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Got injuried back in December of 2012 at work while lifting, twisting, and pushing forward. I initially heard a “pop” sound and suffered extreme pain that only lasted 10-15 minutes. A few days later, as I was getting up off of my back under a piece of machinery. I experienced much worst pain, the type of pain that stops you in your tracks. This pain never seemed to back off, so I immediately sought treatment from my PCP and later was referred to a pain management doctor(work comp doctor). They had a mri done and they found a torn labrum in my right hip. My concern from the beginning was the pain in my lower back that extended down to my right hip(front and back), into my groin area, and down the front of my thigh. In the beginning I would also get occassional numbing in my right foot that only seemed to affect the arch of my foot and the last two toes on top.
The hip doctor that I saw said that it is very difficult to determine in between hip and back pain, but kept suggesting that my pain was caused by this labrum tear and suggested immediate hip scope to correct the problem. September 2013, I underwent the hip scope and to fast forward a bit after six months of continued pain and pt (for the hip and lower back) that was getting worst and these other doctors released me with a clean bill of health. I got a second opinion only to find out that the other doctor removed excessive amount of bone and now I was bone on bone. I was told I would have to undergo a total hip replacement to correct what was done during the hip scope, so October of 2014 I underwent a total hip replacement.
After the normal healing time for the THA and several more months of PT. My pain continued to get worse, so my Hip surgeon referred me to see a back specialist after he did several tests and said I had a abnormal straight leg raise on my right side(operated side). I saw two different spine doctors that work comp sent me to, both of which said there was nothing wrong with my back and the excruicating pain that I have been dealing with is residue pain from my hip.
I finally got another opinion from a pain management doctor that I was also sent to and he disagreed with the two spine doctors after looking at the same mri these other two doctors viewed. The mri report said there was nothing abnormal but he showed me that I had three bulding discs. So for the past year and few months, I have undergone countless injections that only work for a few days, I am taking 90 mg of extended released morphine, and 2400 mg of ibuprofen per day trying to knock down the pain. My quantity of life went from being a workaholic in 2012 to being confined to my couch, because nothing this pain management doctor prescribes or injects seems to work. But my last visit at his office his nurse told my wife and I that the disc bulges aren’t back enough for surgery.
Starting to feel like a cash cow for this doctor not wanting to proceed with surgery. How bad does a person quality of life have to get before someone actually does something? My thought of taking medication for pain is for the last draw when all other paths have been taken and exhausted. He has suggusted a neurostiminator to be tried on a trial basis, but this device doesn’t appeal to me. I have enough unneccessary metal in my body, and refuse to undergo having this thing inserted even on a trial basis. I lefted my medical open, so I could get my back fixed not maintained with a wide range of narocotics and medication to fight the constant problem of constipation( Thats a whole new subject on its own). Overall I have undergone a total of 28 months of physical therapy, 13 injections, and I have been on this dosage of morphine for the past 15 months and they are in the process of changing it because my body has built-up a tolerance to it.
What options do I have on getting these disc bulges fixed? Is it better to fix them before they get any worst? How long does a patient have to suffer before something is done?First-the original pain could have been diagnosed by injections. If the hip was a major pain generator, a diagnostic (anesthetic) injection into the hip would have yielded temporary relief of the hip generated pain. Generally, lower back pain can radiate into the groin occasionally, especially with upper (L2-L4) disc injuries. This pain would not have been relieved by a hip injection if the hip did not cause this pain. This is why a pain diary after injection with recording of what symptoms go away and which symptoms are still present is so important. This now is water under the bridge after your total hip arthroplasty (replacement).
You need to define here on the forum your pain location and activities that cause pain. See the section https://neckandback.com/conditions/how-to-describe-your-history-and-symptoms-of-lower-back-and-leg-pain/ to understand how to describe your current symptoms. There are many physicians who “don’t believe in the causes of lower back pain”. You might need to find a physician who understands this problem but with workman’s compensation insurance, your choices might be limited.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.Bear with me, not to many doctors actually ask or listen about the pain levels and where it occurs. So I failed to include upon my original post.
