Dr. GO? My back's been bothering me...

Dr GO

Chronic back pain due to aging disc disease leading to localized back pain, spasms and pins and needles traveling down into the buttock or legs is troublesome. Many such patients seek surgery for a solution. How good are the results of surgery?

In a study reported in Surg Neurol Int. 2016; 7: 38; 501 surgical candidates were randomized (245 assigned to surgery, 256 assigned to nonoperative management) with imaging-confirmed lumbar intervertebral disc herniation and persistent signs and symptoms of radiculopathy for at least 6 weeks. Patients were randomized to standard open discectomy or nonoperative care as described in the above study design section. The intention-to-treat analysis showed that both treatment groups improved substantially in all primary and secondary outcomes.

So what can you do medically if you elect not to go through surgery to avoid that extra risk when outcomes show no significant difference? I have had amazing success with this following combination treatment plan:

Willow bark extract at 260 mg per day has been shown in a double blinded, randomized control study in comparison to morphine to be better at pain management, to the results of for every patient responding to willow bark, 3 patients were needed to be treated with morphine to achieve the same pain control. So I recommend Willow bark at 260 mg daily.
I also found great success in patients that have purchased the "Back-2-Life" mechanical rocking device. Unfortunately, this device is becoming harder to find, and now anyone desiring one will likely need to purchase it directly from the company. The company notes it is currently on back order (no pun intended). But this machine acts as an at home chiropractor, and it rocks the lower spine to open up the disc space, helping to remove impingement on spinal nerves.

So I recommend giving the above two options a try before electing surgery... OR meeting under a freeway bridge in Spokane!

Pinstriper

Having moderate herniation in L4-L5 and L5-S1 dating back to the first Bush administration, I can say there are exercises that work very much along the principle of (2) above and these have provided some relief. Part of the explanation I received was an increase in blood flow and redistribution of synovial fluids within this disc itself with some sort of nutrient/healing process associated. It may well be hogwash.

Since I never heard of it, I presume "willow back extract" is some sort of new code-speak for some sort of cannabanoid. To my knowledge I am the only person I know that has no experience base in this.

Dr GO

@Pinstriper said in Dr. GO? My back's been bothering me...:

Since I never heard of it, I presume "willow back extract" is some sort of new code-speak for some sort of cannabanoid. To my knowledge I am the only person I know that has no experience base in this.

Willow bark extract is actually a natural salicylic derivative from the willow tree. It is a highly effective agent in this class of analgesics for back pain. It is typically sold in Natural Food stores.

As I was practicing seated a lot, I had a lot of troubles with my back until my doc told me to by such a chair:
https://www.amazon.fr/assis-genoux-ergonomique-réglable-11-Wellbeing-couleurs/dp/B07BB4CSS4/ref=sr_1_3_sspa?keywords=siege+assis+genoux&qid=1554893184&s=gateway&sr=8-3-spons&psc=1
I bought one a year ago and since no more pain (but a lot of gain).

moshe

This post is deleted!

Pinstriper

@Dr-GO said in Dr. GO? My back's been bothering me...:

@Pinstriper said in Dr. GO? My back's been bothering me...:

Since I never heard of it, I presume "willow back extract" is some sort of new code-speak for some sort of cannabanoid. To my knowledge I am the only person I know that has no experience base in this.

Willow bark extract is actually a natural salicylic derivative from the willow tree. It is a highly effective agent in this class of analgesics for back pain. It is typically sold in Natural Food stores.

Thanks, Doc. Never heard of it but will look into it.

Robrtx

I purchased some off of Amazon (Solaray 400mg 100caps for about $9) a couple of years ago when I was dealing with some extremely painful impingement issues from my lower back down my butt. My issues resolved themselves before I really could evaluate it's effectiveness.

One problem that I have with Nsaid pain relievers is that some, such as ibuprofen, tend to elevate my blood pressure, so any non-narcotic alternatives are always of interest to me.

Dr GO

@moshe said in Dr. GO? My back's been bothering me...:

@Dr-GO
For a badly herniated disk, surgery is definitely required.
moshe

Not necessarily. I appreciate that you had this surgery done many years ago, but current recommendations for herniated disc surgery as from my MedScape eMedicine (https://emedicine.medscape.com/article/1999923-overview#a2source) reference states:

Indications
Approximately 90% of acute sciatica attacks improve... with conservative management for nonoperative methods, such as anti-inflammatory medications, physical therapy, and lumbar injection, unless the patient has an acute or progressive neurological deficit.

Indications for lumbar discectomy include altered bladder and bowel function and progressive neurological deficits such as motor weakness or sensory deficit in the lower extremities. Surgery should also be considered in patients with radicular pain that persists after an adequate course of conservative management.

Moshe, my heart goes out to your current pain and functional status; AND I don't know your specific symptomatic details from your past experience leading up to surgery, but "severity" is based on symptoms, not the anatomical classification of "badly" herniated. There was a radiological publication that looked at MRI findings in patients with significant disc herniation, and of these patients, 80% were Asymptomatic. Again, the complications of surgery can be as bad as the disease itself.

As a Primary Care provider, to my patients I strongly recommend avoiding surgery (for reasons and evidence noted above) ONLY if neurological symptoms are progressive (motor and sensory symptoms) AFTER an attempt of conservative therapy (for me that is willow bark and physical therapy) is attempted. HOWEVER, if bowel or bladder incontinence is reported, surgery is urgently necessary and I would refer immediately to a surgeon of the patient's choice.

Dr GO

@Robrtx said in Dr. GO? My back's been bothering me...:

One problem that I have with Nsaid pain relievers is that some, such as ibuprofen, tend to elevate my blood pressure, so any non-narcotic alternatives are always of interest to me.

