L4-L5, L5-S1 back pain

L4-L5, L5-S1 back pain

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Landry
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Joined: 08/23/2010 - 5:15pm
L4-L5, L5-S1 back pain

Hello everyone,
My name is Loren Landry, Im 32 and I have been suffering from lower back pain since about 2003. I first found out that I had a herniated disc in 2003 via a MRI. Which I was able to manage the pain with physical theropy for several years. About 1.5 years ago I was squating during a work out and felt what I can best describ as "grape being squished" between my disc. After several days of excruciating pain, I made it to my doctor and had a second MRI done. It showed that L4-L5 was now herniated as well and that both discs had what appeared to be a tear in the annulus.
I have had injections, nerve blocks, facet block none of which offered any relief. I also had a disc-o-gram done and were not able to duplicate the pain.
My pain is centralized around the disc itself and I have no pain, numbness down my butt or legs. Even though my MRI shows that I should have pain and numbness down my left leg due to nerve impengement on the left side of both discs. It seems to be the worst while I sit, standing for too long does the same thing. The only thing that has ever offered any relief is decompression of the disc. I get 100% relief when I hang upside down on my inversion table and the same if I do some type of traction at theropy. but this will only last for about 10 minutes then gravity seems to re-compress my discs and back to more pain.
I have been on pain meds for almost a year and a half now, oxycodone 30mg 4 times a day. they used to work great, so much that I only needed to take 3/4 of one every few hours, then I had to go up the the full 1 tab every few hours. Now, 1 tab does very little in relieving the pain even after bumping it up to 5 per day. When the meds worked I was able to get through the day with minimal pain, but now it seems as if I am immune to the oxycodone.

Does anyone have any info as to what could help me? surgery? Im only 32 and want to avoid this, but the pain seems to only be worse as each month goes by. Perhaps a different type of pain medicene?

Thank in advance!

Loren

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charry
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Joined: 09/06/2008 - 12:39am
Hi Loren and Welcome

Sorry to hear You're in pain for years now. I haven't had surgery and had to switch from MS Contin first to Oxycontin and recently saw my Dr. as 40mg x2 wasn't working for me and I just started them the end of January so she told me to take 2-3 a day and if I need 3 a day she was wondering if I would try Butrans patch so I wouldn't have to worry about taking pills anymore. In my case surgery wasn't offered to me so if you're offered surgery get at least two opinions from a Neuro or Orthosurgeon. 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

DegenerativeShelly
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Joined: 12/21/2008 - 1:18am
Welcome Lauren

Thats a huge amount of time to be in pain..

Maybe a change of meds is needed or maybe even to see a Back Specialist and a Nerosurgeon just to make sure.

I have no medical degree, I just answer based on my own experiences as I have Fusions at C4/5, 5/6, 6/7 and L3/4, 4/5 and L5/S1..

Take care and please feel free to ask me anything if I can help..

SueD
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Joined: 01/30/2010 - 1:32pm
If it's your disc that's the problem....

then I'm surprised the discogram didn't confirm this. Perhaps, by the time you had the test done, they had 'repaired' themselves, I dunno?

I can sympathise with you on having chronic back pain for years - I had it continuously for 5. I also tried every conservative treatment going, all to no avail. In the end, I had a fusion at L5-S1 and L4-L5 only 6 weeks ago. My original back pain has gone, YAY!!! However, as to be expected, I'm still in recovery and there are certain things that I cannot do yet - but hopefully will do if I look after myself.

I think I would agree with the other peeps here - can you visit your local GP to get a 2nd or 3rd opinion from a back specialist?

I tried lots of different pain meds over the years - finally settling on Butrans patches, Ibuprofen, paracetamol, Amitryptoline (at night to help me try and sleep) and extra morphine liquid as and when I needed it. The trouble with morphine patches is that they can become addictive. The dose that actually made the pain go away unfortunately also took away my ability to concentrate and I nearly had a car accident because I had 'funny heads'. Anyway, hopefully if you see your specialist, they might be able to recommend something different that can help you?

I know only too well how back pain affects every aspect of your daily life. It can be quite depressing when you really want to do things physically, but can't because of how it will affect your pain afterwards (or your ability to work, as in my case) - you feel it isn't worth taking the risk in the first place and that leaves you feeling like you've failed (or it did me). It's also difficult when friends/family ask you how you are - in the end you just say 'fine' because, again in my experience, nobody really is interested and you get fed up talking about your back pain all the time. It does wear you down and it's not as if there's any outward signs of the pain you are feeling (such as a plaster cast if you break your arm etc).

All I can advise is that you persevere looking for some answers - talk to your doctor, discuss alternative pain medications, ask for further opinions and try and find out when your back pain is worse - i.e. is there something you could be doing physically that 'sets it off', if so, perhaps you can make a few minor lifestyle changes that could avoid that activity?

Please let us all know how you get on OK?

