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Severe pain on right side of hip radiating down the leg

Severe pain in right side...

Severe pain in right side of hip radiating down leg and into foot. It hurts to stand, walk, sit or lie down. I've had it for several weeks & have used heat, ice, muscle rub-ons & patches. I regularly take 1 Percocet per night for Neuropathy in feet, but it does nothing for this pain. I also have a muscle relaxatant on hand if I need it, but it hasn't helped with this. It is a real deep pain & has a burning pain to it too. Thank you

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Answered in 3 hours by:
7/26/2012
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,811
Experience: American Board Certified Neurologist, Internal Medicine
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Hi,

Your leg symptoms appear to be secondary to what we call as lumbar radiculopathy, which is pinched or irritated spinal nerves in the lumbar spine area (if back pain is present then it further strengthens the above possibility, but if back pain is absent it does not rule out this possibility because back pain may or may not be always present). The pinching or irritation of the spinal nerves result secondary to arthritis/bone suprs, disc bulges, disc herniation, spinal stenosis, or slipping of the vertebra in the spine etc. Another condition that can mimic pinched or irritated spinal nerves in the lumbar spine is sciatic nerve injury and this injury occurs outside the spine, usually in the hip or buttock area.

If the diagnosis has not already finalized in you then you need a test by name EMG/Nerve conduction study (a nerve & muscle test) of the leg & lower back along with an MRI of the lumbar spine/hip/buttock area. The EMG test will help exploring the possibility of the pinched spinal nerve or sciatic nerve injury, whereas the MRI will help in identifying the pathology in the lumbar spine or hip/buttock area that may be causing the pinching of the spinal nerves or the sciatic nerve injury.

The treatment options for your condition are grouped under 2 categories as below;

1) Conservative (non-surgical) treatments

2) Surgical treatments

The conservative treatment options are generally tried first and such conservative treatment options include as below;

Physical therapy

Nerve- pain pills like gabapentin, pregabalin, amitriptyline

Muscle relaxants like baclofen or tizanidine

Anti inflammatory pain meds like tramadol, diclofenac etc

Lidocaine anesthetic skin patches to the painful areas

Opioid (narcotic) pain killers

Electrotherapy including TENS (Transcutaneous Electric Nerve Stimulation)

Diathermy

ESI (Epidural steroid injections)

Massage

Laser therapy

RF (pulsed or continuous Radio Frequency ablation)

Acupuncture

SMT (Spinal Manipulative Therapy)

IDD therapy (Intervertebral Differential Dynamics Therapy - which is a specialized spinal decompression therapy)

Perineural etanarcept

PRP (platelet rich plasma) therapy etc

I see that you already have tried some of these above options like narcotics, patches, muscle relaxants etc, so you may consider the other options mentioned above that you haven't tried already. The above treatments can be arranged through a pain specialist, and some of these above treatments are available through a chiropractor too.

Also avoid excessive especially strenuous physical activities that involve the spine including twisting, bending the spine, lifting heavy weights, jogging, running especially long distance etc because all these activities can burden the spine further.

If the above conservative treatments fail then surgical treatments are considered too, however surgery is generally avoided as long as possible and tried only if the above mentioned conservative treatments fail.

Please ask me if you have any further questions.

Best regards,

Dr Sathya.

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Customer reply replied 5 years ago

Should I consult a Nerologist or go back to the back doctor I consulted in 2006? At that time he said there wasn't any more he could do for me. I injured my back in a bad car accident in 1960 at age 18, so I have dealt with back pain most of my life, but this pain is more severe than usual, so I wondered if it was something new. I haven't done anything that would have injured my back. I have been dealing with Gastroparesis for the past 3 1/2 years with a lot of throwing up. Would that have any effect? I have had to spend a lot of time down in bed.

Thank you

Since you are recently having more pain than usual we need to rule out any new conditions causing the worsening of your symptoms so you may see a neurologist because you now need a thorough clinical evaluation/examination followed by investigations like MRI & EMG tests to find out the exact cause for your symptoms. Injury or traumas are not always necessary for these conditions (pinched spinal nerves or sciatic nerve injuries) to develop, spontaneous disc or nerve injuries can develop too. Also you may be developing arthritis and it is not always injury related, and the arthritis can cause nerve or spinal nerve root injuries. The above investigations will tell us exactly what kind of nerve injuries you have and what is causing these injuries (disc, arthritis etc) and once a definitive diagnosis is made appropriate treatment will be started and in the meantime you may try one or more of the symptomatic treatments I mentioned above. And although gastroparesis may not have any direct effect on your these symptoms however that you are in the bed most often and not getting adequate exercise might also be contributing to the worsening of your symptoms, so if possible try to do some exercises/physical therapy etc and this also might help in relieving your bothersome pain.

Please ask if you have any further questions.

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,811
Experience: American Board Certified Neurologist, Internal Medicine
Verified
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