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Dear Dr. Croenman,

please find below as requested.

Location and Quality of Pain

What is the quality of the pain?
The pain is in the lower back into buttocksto wiastline and radiating to thigh and leg left, right or both sides with burning, dull and sometimes aching.

Does the quality of pain change with activity?
Yes, Increases while sitting radiates to thigh and leg. Also increases when standing, less while sleeping, but have to change position or will have difficulty in getting up.

Is the skin hypersensitive to touch?
No hypersensitive, but sometimes yse.

Are there associated skin changes like thickening, color change or nail changes? This is important in the foot and lower leg?
No.

Percentage of Pain by Location

What is the percentage of pain in the back vs. buttock and leg?
It 50% back vs. 35% buttocks 15% thigh and leg.

Intensity of Pain

The current pain back & buttocks is 4-6 VAS.
Leg now is now 0-2 VAS.
Thigh now is 0 VAS.
The worst befoer 7 years 9-10 VAS. Radiating from back to thigh to leg right side.

Weakness

Is there weakness associated with the pain?
sometimes, not always.

Is the weakness due to pain inhibition (the muscle is weak from use due to pain) vs. neuropathic weakness (is muscle is weak because the signal from the brain is interrupted due to a pinched nerve)?
Don’t know.

Is there now a limp due to pain or to weakness?
Sometimes.

Are certain activities more problematic like climbing stairs (due to weakness and not pain- such as a weak anterior thigh muscle) or walking due to a foot drop (you catch your toe on the ground when you walk) or even push-off (your foot will not push you forward while you are walking)?
No.

Onset and Length of Time Symptoms Have Been Present

How did the pain start?

Was it a gradual onset over years or was there one specific activity or injury that caused it?
Always present over years, but increases sometimes.

When did that injury occur?
7 years ago.

Describe the activity or action that brought on the pain. Was it a lifting injury, a bike accident or did the pain onset come on gradually?
lifting some heavy.

How long have the symptoms been present and have they changed in quality or intensity?
The pain is present since 7 years on and off.

Activities

What activities increase or reduce the pain?
Increases is Joging, otherwhise pain is always present but in lower level and increases for no reason known to me.

Think carefully about this question as the information produced is very valuable: Is it sitting that increases the pain where standing reduces the pain or visa versa?
Both.

Can you sit for 15 minutes or one hour before you have to get up?
yes, but painful.

How far can you walk?
maybe 2 miles.

Does prolonged exposure to the activity cause more pain?
depending on the activity.

What does bike riding, sitting, standing, walking, lifting, jumping, computer work, driving or flying do to the pain?
Sitting, standing and jumping in general make pain worse. Walking is less but when I stop it pains.

Does the activity cause different symptoms?
Not sure.

Does the lower back hurt with sitting and bending but the leg hurt with standing and walking?
Back and leg hurt with sitting and standing.

Does the neck pain become worse with bending forward vs. backwards?
Yes, sometimes.

Is there instability pain? That is, is there only mild pain with activities that becomes excruciating with a certain movement that you avoid like the plague?
There IS mild pain with activities that becomes excruciating with a certain movement that I avoid.

Does daily function go relatively smoothly unless you bend over to pick something up?
Yes, but I avoid certain movements.

Pain Intervals
•Are you pain free for certain times of the day or with certain activities?
sometime, but have pain with sitting, standing. Maybe the pain is mild with walking but severe with sitting. Possibly there is moderate constant pain that becomes severe with, jumping or some other activity like running.

Are there flair-ups that occur? Are you pain free for most of the day but by the end of the day, pain onset occurs? Do you get pain crises? Are you free of pain for a week, month or even year but one event will cause severe, incapacitating pain?
Pain is always present but on a lower level, but flair-up for no reason or any activity.

When the pain crisis occurs, how long does it last?
Depending when I visit the hospital, generaly 3-4 days.

Activity and Occupational Restrictions

How has the pain changed your life?
Walk and move very carefully.

Have you adapted to the pain by limiting your activities? If so, what activities do you now avoid?
Yes, running suden movements.

Do you no longer participate in recreational activities that you once did? Which activities have you eliminated?
Yes, running .

What activities have you modified?
Now walking & swim vs. running for 45 minute a previous.

