I had an interbody fusion at l4-l5 several years ago. Now following a car accident I have intermittant severe pain radiating down the leg. MRI shows a "bulge", but though they tried everythin including foot veins they couldn't inject contrast, so as I understand it , there is no way to know if this is scar tissue, disc, bone or what. The pain becomes very severe at while sleeping, is helped somewhat by ice. Physical therapy only helped a little. Where do I go from here? here?
Answer ------
Chronic low back pain is a very difficult problem to treat. It sounds like you do not have weakness or loss of control of bowel or bladder. If that is the case, then you seem to not be in danger of losing function from nerve damage. That gets us back to controlling the pain.
Tylenol and aspirin-like medications (for example ibuprofen) take away no more that about a quarter of the pain. Narcotic and muscle relaxant medications help for acute pain for a few days but wear off with continuous use and are addicting. Some antidepressant medications can help with sleep and with reducing _chronic_ pain somewhat. Accupuncture, massage and other physical treatment may help without causing any harm. Self-help support groups as exist for arthritis would be helpful, if they exist.
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Paul Hunter, M.D. family physician 2/18
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