The distribution of the pain that you are describing suggests possible irritation of the L4 nerve root in your lower back region. Many times, a problem like that can show up on the MRI, but because it didn't show up in your case doesn't mean this particular problem couldn't still exist. A nerve conduction test can sometimes pick up a problem like nerve root irritation from the lower back.
Another situation to consider would be something called piriformis syndrome. There is a muscle in the buttock region known as the piriformis, and it happens to sit near the sciatic nerve and can sometimes cause similar symptoms to sciatica. The fact that you get most symptomatic when you are sitting could suggest that pressure on this muscle could be a possible source of the pain. This might be another condition to talk to your doctor about as well a potential back problem, which is far more common.View Thread
I suggest that you consult with a neurosurgeon or neurologist to carefully review your symptoms, exam findings, and review the MRI findings that you have shared here. If you need a referral, talk to your primary care doctor about helping set that up for you.View Thread
I gave a talk yesterday to a group of our patients about nerve pain and gabapentin came up as part of the discussion. Interestingly, while many in the room had tried it at some point, most reported similar side effects to what you all have posted here in this discussion. It is my impression from this feedback that doctors may not appreciate the potential for strong side effects that a medication like gabapentin can generate.
There seems to be a need for greater awareness of what is going on in our patients' lives.View Thread
I am sorry about your daughter's struggles with her pain, and no doubt it has had a big impact on her quality of life at such a young age. For patients that have not yet reached adult age, I usually recommend seeking out a comprehensive pain center that specializes in treating children, adolescents, and teenagers. Depending on where you live, finding the right resource can be challenging. Pediatric pain treatment centers can sometimes be found as part of academic medical centers. For example, in my area, the Stanford Medical Center offers an interdisciplinary care team for pediatric patients, and that is where we typically recommend patients your daughter's age seek treatment.
I hope this helps you find impactful help for your daughter.View Thread
Gabapentin has become a very commonly prescribed medication for pain management over the years. Gabapentin is considered to be a first line medication option to use for the treatment of nerve pain problems. Nerve pain, also referred to as neuropathic pain, is usually related to some type of malfunction or injury to the nervous system. Some typical examples of this include shingles, where a virus inflames the nerves causing bad pain, or diabetic neuropathy.
With back problems that involve nerve root irritation or inflammation from something like a herniated disc, gabapentin is a medication option that sometimes gets tried to diminish pain symptoms. To minimize side effects from gabapentin, doctors typically start patients on a low dose and titrate it up slowly over time. It is possible that you could have experienced less in the way of these side effects had you started off on a lower starting dose to give your system some time to acclimate to it. (For example, starting off on 300 mg a day only for the first week or so.) At the same time, some people are much more prone to experiencing side effects from a particular medication than others, and gabapentin may not be a good match for you.View Thread
I often bring up to patients that I treat a recommendation for counseling help and support to help them better manage their situation. Sometimes they are grateful that I offer this type of service and want to get started right away, and other times I get some push back stating that they aren't interested.
One of the biggest reasons that some patients may not want to talk to someone at first is they may feel that the recommendation suggests that we think the problem is somehow "not real" and rather 'all in their head" which I think is a big misunderstanding. Chronic pain problems are very real, and can also be very taxing emotionally on the person in pain as well as the family involved. Learning tools to better cope with this is very valuable, and getting help with communication at home is also very important to a relationship. It may help to let her know that you appreciate how severe her pain is and the medical problems that she is struggling with, and that you want to make sure that she gets all of the help that she needs to feel better.
Certainly, the medications that she is currently taking could be making things worse, and she would benefit from talking to somebody that could objectively explain that to her. The first step is helping her get to a place where she is open to getting help and opening up.View Thread
Making decisions about spine surgery is one of the most confusing things that a patient can go through. In some cases, a person can consult with several different doctors and get a different opinion from each one. I have seen many questions run through a person's head, like "Will I get paralyzed if I don't have the surgery?" I thought I would pass on a few general thoughts on spine surgery for you to consider while navigating your situation:
Overall, we probably do way more spine surgeries in this country than we need to.
Outcome studies on low back pain with aggressive rehabilitation have been just as good.
Consider spinal fusion surgery for a stability problem but don't expect it to be pain cure.
Once you have had one spine surgery, the chances of having more latter goes up.
If there are no neurological emergencies going on, then there shouldn't be a reason to rush into anything.
I wouldn't think of spine surgery as a way to get the problem "fixed." Us humans are way more complicated than machines, and nobody can reverse age-related changes.
When making a decision, find a doctor who considers the whole person and not just the x-rays and MRIs when making recommendations.
When making a decision about something invasive, consider not only the immediate effects of the treatment but also the long-term outcomes and effects. This too often gets overlooked.
There are many different ways to improve pain management beyond surgery and medications. Try to consider all of your options.
I commonly see patients who were treated by a different doctor prior to seeing me. Most doctors are accustomed to seeing patients want to get different opinions or try different practices. Certainly, you want the new doctor that you are consulting or treating with to know as much about you as possible, including your history of past treatments and tests. You will likely need to sign a release form for your prior pain management doctor to send your records to the new one. If you feel embarrassed about this (but trust me most doctors' offices get used to this) it is possible that your primary care doctor has copies of these records and their office could send them to the new doctor's office, instead.
I think if you do some research on the new doctor and let him/her know why you want to work with him/her, then the new doctor will not only feel flattered but will have a better sense of direction of how to best help you. In other words make it more about why you are picking the new person and less about why you are leaving the old one to create a more collaborative working relationship. Good luck!View Thread
I know it can be really frustrating when you cannot find a physician who shares your philosophy about treatment or management, I thought it might help if I tried to explain some of the science behind why they may be recommending that you go in a different direction from continued opiate therapy.
Outcome-based studies generally don't recommend the use of opiates for the treatment of migraine headaches due to a lack of demonstrated efficacy. In addition, pain medications are now considered to be a major contributor of headaches, and this is sometimes referred to as rebound headaches.
What research has found is that the nerves in our brains are surrounded by these white cells known as glial cells, and they make up what is known as the "white matter" in the brain. Studies on migraine headaches have show that these glial cells release pro-inflammatory mediators that seem to be associated with the headache experience. Narcotic-based medications also cause the same activation of glial cells into inflammation-mode that is seen during migraines, and therefore may potentially aggravate the problem in the long-term. This may also explain some of the limitations of using opiates with other chronic pain problems. Research is being done to find ways to block this activation on the glial cells with the hope of making pain killers more effective in the future.
Again, I know your situation is very frustrating, but your doctors' recommendations may be based on some of these newer findings and recommendations and don't necessarily mean that they don't trust you or want to try to help you.View Thread