What do you now do to prevent pain from occurring?
Don Know what flairs up the pain to avoid reoccurring.

What type of work are you involved with?
Expediting company work in other companies and gernment departments. involves driving, standing and office work.

Describe your work by its physical demands. Do you have to repeatedly lift, bend and twist?
No lifting or twisting.

Do you have to sit without position change for long periods of time?
Yes, Sometimes.

Are you off of work due to the pain or did you have to change your job position secondary to pain?
Same job, but I try to avoid sick leave as much as I can.

How long have you been off work or have changed your position?
In general Sick leave is for 3-4 days.

Liability
•Is there liability from another party (motor vehicle accident or workman’s compensation involved)?
Both motor vehicle accident or workman’s compensation involved

Have you been injured by another’s fault?
Recently I was involved in an accident on 3/June/2012 no direct hit to me but bad damage to my car. Pians have increased and symptoms have changes. Prevously only pain in back radiating to right side.

Liability is too complex to be dealt with by a simple Internet site. Your consultant will need to obtain specific details regarding the injury to help with any decisions on settlement or causality and apportionment.

Previous Consultations or Treatment

What previous treatment have you had?
Yes.

Have you seen a chiropractor?
yes.

Have you seen a therapist?
Yes.

How successful or non-successful has that treatment been?
On and off.

Have you seen a surgeon and if so, what did they say?
Some said surgery others said you can wait.

Did you have previous spine surgery and if so, what procedure?
No.

What happened to your symptoms with the prior surgery?
No Surgery.

Again I thank you for your time and effort.

Dr. Corenman, Thank you for answering my post.

Yes, I have a lot of symptoms going on now and it’s very frustrating not knowing where or who to turn to next to try and figure out what is wrong and how to fix me? I am a female age 54.

A little of my health history if you don’t mind.

In 1990, I saw my GP 3 times for right neck stiffness and right shoulder pain and each time I was given a steroid injection in my shoulder. The 4th time it happened it was for left neck stiffness and left shoulder pain. I got another shot and was sent to have a MRI of my neck.

1990 MRI Findings: There is a slight narrowing of the C5-C6 Disc space. I was told nothing was wrong with this disc … (However, 5 years later this same disc ruptured)

After that, I didn’t have any more neck or shoulder pain. It just went away.

No major problems with my health until

Aug. 1995: I had numbness & tingling in my right hand and forearm. I got a MRI which clearly showed that I had a ruptured disc at C5-6

1995: I had a Ant. Disc Fusion at C5-6 using a donor bone.

Then appox. 8 months later I started having all over body muscle pain and headaches. This is the beginning of my nightmare!!

I went back to my Nero Surgeon to see if there was something wrong with the fusion I had or another disc gone bad. She didn’t find anything wrong. (I don’t have any of these records and she retired not long after my surgery)

I went to several different type of Doctors.

I was tested for MS – Normal, no findings on brain scan
I was tested for Lyme Disease – Normal
I was tested for Lupus – Normal

Nothing explained my symptoms. So, I was dxd with Fibromyalgia.

I did aqua pool therapy, myofashial release massage therapy, Tens Unit, Different kinds of med’s, cold packs, heating pads, walking, resting, I tried it all.

In 1997 I went to the ER four different times with what felt like TIA attacks on the left side of my body. Each time no stroke showed up on any of the scans they ran on me.

Then they just went away, I have not had anymore of those attacks to date.

1998: I went to see another Nero surgeon I had another MRI of the C-Spine: The Doctors notes say … Decision Making: MRI shows a C5-6 fusion, decreased foramina on the right. My suspicion is that she has an incomplete fusion. I believe there is some micro motion at the fusion site, which might explain here neck pain with her head unsupported for any length of time. She may have some slippage here which causes nerve root compression and the shock-like sensations. 

If I remember correctly I did have x-rays done of my neck but the x-rays didn’t show any slippage of my C5-6 fusion. So nothing was done. I just kept going with pain med’s, muscle relaxers to keep me going and working.

