I sustained some kind of serious injury to my lower back in January 2009. It occurred as a result of my having SEVERELY OVERSTRETCHING every muscle group in my body, via floor exercises. I twisted, pulled, held positions to the nth degree. I did this as I had cold turkeyed off of 4mgs of Klonopin. I had NO feeling in ANY muscle for nearly 5 months. ALL of my muscles were completely RIGID. I kept overstretching (and about 5-10 times a day) with the hopes that it would help me get a return of feeling. I was in an acutely agitated state for all of those months. I, as well, started walking with my working up to 10 miles of beach walking about 5 times a week. Ever since the pain hit me, (while walking on the beach sometime in mid-January 2009), I have had debilitating pain. I have had numerous MRI's, C-Scans and x-rays. I have had nerve blocks and epidural injections. I have tried acupuncture, massage and physical therapy, and chiropractic treatments. ALL HAVE INTENSIFIED MY PAIN! I have tried opiates/opioids and muscle relaxants. ALL INCREASE MY PAIN! I have been told that I have bulging discs (L2-S1) and bone spurs. (I, just recently, learned that I have bone spurs). I have been told that the bulging discs should not be causing me to have the EXCRUCIATING pain that I currently have. The pain just keeps increasing. I can barely walk or move. I would like to know if I have permanently damaged my lower back, right buttock, and right hip (permanent nerve or muscle damage). I would like to know if it would be advisable for me to see an orthopedist (the one specialist who I have not seen). I would like to know if all of this is not only from damaging tissue/nerves/tendons but from benzodiazepine withdrawal itself. I did reinstate Klonopin. I have been tapering off of it since October 2009. I am stuck at 2mgs, being too afraid to go lower. Withdrawal or being in "tolerance" causes me to experience extreme terror. Tension and anxiety then follow and then I am hit hard with the pain. Thank you! JudyP.S. I have sat at a computer for up to 14 hours per day since May 2008. I sit in a very strange position. I have my right leg curled under me, placed on my computer chair. My left leg also sits on my computer chair with my knee being bent. I am pretty darn sure that this puts enormous pressure on the affected areas and, thus, causes a repetitive injury. I, as well, worked as a computer tech for five years (2003 - 2008), sitting the very same way. Additionally, I know that I had pain prior to my cold-turkeying off of Klonopin and in my lower back. It seems that I have exacerbated whatever the original injury was (and I think it was a diving accident that occurred sometime in 1976!!!!!! - JS -
I have already denoted treatment methods I have tried.
Hi there. I'm sorry that you are having back pain.
I guess you are not online anymore.
It sounds like you are in a lot of pain and have a complicated issue. I would be happy to help you work through this but it will probably take some back and forth between us to get some good answers and solutions for you.
How old are you? How active are you? Are you otherwise healthy? Did you ever get a diagnosis from a doctor about any specific injury? It sounds like you had MRI, CT, XR and injections. What exactly were these for? Did you have a fracture? You mention some bulging discs, but was the pain you had attributable to them?
Who prescribed the Klonopin and what was the diagnosis for it?
If you had a severe back injury with fracture or disk herniation then you could have weakness and pain to the lower extremities. If there is no "real" pathology found on all of the imaging then one option is that you have what is called complex regional pain syndrome. Please Google it and see if it sounds like some of the symptoms you are having.
In this syndrome, the threshold for pain get significantly lowered in a person, usually due to an accident, injury, or trauma. Essentially your nervous system gets activated so that normal things cause severe pain that should not.
It is a diagnosis of exclusion, meaning if you have a lot of pain without any anatomical findings or pathology to explain them then that is what could be going on.
Why don't you tell me more and then I will check back later tonight to follow up. Thanks.
I am so appreciative of your responses and of the information that you provided.
Today is NOT the day for me to be asking you additional questions as I am experiencing great pain.
I do want to have additional communication with you.
I do have one question for you: do you know about benzodiazepine withdrawal?
I also apologize that you received two emails from me. I meant for the second one to go to a psychiatrist. I am not sure why you received both of them.
Please do tell me if you are WELL-ACQUAINTED with "benzodiazepine withdrawal".
I did do a Google search to obtain more information about "Complex Regional Pain Syndrome". It very well could be the condition that I have; but, I am not at all certain.
I am 60. I am completely INACTIVE. Have no other health problems. I have had the diagnoses of sciatica, soft tissue injury, sacroilitis, bulging discs, and bone spurs. The diagnostic tests were done to try to ascertain why I have such severe pain. I was told that the bulging discs should NOT be causing me this much pain. Klonopin was prescribed for Panic Disorder.
I will write more to you at some other point in time.
Again, I thank you for your most informative reply!
Hi Judy - Thanks for your accept. I am not an expert of benzo withdrawal. Sorry about that I do Orthopedics. When you feel better just message me and we can continue to try and get you the answers you need. It sounds like you never had a diagnosis that explained all of your symptoms. So in that case I do not think that complex regional pain syndrome is a distinct possibility.
I usually get online once or twice a day. If you don't hear from me right away please don't get offended. It's the busy life of a doctor but I do try and help people online when I can. Thanks.
You are welcome, OrthosportDoc!
I certainly can understand how busy you are.
