like I said, it seems like common sense that the younger ones would heal better and have more time to learn spine dynamics to keep the adjacent discs from having problems too soon.

    Good to see you again, although I wish there was better news.
  • Ozone, can you please point me to a piece of peer reviewed research showing Prolotherapy is as effective as fusion for this type of injury?

  • Thanks for the replies. Cath111 i could not agree with you more. My opionion is i would like to get relief and be able to move around while i am young enough too, by the time they think i am old enough i may not be able to get around anymore anyways.

    Before i saw the neuro surg. I had seen my PM and he told me he could not figure out the cause of my pain and nobody probably ever would, ween off the vicodin and get on with my life. I told him if that was possible i would, if i felt that good i would not be here in the first place.
    Now i refuse to see him anymore and am switching back to the first PM.
    Things just are not moving forward for me at all and i am really stressed and always in pain.
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