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  • bigbahookie
    Member
    Post count: 2

    Hi there
    I wonder if you could suggest a treatment to release me from the severe arm pain I have been experiencing for the last 6 months. Currently I am prescribed, 8 x co-codamol 30/500, 8 x zydol 50mg, naproxen 250mg x4, amitriptyline 100mg and gabapentin 900mg x 3 times a day.

    I am still in severe pain and the most recent GP visit suggested cutting the amitriptyline to 50mg per day, and reducing my co-codamol by 1 tablet per day until I am no longer using co-codamolas he felt I shouldn’t be on co-codamol and zydol at the same time. Instead he has given me a prescription for diazepam 2mg 3 times a day.

    I have been seeing an NHS physiotherapist who gives me exercises for my neck- chin tucks. I saw a neurologist who referred me for an MRI and here are the results.

    There is multi level degenerative disease present most evident in the mid and lower cervical spine. There is straightening of the normal lordosis but allignment appears maintained. No definite abnormal signal identified within the cervical or upper thoracic cord, although some artifact does make interpretation difficult.

    At c4/5there is broad based disc osteophyte which centrally indents the theca and mildly distorts the anterior aspect of the cord.

    At C5/6 there is a broad based disc osteophyte which is a little more prominent on the right, indenting the theca and minimally flattening the right lateral aspect of the cord, No foraminal compromise.

    At C6/7 there is a broad based disc osteophyte which indents the theca and flattens the anterior aspect of the cord. There is narrowing of the left foramen causing some compromise to the existing C7 nerve root.

    Conclusion: Broad based disc osteophyte diseas at several levels a described with foraminal narrowing at C6/7 on the right and some compromise to the existing C7 nerve root.

    I have had arm pain for 6 months and now I am feeling pain on top of shoulder, back of shoulder blade and under my arm.
    I need to gain some relief from this pain so I can return to work and wonder if you could suggest any treatment which mey help,
    Thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    I assume you have right arm pain-the same side as the spur at the C6-7 level. You have apparently failed conservative care (physical therapy and medications) and have had the symptoms for 6 months. In my opinion, you are potentially a candidate for surgery.

    This is predicated on the fact that the symptoms are on the same side of the nerve compression and a physical examination confirms this is the C7 root (sensory and pain in the dermatome of C7, reflex and motor weakness possible in the C7 distribution and a positive Spurling’s compression test).

    If there is any question, a selective nerve root block (SNRB-see website) could be performed to determine if this is the pain generator (see pain diary). A positive block (relief of arm pain) would confirm the diagnosis.

    As I know the NHS is very slow for surgical scheduling, home traction can yield temporary relief. In addition, you can try membrane stabilizers (Lyrica, Neurontin) for temporary relief.

    Dr. Corenman

    bigbahookie
    Member
    Post count: 2

    Thanks for your input. I am desperate for an end to this pain and the GP has agreed to refer me to a pain management clinic.

    I have previosly asked my GP and physio about getting a steroid injection and they both said it wouldn’t help as I have nerve pain – however your reply seems to suggest itmay help.

    I am going to print off your reply and take it with me to the pain clinic and hopefully they will agree to the procedure.

    Regards
    Carol

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Au contraire. Steroid injections are the most effective treatment in my opinion for nerve root compression.

    Dr. Corenman

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