SUE
2 x Microdiscectomy 2005 / PLIFusion 2-level 2010 / revision surgery 2011 / NEVRO Senza spinal cord stimulator implanted February 2013. I WILL NOT GIVE IN / UP !!

Cath111
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Joined: 09/02/2008 - 10:06am
Hi Loren

Welcome to Spine-Health. You'll find a lot of information throughout the site via articles and videos and the forums are great for support and information as well.

Have you seen a spine specialist? Have you talked with a surgeon about the situation? I'm also surprised that the discogram didn't recreate the pain and I know that's frustrating. My suggestion would be to see a fellowship-trained spine surgeon, ortho or neuro, but someone who only works on spines. Just because it's a surgeon you'll be talking to doesn't necessarily mean surgery, but in my opinion would likely be your next step.

As to the meds, it sounds like you've built up a tolerance to the medication you've been taking. That's very common when taking the same medication for a long period of time. When that happens, sometimes a doctor will change you over to something else for a while and then switch back.

Be your own advocate and find a doctor that's willing to work with you to find a plan of action to help you get better.

Take care and please keep us posted.

Cath

Landry
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Joined: 08/23/2010 - 5:15pm
Thanks. Regarding the

Thanks.
Regarding the discogram, my doctor said that since I do not have any sudden sharp shooting pain the discogram could be negative but that the disc could be the root of my problem. My pain is more of a dull ache that stays localized at my discs, and slowly gets worse and worse as the day goes on (which is why the discogram may not duplicate it). Sitting is by far the position that caused the pain to worsen the quickest, but standing will do the same thing, it just takes a little longer. By about noon it is nearly unbearable with out the meds. By about 5pm the meds do very little to help. Which is bad because I have many nights that I work until about 8:30 or 9:00pm.......my job requires me to sit behind a desk most of the day sometimes close to 12 hrs.
I have yet to speak with a surgeon, but am currently looking for someone in my area.....any suggestions is greatly appreciated. I live just north of New Orleans, LA.

Thank you all for you advice and comments.

Loren

hollyk
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Joined: 08/24/2010 - 9:09pm
Ok, here are my MRI Results..help

I am a 52yr old female. I have had lower back problems all my life. I was diagnosed with spinal stenosis 5 years ago, and now the new MRI says I do not have spinal stenosis. Here are my MRI results..advanced degenerative disc disease at L5-S1 with severe interspace loss. Moderate degenerative disc disease L4-L5 with slight narrowing at L3-L4 posteriorly. L4-L5 broad based disc bulge causing flattening of the anterior thecal sac with slight impingment upon emerging L5 nerve roots without spinal stenosis. OK, so I am very confused. The MRI was done without contrast. Could they be missing something, and how bad does this sound? I have no feeling in my right thigh, my right leg goes out on me when walking, and I feel like there is a knife in right calf. Help, please...thanks !! Holly

Coyote
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Joined: 03/06/2010 - 3:42pm
Hi Loren

I have been coming to Spine Health for about a year now, and of all the posts I have read, your situation sounds the most similar to mine. I am somewhat older than you (46) - I had back pain that was very manageable and did not really interfere so much with my life, from the time I was about 20 (when I believe I may have herniated the disc picking something up). However, I went on a roller coaster about 3 1/2 years ago and REALLY hurt my back - since then I have been unable to work. I am on lyrica and Oxycodone - I can't take that much oxy because I get VERY sick from it. I do have a little butt/leg pain, but MY MAIN COMPLAINT is the dull ache that builds in my spine (l4-l5) whenever I do anything. My pain is pretty low at rest (a 2-3), but whenever I do ANYTHING, it will quickly rise to a 5-6, and then I can also easily re-hurt it - so I can only stand or walk with support and AGONY. My MRI and Cat Scan shows DDD, an anular tear, loss of disc height, a small disc bulge and mild stenosis, all at L4-L5. But my DISCOGRAM WAS ALSO NEGATIVE. I have always wondered whether it was because they gave me too much anaesthetic - I have a very low tolerance of pain meds (or any meds). Because I spend most of the day just lying around, plus medicated, when I see the Dr's - I look so healthy many find it hard to believe how limited my activity has to be to manage the pain. Sometimes I think I should try to see the Dr's when I'm at my worst (if I do just one load of laundry, I can barely move afterwards) so they would understand better. But it's hard to inflict pain on yourself intentionally.

I've had all the injections - facet joint injections reduced my morning pain for a while (it takes me an hour or two to get moving in the morning - I have to wait for the pain meds to kick in), but they did not take away the dull ache in my back you also describe, nor the pain I feel from sitting/standing too long or from bending; ESI's reduced the back pain for a week or two when I had it two years ago, but in return I had agonizing menstrual pain and severe disruption of my period for about two months. I just had another ESI about two weeks ago and it has removed the ache from my leg and foot, but no change in back pain; I had a sacroiliac injection that actually seemed to cause pain. Physical therapy always ended with me hurting my back, and greatly increased my hip pain. Pain meds - NSAIDs, Oxy, Lyrica, Celebrex, Tramadol - all make me feel a bit better, but only when I'm at rest - they don't actually help me do any more activity, plus they all come with a whole host of side effects. I've become a very kind of dumb, loopy, forgetful, clumsy person - whereas once I was a sharp, driven, workaholic.