In the beginning before the first hip surgery, I received two injections into the hip joint. Neither of the injections provided much relief for more than 3-4 days so I couldn’t tell if it was the anesthesia or the actual injection. My pain level before the injection was a stable 9 and afterwards an 8. But I also received injections into my SI Joint and near my ischial tuberosity which did nothing for the pain in my groin area or the back side of my pelvic region.
After the hip scope I started experiencing much worst pain in the hip joint area. I continued to plead with the hip surgeon to double check his work, because the pain had gotten unbearable (a solid 10 on the pain scale), so I went to a independent hip specialist and got a second opinion. Upon our consultation with him, he explained how difficult it was to correctly diagnose a back injury from a hip injury. But he stated in his opinion that the hip surgeon removed an excessive amount of bone which left me bone on bone and referred me to another hip specialist at the Washington State University School of Medicine in St.Louis, MO for prehaps some alternatives other than a THA.
The examination and the review of my medical records with this new hip specialist resulted with the same opinion, but there were no alternates other than a THA available. Sometime either before or after this surgery he informed me to make a pain diary so if I had problems he could easily go back and see what actions intensified or make my pain better. So I have a pretty decent pain diary for that year and occassionally after that when I started seeing the current pain management doctor that attempts many different injections.
During my physical therapy after the THA my pain continued. In general my pain is in the middle of my back above my beltline and progresses down into my buttocks and around the outside of my right hip into my groin and down the front side of my thigh. On a pain scale, my back usually is a mild burning/ ache (7-8), front and back of the pelvic area is a intense burning/ stabbing pain (9), and down the front of my leg is a burning/ ache pain (7-9)( with activity such as walking, twisting, bending all areas increase with pain – leaning over a table unsupported by my arms or riding in a vehicle in such a manner where it feels like my back is a shock absorber gets the back inflamed with a burning and down right painful pain that doesn’t just resolve on its own). I have never experienced any pins and needles in my back, pelvic region, or down my thighs. I am weaker on my right leg when pulling up or pushing down my toes against resistance. Before and after the hip scope and THA I had some numbness in my right foot primarly in the arch of my foot and the last two toes but in the last six months that numbness has subsided but the pain continues.
Since my first post I have undergone two more epidurals at the L2 and L3 region. Surprisely I had very good results but it only lasted for 8 days. My pain went from a 9 to a 1. I experienced some migrain headaches and experienced a extremely fast heartrate for a day, so it was a rough few days but once that was over I finally got to experienced what being normal was like. I had a minor ache in my back throughout that week that wouldn’t go away but it was a relief to be pain free for the short time. Its the first time they have ever let me influence them to give the injections higher so perhaps their misses everytime might actually provide some relief.
But my return visit with the doctor today wasn’t very productive in my opinion. After three years of continued conservative treatment they don’t want to explore or try anything else except the same manner in treatment. Due to new provisions that were outlined by workers comp in a mailed letter they are switching my medication from 90 mg of morphine per day over to 5 tablets of 325 mg – 10 Norco per day. This was a medication I used to take on a higher dosage(12 tablets per day) before the extended release morphine. The reason for the change was I wasn’t getting enough rest before I had to take another dose and my PCP didn’t want the Tylenol to eat my liver. So I am back into this endless cycle once again.
I did look into Laser spine surgery to see if this might be an option that is widely televised about but after filling out all of the required documents once they realized it would be paid by work comp I received a pleasant email stating that they do not accept workers comp for payment. I got to wonder if I had regular insurance if more options would come available and these doctors would take the necessary steps to help relieve me of the ongoing issues that I have faced for so long. Well I am actually going to test my theory, because this is getting ridilious.First-you misunderstand how a pain diary works. The first three hours only are critical for diagnosis. This is because the numbing agent (lidocaine or marcaine) wears off after three hours and the steroid then is the driving force for relief after about 12 hours. Since steroids can become systemic (absorb through the blood stream and distribute throughout the body), the “steroid affect” is not diagnostic. That is, how you feel in the next three days is not diagnostic.
