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  • deritis
    Member
    Post count: 18

    Dr.
    Been a while since I’ve been here — you helped me immensely last year on this forum. I had a very painful herniation at L5/S1. Had surgery. One month later the disc reherniated, not as severe but the pain was still bad. It has been 4.5 months since recurrence and things have improved, but not by much.

    I had an epidural a month ago that did wonders. I had a second ESI recently and the pain has overall gotten worse. One Celebrex brings it down to less than a 1. At the end of this month it will have been five months since recurrence and six months since surgery. My doctor says the nerve is still inflamed. Since I have had three total ESIs in the last six months, I cannot have any more. A second surgery seems like it would be excessive. I have no muscle weakness, no nerve damage, and I am pretty much fully functional – though I have seriously reduced my gym time. But the pain continues.

    I don’t even know if the recurrent herniation is still there or shrunk down. There are days/hours when the pain is almost gone and days/hours when it’s there. I am on a low dose of Gabapentin and I probably only need NSAIDs a couple times a week at worst. Will the nerve inflammation ever finally resolve (seems like it should have by now), or do I need to accept that I will be in pain for the rest of my life?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    For disc herniations that do not cause motor weakness, pain is the guide for treatment. Can you tolerate the pain and are you satisfied with your current limitations?

    A second surgery might be something to consider if you are not satisfied with your progress. The other option is to continue to rehabilitate with therapy and see if you progress.

    Over time, you can improve without surgery but how much of this progress is unknown. You do have some current evidence to compare as it has been four months since the recurrent herniation. Are you much better than you were or are you at a status quo regarding your symptoms?

    Possibly a new MRI would shed some light on the significance of the recurrent herniation.

    Dr. Corenman

    deritis
    Member
    Post count: 18

    Pain is definitely the guide. I have never had motor weakness or nerve issues of any kind, other than pain. Explosive debilitating pain prior to surgery, a more consistent achy pain after reherniation. It is improved since reherniation, but not by much. MRI showed a rather small recurrence that the doctors described as what appeared to be some disc material. But it showed a significant enhancement of the nerve. I have no limitations at all, other than psychological — it hurts and I have concerns about causing further damage. Basic NSAIDs virtually eliminate pain altogether (though I am on Celebrex to reduce chances of intenstinal issues — works great). Have had two ESIs that helped greatly for a few weeks each. Seems that something that is so easily dealt with by OTC nsaids should have gotten better by now. Appreciate the advice. Thank you for the insight.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    The nerve sounds inflamed “‘MRI’ showed a significant enhancement of the nerve”. This inflammation can also be associated with scar tissue that can make the nerve immobile. These nerves need to be able to move in the canal by as much as a centimeter.

    There are times that a small recurrent herniation can create as much compression as the original large herniation due to the nerve root being “bound down” and unable to “move” out of the way of this small herniation.

    Nonetheless, if Celebrex allows great relief and you have no cardiac or gastrointestinal problems, use this medication and be patient.

    Dr. Corenman

    deritis
    Member
    Post count: 18

    In these instances does the nerve eventually unbind? Or does it otherwise find a way to settle and return more or less to normal?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    The nerve will somewhat continue to be adhered but over time with stretching (hamstring stretches which also stretch the L5 and S1 nerves), this nerve can loosen up. The inflammation over time can reduce also which is the big factor in reduction of symptoms.

    Dr. Corenman

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