I've seen 4 surgeons (neuro and ortho), three physiatrists, and three pain management Dr's. Because of the negative discogram, surgery is very iffy, because of the ambiguity about where the pain is coming from. Honestly, I believe I have some little hurt spot right in my spine that gets irritated every time I move, and I believe a fusion will help stop that spot getting rubbed - but the negative discogram has thrown a big spanner in the works.

I have aggressively sought treatment for the past three and a half years, and it always comes back to pain management, and that just helps make my days bearable, not make me in any way more productive. I CANNOT work (even part-time which I tried), take public transport, be in crowds (too much swerving and jerking), shop, clean my floors, garden, do my laundry, babysit for my friends children, cook, dance, socialize (other than in my neighborhood for a couple of hours - and only sit and chat), or a million other things.

I'm sorry, I really can't offer any advice, only to say - I am kind of glad I've found someone with pain like mine with a negative discogram (like you, Loren). I don't know what to do myself - other than accept my condition and learn to navigate and enjoy life as best I can. But you are younger, and even though we are similar, no two people are alike.

Keep searching for an answer, and keep us posted. I would especially be interested if you find any answer to why you feel the pain in your disc/spine, but it doesn't show on the discogram.

The only really supportive Dr's I have had are the two pain management Dr's I have - one for meds, and one for needles. All the other Dr's I have had have seemed quite disinterested in my condition because I don't fit into their little diagnostic box, and they just kind of push me on, back to pain management.

Sorry about the long post - I am just so interested that finally I've found someone else with the same negative discogram situation (but please believe me, Loren, I do not rejoice at all in your situation- I'm so sorry that you're so young and must endure so much).

All the best, Loren, and keep us posted.
Stefany

Landry
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Joined: 08/23/2010 - 5:15pm
Hi Stefany, Im glad to know

Hi Stefany,
Im glad to know Im not the only one with back pain and a negative discogram......With the exception of one of my doctors the everyone seems to think that my pain must be from another source other than my disc. Some how, though, I know that the disc is the cause of all this pain. I am much like you, in that I look very healthy and aside from me telling people about my pain, most would not know. I dont have any problems walking, aside from my lower back hurting the longer I do. Sitting however, is the worst. This limits pretty much everything I do to either not doing it or only doing something for an hour or so because my pain meds will wear off.
I will be sure to keep you informed as I continue to find some relief. I wish you all the best!

Loren

Coyote
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Joined: 03/06/2010 - 3:42pm
Sometimes you feel like you're going crazy

One of the surgeons wouldn't even talk to me when he found out I had a negative discogram. And how you say you can walk - this is also the same with me. Sitting, standing and bending cause the pain for me - and I cannot lift or carry more than a few pounds. Because I can't do physical therapy, I try to keep myself healthy by walking 1/2 hr to an hr each day, and I also will carry a few pounds of groceries, slowly and carefully home a block or two, to keep upper body strength.

I do have a couple of things I would recommend though (BUT I REPEAT - I AM NOT A DOCTOR):

Firstly, get a good pain management doctor who you trust, who listens to you, and who believes you. My pain management Dr. has been WONDERFUL - and he always says to me - There is so much that is not known about the spine. It's true - when you look at the spine and the spinal cord - well - the spinal cord is like a primitive brain - SO COMPLEX. My pain management Dr. has really been the key to me being able to have at least some access to THE REAL/NORMAL WORLD.

Secondly, because of the ambiguity of the cause of back pain, do be cautious about going into surgery. Two surgeons would have operated on me anyway (they said that the evidence from the MRI was enough for them) but they could not explain why I had a negative discogram. My pain is bad, but at least when I lay around all day, and take my meds, it's not usually too bad - it is bearable. But I have had advice from people on this forum, like STRAKER - who suffers agonizing pain when he is rest as well - that pain from a bad operation is so much worse. When they mess surgery up - which I think is much more likely when they don't have TRUE diagnosis for the pain - the pain is unrelenting.

As I say, Loren, I do wish you all the best. Perhaps you will have better luck than me. I live in New York City, and have seen all the top Drs. in the top facilities in the WORLD. I am fortunate that at least leading this very sendentary lifestyle is manageable - although I live in terror of losing my disability benefits (with the economy, I guess everyone is worried about the future). Keep searching, but also find a place of peace for yourself - we all have our burdens in life - it's part of the deal, ha-ha.

And yes - let's post whenever we make progress (it's also good to post when you're feeling hopeless - because as is said, over and over in this forum, you are not alone). Discograms are not a perfect test - and I agree with you - often the pain is latent (I don't feel it until I get home and lie down), and I don't feel like the discogram is sensitive to pain that builds up over time. Like you, I can only think that is why the pain didn't show up.

Keep optimistic.
Stefany