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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29796
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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hips..severe cramps/pain in my right leg -- nerves are being pinched

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I was recently diagnosed with arthritis in the lower spine. The hips look OK. The major symptom is severe cramps/pain in my right leg -- nerves are being pinched. My calf is constantly painful from being beaten up by the spasms. Sleep is interrupted with extreme pain when I turn the wrong way. The first right step in the morning can really hurt. Chiropractic helped with temporary relief. I'm scheduled for PT next week.

What can be done medically to lower my level of misery?
Submitted: 3 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 3 years ago.

Greetings.

 

Following measures would be helpful in pinched nerves in the back due to arthritis;

 

1) Back care in the activities of daily living;

a) Avoid activities which increases the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor

 

2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants

 

3) Local analgesic gels or sprays / ointment

 

4) Hot fomentation

 

5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

 

6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

 

7) Lumbosacral corset or support or brace

 

8) If obese or over weight, reduce weight for long term benefit.

 

9) Epidural steroid shots

 

10) Surgery is usually last resort, when the above conservative measures fail.

 

You can start the following exercises;

 

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

 

2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

 

This is a slide show for the exercises (you can pick up your own set, which suits you);

 

http://www.mayoclinic.com/health/back-pain/LB00001_D

 

You can consult following specialists (apart from your GP);

 

a) Orthopedist

b) MD in Physical medicine and rehabilitation

 

Please feel free for your follow up questions.

 

I would be happy to assist you further, if you need any more information.

 

Dr. Arun

Customer: replied 3 years ago.
Thanks for your response, Dr. Arun.

The medical side could use some help. I have the following in my medicinal aramentarium: Celebrerx 200 mg caps; oxycodone 5 mg tabs; cyclobenzaprine 5 mg tabs; and gabapentin 300 mg caps. I use Tylenol ER 2x650mg tabs tid.

What would be the optimal dose schedule for these drugs? Are they the correct drugs to be using for the arthritis?

Note on oxycodone: I was doing just fine with Darvon 65mg caps qid for neck pain, naseua, and headache from arthritis in my upper spine. When the FDA banned Darvon, I was switched to oxycodone 5 mg tabs qid. The drug was presented to me as 3x more powerful than Darvon, In my opinion, it's 3x less powerful than Darvon.
Expert:  Dr. Arun Phophalia replied 3 years ago.

You are very welcome.

 

These are correct medications for the arthritis. A correct schedule is absolutely individual as is dependent on the pain intensity. I agree that pain in some people do not respond well to oxycodone, compared to Darvon. Your physician may consider increasing the dose of Oxycodone.

 

It is privilege assisting you.

 

Dr. Arun

Customer: replied 3 years ago.
Thanks again, Dr. Arun.

Would codiene be a reasonable alternative to oxycodone? From dentstry, I learned that codiene sulfate does little for pain in the mouth but works terrifically on my neck and headache.

Leaving out the oxyconone, my schedule for the other drugs is:cyclobenzaprine one 5mg tab tid and gabapentin one 300 mg cap tid. Both these drugs are new to me and seem very helpful. Would you recommend increasing these doses? I ask only because today's phone call to the primary is still unanswered.


Expert:  Dr. Arun Phophalia replied 3 years ago.

You are very welcome.

 

Gabapentin dose can be increased gradually and a dose of up to 1800 mg per day in three divided doses can be given. For most patients, the recommended dose of cyclobenzaprine is 5 mg three times a day. Based on individual patient response, the dose may be increased to 10 mg three times a day. Codeine is good alternative to oxycodone and you may discuss this option with your doctor.

 

Dr. Arun

Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29796
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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