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I have chronic lower back pain. I had tow surgeries and is…

Customer Question
I have chronic lower...

I have chronic lower back pain. I had tow surgeries and is still the same

Doctor's Assistant: Have you had any recent injuries? What seems to make the pain better or worse?

No. and nothing make the pain go away

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

They are suggesting a spinal cord stimulant

Submitted: 8 months ago.Category: Medical
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Answered in 3 minutes by:
12/9/2017
Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago
Dr. Arun Phophalia
Category: Medical
Satisfied Customers: 39,064
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer, or further information request.

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Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago

What is your age and gender?

What treatment have you done for chronic lower back pain?

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Customer reply replied 8 months ago
81 male
Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago

Thanks for the additional information. I am writing the answer for you and will get back to you in 4-5 minutes. If you get a phone call request, you may ignore it as that is an automated site trigger. Thank you.

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Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago

Following measures would be helpful;

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

Was this information helpful to you? I would be glad to answer any further questions.

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Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago

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.

4) Sympathetic blocks

5) Bier block (intravenous regional block)

6) Continuous epidural infusion

7) Spinal cord stimulator

8) Baclofen pump; Intrathecal infusion (Intrathecal bupivacaine infusion or Morphine pump are the other alternatives)

9) Sympathectomy; Surgical sympathectomy (Endoscopic cervicothoracic sympathectomy) or Chemical sympathectomy or Radiofrequency or cryoprobe lesioning should be considered.

10) Acupuncture

11) Relaxation techniques; associated with the above treatment.

12) Biofeedback training

You need to consult following specialists;

a) Pain management physician

b) MD in physical medicine and rehabilitation.

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Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago

Was this information helpful to you? I would be glad to answer any further questions.

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

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The rating button is on the left upper side of this thread.

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Wishing you all the very best in life.

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