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HomeAnswersNeurologymri cervical spineHow to treat horrible pain in my neck and lower back area?

How to manage horrible pain in my neck and lower back region?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At December 22, 2022
Reviewed AtOctober 10, 2023

Patient's Query

Hi doctor,

I am having symptoms that exist with the following. Muscles pull against each other in my neck and lower spine. I have tension running up my head from the neck and down my left arm. I have horrible pain in the flanks and sciatica down both legs and lower back.

The doctor prescribed Gabapentin 300 mg, Baclofen 10 mg daily, Tramadol 50 mg two to eight times a day, and iron supplements. Furomiside 20 mg a day. Tizanidine one to three at night.

The following MRI report on my neck.

MRI cervical spine findings,

Sagittal T1W and T2W and T2W spin echo and T2 W gradient echo images were obtained.

  • The sagittal images show normal alignment, but there is some loss of the normal cervical lordosis, and the vertebral bodies all look normal. There is no abnormal signal in the cervical cord.
  • At C5-C6, there is a minor loss of disk height and disc bulges posteriorly. There is a minor canal narrowing here, but the cord is not compressed. There is also some narrowing on the left C6 exit foramen, and there may be very early compression of the exiting nerve root. The right C6 exit foramen looks normal.

At all other levels, normal appearances are demonstrated.

Conclusion.

There is a broad-based bulge of C5 and C6, which I suspect slightly compresses the left C6 nerve root. No cause is demonstrated for the right-sided symptoms, however.

My Lower back image results are as follows.

MRI spinal Lumbarsacral.

Technique routine multiplanar, multisequence imaging of the lumbar spine, including a sagittal STIR sequence.

  • Comparison made with the previous study; there is a previous left laminotomy and microdiscectomy at L4L5, and a broad left L5 transverse process articulates with the S1 segment alar.
  • Normal vertebrae body heights and alignments, at L4L5, there is a disc height loss and posterior broad discus protrusion. This is prominent on the right and left paracentral aspects; on the right side, the bulging is no different from the previous, causing mild right L5 neural impingements at the lateral recess. The disc bulging at the left paracentral aspect abuts the left L5 nerve, and there is also no difference to previous no perineural fibrosis.
  • There is minor disc dehydration at the other lumber levels but no focal neural impingement. The pars interarticularis is intact. Normal terminal cord and cauda equina.

Conclusion.

  • No significant interval change of the broad posterior disc bulging at L4L5 prominence at the right paracentral aspect causing mild impingement of the right L5 nerve in the lateral recess disc abuts the left L5 nerve at the lateral recess.

So my question is, what does all this mean, and what are my options, cause I am in horrible pain every single solitary day, and this has been going on well over the last two years with the lower back.

Answered by Dr. Aida Abaz Quka

Hello,

Welcome to icliniq.com.

I understand your concern.

Your cervical and lumbar spine MRI (magnetic resonance imaging) reports indicate chronic spine degeneration. There is no indication for surgery. I would not suggest taking Tramadol and Baclofen for a long time, as they can cause addiction and tolerance if taken for a long time. I would suggest increasing the dose of Gabapentin up to 2100 mg daily (seven tablets) and performing a lot of physiotherapies. Another option would be Amitriptyline.

I hope you find it helpful.

Kind regards.

Patient's Query

Hi doctor,

They gave me 2400 mg and 900 milligrams of Gabapentin, so I am on 3100 mg already. I have done physiotherapy, I have done acupuncture, and I have done a chiropractor, and I have had numerous epidural injections. None of this explains why I am constantly tremoring on the left-hand side of my body.

Answered by Dr. Aida Abaz Quka

Hello,

Welcome back to icliniq.com.

I understand your concern.

The constant tremor could be related to nerve damage.

It is important to consult with your neurologist for a physical examination to investigate other possible neurological signs (the type of tremor, reflexes, and the muscle tonus) to have a complete idea of what is happening with you.

I would suggest performing a nerve conduction study to examine your nerves and some blood lab tests to investigate for the possible causes of tremors:

  1. Complete blood count for anemia.
  2. Blood electrolytes for any possible imbalance.
  3. Vitamin D and vitamin B12 plasma levels for possible deficiency.
  4. Thyroid hormone levels for possible thyroid gland dysfunction.
  5. Meanwhile, I would suggest discussing with your doctor the possibility of adding Duloxetine to your therapy (Amitriptyline may cause further fatigue).

    Switching from Gabapentin to Pregabalin may be a treatment option.

    Avoid taking Baclofen and Tramadol for a long period. They may exacerbate your condition.

    I hope you find it helpful.

    Kind regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Aida Abaz Quka
Dr. Aida Abaz Quka

Neurology

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