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Jef Burk
Jef Burk, Doctor
Category: Medical
Satisfied Customers: 2639
Experience:  MBBS. I've been teaching,practicing and learning since 1985.
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Mild degenerative disc change is noted at L4-5. There is evidence

Customer Question

Mild degenerative disc change is noted at L4-5. There is evidence of previous surgery in the right side of L4-5. The previously noted right sided disc bulging is no longer present. There is some scar tissue which enhances around the right side of the thecal sac and the lateral recess. What are my options as I have worse pain now than before the surgery.
Submitted: 6 years ago.
Category: Medical
Expert:  Jef Burk replied 6 years ago.

Hi

 

Where is your pain?

 

Clearly there are no surgical solutions.

 

Dr Jef

Customer: replied 6 years ago.
The pain is still in the L4-5 region deep pain
Expert:  Jef Burk replied 6 years ago.

Hi

 

Never root pain - disappointing that it has not responded to the Lyrica.

 

Can you clarify " 150mg define" for me?

 

Dr Jef

Customer: replied 6 years ago.
2 Capsules of difene(diclofenac sodium) 75mg each dual release. One in the morning and one in the evening
Expert:  Jef Burk replied 6 years ago.

Thanks

 

Have you tried a strong opiate to see if you pain is opiate responsive?

 

Dr Jef

Customer: replied 6 years ago.
I am allergic to morphine and codeine. But you have not answered what the results of the mri scan mean. I need it explained please
Expert:  Jef Burk replied 6 years ago.

Hi

 

Sorry - I did not appreciate that you wanted the MRI interpreted.

 

Some osteo-arthritis between the L4/L5 vertebrae.

 

The rest of the scan is as you would expect post op - just some scar tissue around the lining of the spinal column on the right at the level of the L4/L5 disc.

 

Dr Jef

Customer: replied 6 years ago.
So what are my options as in my original question? Will I need futher surgery or is there some other method of relieving the pain caused by the scar tissue?
Expert:  Jef Burk replied 6 years ago.
Hi

Sorry for the delay in getting back to you - as a busy physician I am not always on-line.

You have several options to consider.

1.trial of opiate - some nerve root pains will respond - ie to morphine , oxycodone

2.TENS machine

3.lidociane patches

4.nerve root block - this can provide some relief - but is usually only temporary - a caudal block will only hit your sacral roots so is not an option

5.venlafaxine/duloxetine - these are SNRI type antidepressants but are of use in chronic pain

6. if your pain is considered to be related to the scar tissue then epiduroscopy can be considered - it is highly specialized - I will post a link about this

To be short you should attend a specialist pain clinic to see if some ( or all ) of these options can be used.

Dr Jef

Please get back to me if you need to.


http://www.painclinic.org/treatment-epiduroscopy.htm
Jef Burk, Doctor
Category: Medical
Satisfied Customers: 2639
Experience: MBBS. I've been teaching,practicing and learning since 1985.
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