Very true. The good news about Willow bark is it is a "pro-drug" and your body converts it to an NSAID like compound once it passes through your liver. That effect does avoid some of the stomach upset you can get from Aspirin or ibuprofen. HOWEVER, once inside and converted, it can cause the bleeding complications, kidney and blood pressure problems seen with other NSAIDS.

My advice is if started, do retake twice a day blood pressures a week before starting and a week after starting to see if you would be one of the very rare patients that would have blood pressure elevations.

As with ALL medications, there are good (pain improvement or relief) and bad (side effects). THEN there is the comparison to the alternatives: opioids. Opioids will lead to dependency after just two weeks of constant use. I did not state addiction so please don't read into this. Sometimes pain control is so important that the patient will accept the complication of dependency.

scottfsmith

Bringing this back to trumpets .. do trumpet players have relatively more back problems? I was moaning to my trumpet teacher about my back problems and he moaned back about his, and then I got thinking my recent back problems started when I got more serious about the trumpet a few years ago. The PT told me my lower back is too tense, and playing trumpet to get out the high notes also causes that to happen..

Any connection here?

Dr GO

@scottfsmith said in Dr. GO? My back's been bothering me...:

Bringing this back to trumpets .. do trumpet players have relatively more back problems? I was moaning to my trumpet teacher about my back problems and he moaned back about his, and then I got thinking my recent back problems started when I got more serious about the trumpet a few years ago. The PT told me my lower back is too tense, and playing trumpet to get out the high notes also causes that to happen..

Any connection here?

A study out of North Texas State reports the overall complaint of lower back pain in trumpet players is 17.5%. There are many publications of Chronic Lower Back Pain in the general (non-musician population), and the most referenced is at 20%. So by an indirect comparison between two separate studies, there is really no evidence for Chronic Low Back Pain to be significantly prevalent in trumpet players over the general population. Here is the reference Table from that article from North Texas State, published in Medical Problems in the Performing Arts, 17:93-98;2002:

A German study (Clin Rheumatol (2015) 34:965–973) parallels these findings; with a lower risk of back pain among trumpet players than other musicians; however in trumpet players, that study showed a 2.5-fold higher association of pain in the teeth/jaw for brass players.

moshe

This post is deleted!

Dr GO

@moshe said in Dr. GO? My back's been bothering me...:

@Dr-GO said in Dr. GO? My back's been bothering me...:

@moshe said in Dr. GO? My back's been bothering me...:

@Dr-GO

If the herniated disk is crushing the spinal cord,
only surgery will solve the problem.

moshe

Please see my above post. Unless physical symptoms are present, conservative therapy is the standard of care. Symptoms dictate not anatomy. "Only surgery" does not necessarily solve the problem AND may even complicate it as you have stated in your post surgical experience. The reference I posted is evidence based. Conservative management was as effective as surgery and surgery has additional risks above and beyond the evidence-based outcomes.

Again, 80% of patients with MRI demonstrating spinal cord impingement (the word you use is crushing) had no symptoms and did not have a surgical indication for therapy. That again is today's standard of care.

Please try to understand, if nerve impingement is not symptomatic, there is no "problem" with the nerve. The "problem" is with the picture of nerve. With conservative therapy, further impingement with physical therapy may be avoided AND is just as effective as surgery, but without the risk.

Vulgano Brother

Aleve and beer work for me.

Dr GO

@Vulgano-Brother said in Dr. GO? My back's been bothering me...:

Aleve and beer work for me.

At least I have purchased for you, half of that remedy in the recent past. It would be my honor to come back for a visit to administer a second course of therapy!

Vulgano Brother

@Dr-GO I'm thinking something stronger some days. The beer takes care of the inflammation, but sometimes the pain persists. Doesn't cocaine have pain-killing properties?

It's not just my back though. After the Viagra you sent me I developed carpal-tunnel syndrome.

djeffers78

I’ve been a pot smoker for years and don’t believe at all that it is any kind of pain killer.

Recently I’ve used all hemp high CBD content rolling papers and I do think that stuff works

BigDub

Is this an open medical advice forum?
I think it is a good idea. It will keep you busy, out of trouble, and give you a sense of accomplishment if you are going to be retired and all.
I will provide you with a list of FAQ's to begin with soon. Brilliant.

Tobylou8

@BigDub said in Dr. GO? My back's been bothering me...:

Is this an open medical advice forum?
I think it is a good idea. It will keep you busy, out of trouble, and give you a sense of accomplishment if you are going to be retired and all.
I will provide you with a list of FAQ's to begin with soon. Brilliant.

Well dude, I like took some stuff one time and it was crazy good and worked great. Yeah, it was umm, uh, man, I can't remember, but it was awesome.

SSmith1226

@Vulgano-Brother said in Dr. GO? My back's been bothering me...:

@Dr-GO ...
It's not just my back though. After the Viagra you sent me I developed carpal-tunnel syndrome.

Vulgano Brother and Dr.Go,
I ask for your forgiveness and understanding for inserting myself in this exchange, but I had some relevant thoughts about Vulgano Brother’s carpal tunnel syndrome. Certainly if allowed to advance, the carpal tunnel syndrome would adversely affect his trumpet playing to the point that Clarke Studies would no longer be possible to play.
My first thought would be to go to a well qualified massage parlor for therapeutic massage. If a minimum of five treatments per week for a month do not improve your carpal tunnel syndrome, or at least take your mind off of it, wearing the below pictured gloves 24 hours a day will certainly give your hands and wrists adaquate rest to allow all swelling to subside.
Good luck!!!