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Q. Please suggest the best remedy for back pain.

Answered by
Dr. Akshay Kumar Saxena
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 10, 2016 and last reviewed on: Apr 17, 2020

Hi doctor,

I have been battling with back pain since a year. I associated this pain with a kidney stone which I had for a couple of years. I had a ureteroscopy, crushing and removal of the stone a month ago, but however the back pain still persists. An x-ray done today is attached. I had some back pain before two years due to herniated disc. I have undergone bariatric surgery for weight loss. My weight today is 113 kg. Five months before, during the gastric bypass surgery my weight was 145 kg. My worry is that I cannot exercise or walk long distances. As soon as I walk for 5-10 minutes the back pain is terrible and I need to either sit and rest the spine or press and stretch my back to get some temporary relief. The pain is quite unbearable. I current taking Ultracet and Myoril 8. Please do suggest the best remedy to enable me to become pain free at the earliest.

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#

Hello,

Welcome to icliniq.com.

I have gone through the investigation reports (attachment removed to protect patient identity).

  • Your blood investigation appears to be fine apart from high CRP (C-reactive protein), which could either be a manifestation of any inflammation or infection somewhere in the body. Also, you are relatively young at 43 years of age.
  • What I need to know from you is, what is the severity of back pain on a scale of 1-10?
  • Apart from the back pain do you have any radiating pain in the legs as well? Do you have any other neurological symptoms like numbness, weakness, or paresthesias in the legs?
  • Your x-ray report shows retrolisthesis of L4- L5 region, which is a potentially unstable area and could be contributing to your back pain.
  • Also, the report mentions the collapse of D11, D12 and L1 levels, which is a bit of a concern in your case as you are very young to have such radiological issues without any previous significant history of injury.
  • I would advise you to get two things done. They are MRI of your dorso-lumbar spine with extension to the lumbosacral junction (LS) and an x-ray LS spine (lateral flexion and extension views) to look for the amount of instability at L4 - L5 level.
  • Since your case is a long standing one, it is advisable to get these investigations done and then send the reports across to me so that I can see and advise you accordingly.

Investigations to be done:

1. MRI of dorso-lumbar spine with extension to LS junction.
2. X-ray LS spine (lateral flexion and extension views) to look for the amount of instability at L4 - L5 level.

Regarding follow up:

Revert back with the investigation reports to a spine health specialist online.---> https://www.icliniq.com/ask-a-doctor-online/spine-health-specialist

Thank you doctor,

Further to my earlier query, please find my MRI report attached.

#

Hi,

Welcome back to icliniq.com.

I have gone through your images (attachment removed to protect patient identity).

  • It does not appear that there is a significant pressure on the nerves. It is getting extremely tedious to actually download each image and then understand the level in the axial view because it is not clear that ways.
  • I will still advise you to send me the file, which I can run on my DICOM software as that is a better way to see the films and also makes a better understanding of the MRI.
  • Also, kindly send your flexion and extension view x-ray.

Revert back with the images to a spine health specialist online --> https://www.icliniq.com/ask-a-doctor-online/spine-health-specialist

Thank you doctor,

I have sent the files as you said for your reference.

#

Hello,

Welcome back to icliniq.com.

I have gone through your MRI images (attachment removed to protect patient identity).

  • Frankly, there is no compression in the spine apart from stenosis at L4/5 level.
  • Also, since you have not mentioned my other questions, it appears that there is no leg pain or any other neurology.
  • There is compression in the spinal vertebrae at the dorso-lumbar junction with some swelling in the bone, but we will monitor it again after a few months and have to see whether you are getting better or not.
  • As I said, I would also like to see your dynamic flexion and extension views so that I can see whether there is any L4 - L5 instability or not.
  • Can you tell me whether there is a previous history of injury to the spine as that can explain the compression at the dorso-lumbar region?
  • Do have any history of prolonged fever, sweating at night, weight loss, etc., as well?
  • I think as of now please start with anti-inflammatory medications. I suggest you tablet Dolonex Rapid (Piroxicam) 20 mg once daily, tablet Myoril (Thiocolchicocide) 8 mg twice a day and tablet Ultracet (combination of Acetaminophen and Tramadol) one tablet thrice a day.
  • Continue with Calcium and vitamin D supplementation as well. Consult your specialist doctor, discuss with him or her and take the medicine with consent.
  • Also, you must start with gentle physical therapy, especially modalities like laser therapy which is supposed to play an important role in such cases.
  • In the event, you do not improve; I will like to get a few blood investigations to rule out an inflammatory pathology and dynamic x-rays.

The Probable causes:

1. Degenerative disc disease.
2. Inflammatory pathology.

Regarding follow up:

Revert back after three weeks to a spine health specialist online.---> https://www.icliniq.com/ask-a-doctor-online/spine-health-specialist


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