Q. My mom has severe back pain that radiates up to toes. Please suggest a solution.

Answered by
Dr. Anuj Gupta
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jul 30, 2020

Hello doctor,

My mother is suffering from back pain. I have taken MRI by consulting a doctor. Can I get the best suggestion for this problem?

MRI impressions:

1. Spondylolysis of L5 vertebra.

2. Bulging L5-S1 disc with central protrusion, small osteophytes, hypertrophy of facets causing indentation on theca, encroachment of neural foramen.

3. Bulging L5-S1 disc causing mild impingement on theca, encroachment of neural foramen.



Welcome to icliniq.com.

Well, first of all you have given incomplete information. Tell me if her back pain also goes to any of the lower limbs? How much distance she is able to walk in one go? Please tell what all medications she is taking? I cannot understand anything written by your doctor (attachment removed to protect patient identity).

Also, it will be my advice to book a video consultation of mine because the treatment procedure is quite lengthy and I have to explain to you all the available options.

Thank you doctor,

My mother is suffering from back pain and it goes to the right lower limb until toes. She is able to walk only for 5 minutes and later on suffering from pain and unable to sit for more than 10 minutes. For two days, she is getting swelling in her legs.

Medicines used by her at present are Gabapentin, Methylcobalamin and Nortriptyline tablets in the night, Enteric-coated Rabeprazole sodium with Domperidone SR capsules in the morning, and Aceclofenac, Paracetamol, Chlorzoxazone tablets daily morning and evening.



Welcome back to icliniq.com.

Well, she has lumbar canal stenosis. So what happened in this is, there is a decreased diameter of spinal canal due to which she is not able to walk for more than 5 minutes.

Now, considering her walking time, she needs surgery because 5 minutes is very less and this signifies that compression is severe. But, we can give her a fair trial of conservative management. If she responds, then it is good. If not, then you will have a satisfaction that everything has been tried now.

So, coming to the medication part.

1. There are three kinds of drugs that are given in this condition. All three drugs have different maximum dose and we titrate the dose accordingly. Which means, we increase the dose gradually. So you have to be in regular follow-up with me.

2. Stop Nortrytiline and make tablet Gabapentin 300 mg twice a day.

3. Do not take Aceclofenac and chlorzoxazone for a long as they can be harmful to the kidney.

4. Get TENS (transcutaneous electrical nerve therapy) therapy done for two weeks from nearby physiotherapists.

Ask her to walk frequently as much as she can. Walking will improve the strength of her back muscles.

Please contact me after three days. If no relief, then we will increase the dose further.

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