So, you are saying that you DO NOT think that I have Complex Regional Pain Syndrome?
Thanks for informing me that you do NOT know about "benzo withdrawal".
I'll be writing more another time.
Hi Judy - I can't say for certain whether you have CRPS. However, the hallmark of that condition is severe pain that is not explainable by any pathology. Meaning that all of the studies and imaging do not show an injury or lesion that would explain the pain. It sounds like you have an several invasive treatments such as spinal injections and nerve block that have not relieved your pain as well as noninvasive treatments such as PT, chiropractor, accupuncture, and massage. I think it iwould be important to see someone who specializes in this diagnosis.
That doctor may be a pain management specialist or a physical medicine and rehabilitation specialist. Additionally, it sounds like you have not seen an Ortho doctor to get a real diagnosis. The longer you go without finding out answers to these questions, I think the longer this will continue to bother you unresolved.
Good luck to you. You know where to find me. Thanks.
You have hit the nail on the head on all accounts, Ortho!
Would you please explain to me what a rehabilitation specialist is? Do they have other titles?
As a result of the advice that you have given me, I am going to be arranging to see a neurologist (not a neurosurgeon) so that I can be tested to see if I have nerve damage and to learn what can be done about it, if I do. I, also, am going to arrange to be seen by an orthopedist. Additionally, once I learn from you what a rehabilitation specialist is, I will work on trying to find one and to be seen by one.
Ah, just re-read what you wrote. You explained that a doctor who might be able to determine if I have CRPS would be a pain management specialist, physical medicine specialist, or a rehabilitation specialist. I have no idea what a physical medicine specialist is.
I do want to share some additional information with you. It is my belief that my having sat in an awkward way at my computer for four years has resulted in my re-injuring my original injury. I have been too afraid to MOVE, as the pain is so excruciating. I would like to know if I were to start walking (short distances) if this would help or hurt any damage that might exist. As most of my pain is muscular and nerve pain, what do you think? Would I just be exacerbating my condition if I started walking? I have done minimal, very minimal walking for nearly four years. It terrifies me to walk and to feel increased pain after I have done so. Is there a possibility that walking would strengthen my back and, in time, cause me to have less pain?
Please know that I am SO VERY APPRECIATIVE of your communications, your putting much thought into what might be the cause of my pain, and for all of the most knowledgeable information/advice that you have provided me. After you answer the questions I have asked in this communique, I believe our "online relationship" will come to a close. I will, however, (after seeing the specialists I have named), get back in touch with you and let you know what was discerned.
I don't know how much you get paid for your services. I hope that it is a very fair and reasonable amount. The service that you have provided for me has been invaluable.
After I next hear from you, I will hit the ACCEPT button!
I thank you, again, for having spent a great deal of your time communicating with me. You've no idea how helpful you have been!
Your office patients have to receiving GREAT benefit from you. It sounds to me like you are the type of doctor who listens, gives time to your patients, and who REALLY cares about them.
They are most fortunate to have you as their orthopedist or orthopedic surgeon!
Until the next time.......
Be well and keep doing a fantastic job with all who you help!
Judith E. Schrag
I am ACCEPTING. Does this mean that I will not hear from you again (see above questions)? I'd like to know your opinion about my attempting walking.
Thanks, again, so VERY much for EVERYTHING!
Hi Judy - a physical medicine and rehab physician (PM&R) is a doctor who specializes in people with chronic injuries or disabilities. They can treat patients with varied problems such as disability from a stroke to chronic pain. Within the PM&R specialty there are physicians with an interest in physical disability vs some with interest in pain. If indeed you have CPRS then walking would actually be good to start. It would likely not damage or worsen anything that is going on. Part of recovering from chronic pain or CPRS is to get your body used to a higher amount of activity with minimal pain. Usually people get some relief after they have built up some tolerance to basic activities such as walking and yes I do believe it will help strengthen your back.Thank you for accepting. I don't answer questions online for the money but I guess I feel that there is a problem in the medical system that some people need answers right away or have urgent problems and can't afford or don't have the means to wait 4 to 6 weeks to see a specialist, so I try to help. You can always reach me in the future by clicking on the question history and on my username or by simply putting into the title of a new question "For Orthosportsdoc Only" Thanks and good luck to you.
I am not sure, OrthoSportsDoc, if I can still correspond with you. I very confused about JUSTANSWER's "subscription plan" vs. their "free trial". I hope that you receive this, my final email to you.Thank you for explaining why walking would be helpful, not harmful, for me!!!!!It was a delight for me to have had you tell me that you don't help people who come to JUSTANSWER for the money, rather, simply to be of help to those who need an immediate answer or to those who cannot afford medical care, etc. You are a rarity! I wish that you were located in the State of Florida. I'd make an appointment with you!Also, thank you for explaining to me what a PM&R specialist is. I am now combing the internet to find one who practices in my area.Thank you for you well wishes!You have been GREAT! I have no words to express how much I respect you and how greatly I appreciate all the assistance that you have provided me.May many more people find you here at JUSTANSWER and benefit from you kind, caring, and knowledgeable answers.Respectfully,Judith E. Schrag
Thanks Judy. If you need to reach me in the future you can submit a new question with the title "For Orthosportsdoc Only" Thanks!