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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31594
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I had an MRI back in July 2015 because of back pain and pain

Customer Question

Hi, My name is ***** ***** I had an MRI back in July 2015 because of back pain and pain and burning etc down front of left leg and at times right leg. The back pain and leg pain has become a lot worse in recent months perhaps not helped by having to get around in a moon boot with 2 fractures in ankle. Although ankle much better I find pain in the back MUCH worse and also leg pain that all means difficulty getting dressed and just plain difficult to get around and do everyday chores. Fortunately I am retired. I am 56.Oh, also the last 6-8 weeks I have been on Lyrica. Started on 25mg which did nothing and gradually I have progressed to now taking 450mg in one day and still have a fair bit of pain. I will give you the Conclusions reached from MRI.
1. Multi-level degenerative degenerative discogenic disease of the lumbar spine, most prominent at L2/3.
2. S-shaped thoracolumbar scoliosis.
3. Multi-factorial mild L2/3 central canal stenosis.
4. Possible contact of the exiting right L4 n
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello and welcome,

Let me first give you treatment plan for the pain;

Following should be integrated in your management;

1) Physical therapy and occupational therapy, plays an important role in functional restoration. The goal is to increase strength and flexibility gradually.

2) Recreational therapy; take part in pleasurable activities that help to decrease pain.

3) Vocational therapy; provide work capacities and targeted work hardening, and one may return to gainful employment.

4) Acupuncture

5) Relaxation techniques; associated with the above treatment.

6) Biofeedback training

You need to consult following specialists;

a) Pain management physician

b) MD in physical medicine and rehabilitation.

This is my initial answer. I am writing you further detail,, so please wait as I am typing further response.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Following measures would be helpful for your back issue;

1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

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) Neurologist

c) MD in Physical medicine and rehabilitation.

Expert:  Dr. Arun Phophalia replied 1 year ago.

The helpful herbs for chronic pain are;

1) Willow bark
2)
Devil's Claw
3)
Feverfew
4)
St. John's wort
5) Valerian
6)
Boswellia
7)
Curcumin
8) Ginger extract

You can take Rhus Tox 30, 2 globules, three times a day as an homeopathy treatment.

Supplements and alternative integrative therapy protocols for pain relief are;

1) Evening primrose oil

2) Acetyl-l-carnitine

3) Alpha-lipoic acid

4) Benfotiamine (Milgamma), 100 mg, is a lipid-soluble vitamin B1 analogue

5) Vitamin E

6) Acupuncture

7) Yoga

8) Prolotherapy

Commonly used medications are;

1) amitriptyline (Elavil, Endep),

2) nortriptyline (Aventyl, Pamelor)

3) desipramine (Norpramin)

4) pregabalin (Lyrica)

5) phenytoin (Dilantin)

6) carbamazepine (Tegretol)

7) venlafaxine (Effexor)

8) duloxetine (Cymbalta).

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

Please consider a positive rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work. You are not charged again for giving a rating.

Thank you.

Wishing you all the very best in life.

Expert:  Dr Chaithanya replied 1 year ago.

Thank you.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Please let me know how it goes and please do not forget to rate the interaction

Expert:  Dr Chaithanya replied 1 year ago.

.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited for my work.

Now, I will provide an Additional Service offer so that you have this option available on your question list to get a hold of me directly in the future.

This additional service offer can be used for

- if you would like to schedule a new, private email session or to ask me directly a new question. It's up to you.

Thank you.

Expert:  Dr. Arun Phophalia replied 1 year ago.

I would appreciate the 5 stars (excellent)!

Expert:  Dr Chaithanya replied 1 year ago.

Thank you.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Let me know how you are doing?

Please feel free to ask, if you have any unanswered questions.

Expert:  Dr. Arun Phophalia replied 1 year ago.

I would appreciate a positive rating as this is the only way we are credited and paid for the time and work.

Let me know if you need any further information or clarification.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited for my work.

Now, I will provide an Additional Service offer so that you have this option available on your question list to get a hold of me directly in the future.

This additional service offer can be used for

- if you would like to schedule a new, private email session or to ask me directly a new question. It's up to you.

Thank you.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Hope you are doing good.

Please let me know if I can do anything more for you.

Thank you.

Regards,

Expert:  Dr. Arun Phophalia replied 1 year ago.

Hope things are very good for you.

Let me know if I can assist you further.

Please consider a positive rating.

Expert:  Dr. Arun Phophalia replied 11 months ago.

Wishing you a very happy, healthy and prosperous new year 2016.