Your notation, “pain is in the middle of my back above my belt line and progresses down into my buttocks and around the outside of my right hip into my groin and down the front side of my thigh” sounds like a spine pain origin as typically, hip generated pain does not radiate into the lumbar spine. Your relief from the spine injection ” two more epidurals at the L2 and L3 region. Surprisely I had very good results but it only lasted for 8 days. My pain went from a 9 to a 1″ also helps to indicate a spine origin but the caveat is the first paragraph.
It is probably good that your medication is being reduced. You will probably have a tough time reducing your narcotic dosage (initial withdrawal) but eventually you will have some benefit from this.
It is also probably good that you were not accepted at the Laser Spine Institute.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.I am curious, for each of these epidural injections that I received is performed at the hospital and I am literally knocked out. My wife dresses me after I have about an hour nap in a hospital bed, then we head home. I am lucky if I even remember bits and pieces of that entire day. If the first three hours are critical for diagnosis then why in the world would they knock me out?
I already suffered through a mishap a couple weeks ago when they wanted to switch me to Embeda. No pharmacy had this medication onhand and it was on a Friday, so I went back to the doctors office to attempt to get another script with no success(Authorized doctor was out of the office). So I ended going cold turkey off of this high dose of morphine. That experience was the worst and at that moment I decided it was time for a change instead of more and stronger meds. So first thing Monday morning I informed my doctor office that we needed to find a solution to this constant pain instead of more and stronger pain medication which has been their standpoint from the beginning six months ago. The extended release morphine helped alot for the first six months but after that it seems to be less effective for my pain.
My doctor is really pressuring me to get this neurostimulator, a product by St.Jude, but the idea of having a battery encased within a metal case under the skin really doesn’t seem like a good idea especially for me. I make doctors nervous during any procedure. They call it runners pulse. During this last procedure my vitals were Pulse rate 37bpm Resp rate 14br/min Blood Pressure 110 mmHg O2 Sat 98% Weight 69.2kg.
So now they are planning on sending me to see a neurosurgeon for a second opinion. I am curious just from everything provided to you. What is a viable next step and is there a actual treatment for buldging discs? Every MRI I have done it seems like the person reading them just writes a report and puts his stamp on it. I had to take my MRI and the report to my hip surgeon so he could show me exactly which discs were bulging. And he was the one who performed the straight leg raise on me. When I go to these spine specialists they read the MRI report and then give their opinion, and thats the problem. Even if I point out that they need to look at the MRI and not the report then I get the same response each time- “The pain is residue pain from your hip and its not from your back”. I have been told this twice by two separate spine “specialists” supplied by work comp.
The temporary relief I get from these injections gives me hope and I continue to push on to find a solution, but after giving up so much after three long years it has taken its toll on me. I could use some suggestions(free) on what to try next, because six injections a year will only provide six weeks of relief then its back to life on the couch. ~Living with back and hip pain isn’t much of a life~ Those of us who are dealing with this really understand this phrase better then anyone or any doctor.You have to understand that the diagnostic results of injections are generally ignored in the “injection” and spine world. This is simply because of prior training. The injectionist uses “conscious sedation” which means an IV concoction to make you comfortable, tired, less anxious and limits pain. Unfortunately, if the sedation technique “knocks you out” for 2-3 hours, the diagnostic portion of the injection is lost. The technique to create sedation for a very short period of time exists (as we use it every day in our clinic) but is not commonly used as it requires more strict attention to detail and is not appreciated as many injectionists do not understand the significance of keeping pain diaries.
Your back pain is probably from at least one and possibly all three of your “bulging discs”. The problem is that fusion is the general answer to lower back pain but three disc fusions have less success surgically than one or two level fusions. The MRI images could be helpful for understanding if one or two discs are the pain generators (see IDR or isolated disc resorption).
The definitive test in my opinion is a lumbar discogram (see website) to see if you could be a candidate for surgery. This would be performed by a well experienced discographer in a blinded fashion (you would not be able to know which levels he or she was testing). You might not be a candidate for fusion after the results of this test were made apparent and might then be a candidate for a stimulator.
The stimulator seems to be a burden but in about 50-60% of cases, is a useful tool. It can always be removed if you don’t like it.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books. -
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