Q. Why is back pain persisting despite taking medicines and undergoing physiotherapy?
Hi doctor,
My mother, aged 54, has been suffering from lower back pain for the last two years and is not able to walk or climb stairs. She has the following complaints, numbness, fatigue, depression, low appetite, and always feeling sleepy. She feels like she has less control over her left leg. MRI and X-ray were done earlier, and she took neuropathic painkillers, vitamins and calcium tablets, Gabapin 100 mg tablet, and medicines as per the attached prescription and underwent physiotherapy for this complaint. The condition improved a little, but in the last four to six months, she had the same problem again. We consulted an orthopedician recently, and he suggested doing the tests again and gave me some medicines. He said surgery might be needed to diagnose this. I want to know whether her illness can be cured by taking medicines, therapy, exercise, and without doing any surgery. Please see the attached reports. Also, I request you to please prescribe some medicines to get relief in the interim. I hope to receive your best advice soon.
Hello,
Welcome to icliniq.com.
I thoroughly read your query and understand your concern.
You have mentioned pain in the lower back region, with pain spreading to the legs with associated numbness and weakness as well.
Please tell me the following:
1. What is the intensity of back pain on a scale of one to ten?
2. Is leg pain more or back pain?
3. How much distance can she walk normally?
4. What are the painkiller requirements on a daily basis?
Please send her current neurological charting, including a detailed description of motor and sensory examination of lower limbs. Also, kindly send me the following:
All reports of recent blood tests, X-ray of lumbar spine AP (anteroposterior) and lateral (flexion and extension views), and MRI (magnetic resonance imaging) of the lumbar spine. I need images of these tests because I want to see films and not just reports. Once you have sent me all this information, I can have a look and let you know what needs to be done.
Kindly let me know if you need any further information.
Thanks and regards.
Hello doctor,
Thank you for replying.
As you asked, please find answers.
1. Intensity of back pain on a scale of one to ten is eight, but the pain varies from moderate to a little high.
2. Back pain is more than the leg pain.
3. We live on the second floor with no lift. She finds difficulty going down and climbing on a plane surface. She walks slowly up to 100 to 200 meters and then feels like she cannot walk further.
4. Pain killer requirements on a daily basis would be one tablet in two to three days.
5. Her current neurological charting, including a detailed description of motor and sensory examination of lower limbs, is attached. I tried my best to attach the photos of MRI and X-ray films, some may be repeated, and blood test reports are quite old. Please advice.
Hello,
Welcome back to icliniq.com.
I understand your concern.
I have gone through the investigations sent by you to me and looked at the MRI images (attachments are hidden to protect the patient's identity). I cannot see any significant compression on nerves which correlates with the clinical complaints described by you, although there are insufficient images from the MRI scan. The probable cause of the symptoms can be degenerative disc disease or any medical or neurological pathology. The treatment plan will be conservative for now till a final diagnosis is reached.
Also, you have not sent me any of the following, and a follow-up with all information is required:
1) Flexion and extension views of the lumbar spine and X- rays which were advised by me.
2) There is no detailed motor or sensory charting done by any physical therapist or a doctor by which I can understand what kind of weakness is there in her lower limbs.
3) Also, some other tests need to be done: Nerve conduction studies of both lower limbs because you have mentioned significant weakness in the left leg. Blood tests including serum calcium, serum phosphorus, serum alkaline phosphatase, serum vitamin D and vitamin B 12 levels, KFT (kidney function test), ESR (erythrocyte sedimentation rate), and CRP (C-reactive protein) levels.
Also, I would advise you to consult a good neuro physician as her symptoms could be due to a medical or neurological issue from MRI images sent by you. There is no great compression on the nerves. Once you have compiled all this information and details, kindly get back to me once again so that a final decision can be taken regarding her management.
Thanks and regards.
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