*** Note: Much later after my fusion healing time, I’ve always been able pinch the front of my neck and move that donor bone at C5-6 in my neck on the right side only with my fingers and it rubs bone to bone, I can hear the bones rubbing together it in my head when I do this too. I didn’t try to move it before I thought was plenty of healing time like probably a year afterwards. I can also hear lots of cracking in the back of my neck when I move it from side to side. I’ve told several Doctors this but they have all said it’s normal to be able to move your neck bones around and to hear a crackling neck. ***

Feb 2001 I’m once again in extreme pain!

Muscle pain, headaches, mostly cervical neck and upper trap’s area of my shoulders pain.

My GP sends me to a pain clinic. I had 3 Cervical Epidural Injections done. The 1st one lasted about 2 weeks, the 2nd and 3rd only a few days each. With 200.00 co-pays for each time I had one I just couldn’t afford to have anymore besides they wasn’t working for me anyway.

After that, the pain Doctor put me on the Duragesic Fentanyl Transdemal pain patch. I started off on the 50 mcg changing it every 3 days. When they didn’t work anymore I was changed to the 75 mcg changing it every 2 days. Was ok for awhile but the pain got really bad again and was switched to the 100 mcg changing it every 2 days. Then believe it or not with that much pain med’s my pain was getting worse again. There was no way I would be able to go higher than what I was on without overdosing.

I was a total Zombie. Finally, I ran across something that was called Re-Bound Pain. I read as much as I could about re-bound pain from pain-killers and was astounded. All I had asked my GP for was 1 more vicodine a day to get me through so I could continue to work but he wouldn’t go for it and sent me to that pain clinic. What a mess it turned out to be.

I asked my pain mgmt. Doctor to take me off of the pain patch but he took me off way too fast. After being on them for 2 years I see now that I should have been down dosed much slower. His down dosage took me from the 100 mcg pain patch every 2 days to off completely within 3 weeks.

Aug. 2003 I was in the hospital in severe withdrawals. They put me on IV with delodid I think but couldn’t be in the hospital forever they down dosed me until the vomiting stopped which was about a week and sent me home. I was in withdrawals for months.

2009: Found I have acid reflux disease, Gerd, and diverticurlos,

2009: I had lower back surgery at L5-S1 not fused just shaved the disc. Surgery went well. Haven’t had any problems with lower back since then.

2009 & 2010: Had lots of teeth work done. Found periodontal gum disease.

2010: I had a major heart attack in the left main Coronary Artery. I Had to have 2 stints placed in the artery it was 90% blocked.

2012: Went To ENT doctor

June 18th 2012: I had 22 teeth extracted and am still trying to recover from that. I haven’t been tested and don’t know what my heavy metal or mercury levels are yet.

The post I sent you prior to this one is where I’m at now:

I’m concerned about the C3-C4 Disc on my MRI

From past experience with my C5-6 fusion. C3-4 pretty much says the same thing that it did 5 years before my C5-6 disc ruptured.

Also, from what little I was able to find on the internet about the symptoms of C3-4. I read that the C3-4 disc nerves can be a cause of the rocking / swaying vertigo, neck and head pain. Any idea on this?

And lastly where is says Mild to moderate C4-C5 Chronic degenerative disc disease. Could this disc rupture?

I don’t take any pain med’s anymore after what I’ve been through with that pain clinic, the only time I take any is for after surgery pain, nothing on a long term basis. Other med’s are for heart, and Zorcor to keep down colsetoerol.

I also have restless leg syndrome and am on Requip which it works great for restless legs.

I know this is very long, but thought I’d give you my complete history.

Should I also show this to my Neurosurgeon who did my back surgery in 2009? Or is it too much for him to decipher?

Thank you very much.

Something else I forgot to ask:

You said:

“Pins & needle sensations, electric shocks sensations I feel like they start from my head/neck area then travels on down my whole body” can occur from compression of the spinal cord but there is no evidence of cord compression based upon MRI report.

Could my MRI report have been miss-read? Or is there any other tests that would show cord compression? The electric shocks sensations I have every morning when I get up and lessen up after a few hours, until the next morning.

Perhaps I worded the pins & needles incorrectly? Where I feel these are constantly in my legs, most of the time in my feet not always and sometimes in the trap’s area of my upper shoulders and base of my neck. The sensations are very hard to explain what they feel like. Instead of pins & needles – more like lots of little electric sensations would be a better wording I’m looking for.