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Hi Dr. F
1) What other medical problems do you have? I take low dosage of medication for blood pressure and cholesterol. I have peripheral myopothy(sp?). I have had a L-L4,5 decompression without effect.
2)What medication are you taking 2200 mg of? Ibuprofen 600 mg x 2/da: Vicodin 500 mg x 2/da.
3) Have you had an EMG? No, if that means electromyogram.
if your pain was strictly in the lateral thigh, I would suggest that you had lateral femoral cutaneous nerve syndrome, meralgia paresthetica.
WIth back pain, and no relief from decompressive surgery, plus normal scans, a peripheral neuropathy seems the most likely cause. This pain will not be well treated by Vicodan. Better drugs include neurontin and Lyrica which work at the membrane level of the nerve to prevent pain signaling. .
In someone without diabetes, the cause of the neuropathy should be sought, but may not be found. Testing should include thyroid and B12 levels, and liver and kidney function tests.
If this answer is giving you the information you are looking for, please let me know, and I will conclude, or change focus...depending on your response.
Blood work has come back normal including thyroid and B12 levels, and liver and kidney function tests.
Would you please expand on peripheral neuropathy. What it is and how would it cause pain in the groin and numbness in the leg.
Thank you for your response.
The concrete way to think of a peripheral neuropathy is to realize that the nerves are electro/chemical in function. Certain conditions, such as diabetes, affect the insulation of the system (demyelination) resulting in signal malfunction...which is pain , numbness, and in some cases weakness. The problems depend on which nerves are affected. Nerves which supply sensory information to the body, such as pain , temp position,etc, are thinner, and more vulnerable to injury, compared to nerves that supply motor movement. Therefore, an affected nerve can be anywhere, including leg and groin
We do not have any good ways to "undo" nerve injury. Sometimes treating an underlying problem like kidney or liver failure, a vitamin deficiency or diabetes, will make things better, or at least keep them from getting worse.
It is important, as you have had done, to look for treatable things like lumbar disc compression or spinal stenosis, to try to help the nerves recover.
Sometimes, as part of the evaluation, the physician will do an EMG, or a nerve biopsy, to look for causes and to document extent of effect, although these are not essential to the diagnosis.
In the end, treatment is symptomatic as I described before, if nothing "fixable" can be found. Sometimes, an immune therapy of IVIG is used, but this has associated risks, and I would reserve it for individuals who are becoming incapacitated
I hope t his information helps you
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I have seen nine doctors of various specialites all of them are, as my primary care doctors says, "not smart enough to understand the problem". We are now in a "pain killer" mode. Can you think of any further approach that I could take to study the problem or make me more able to do normal tasks or whom to see next?
Thanks so much for your insight!
The good news is that these doctors have done the right things to find the fixable problems.
The next step is pain management and functional recovery. I am a big believer in Physical Medicine and Rehab physicians, as their focus is on making the most of what you have, and getting the right therapy and medication to get you in the best functional condition
I hope that helps