Dr. Anuj Gupta
Spine Surgery
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have lower back pain on and off from last two years. Two weeks before I got severe pain in my right leg. I was unable to move my leg. Physiotherapist suggested taking bed rest for four days. My trauma and orthopedic doctor asked me to do surgery if I was unable to tolerate pain. After four days, the pain in the leg and lower back pain were gone and I got mild numbness below my knee (back side of my right leg) and thumb finger of my toe. Physiotherapist asked me to do some exercise regularly and it will be cured automatically. Please advice. Do I need to consult a neurologist for numbness?
Hello,
Welcome to icliniq.com.
Basically, it is a nerve pain due to compression at your lumbar spine. Usually, 90 to 95 % of patients respond to conservative management. Only 5 % of patients require surgery. The ailment basically you have has waxing and waning course. A few days back you had pain and now no pain. The treatment of this has two parts. First is the treatment of your current pain or numbness and the second part is to prevent pain to appear again. Kindly answer these questions for me to decide the management. How much is your back pain now? How much distance you are able to walk comfortably? Is there any problem in urination like increased frequency or straining while urination? Are you able to walk on your toes and heels? Is there any numbness in the perineal region?
Patient's Query
Hi doctor,
There is no back pain now. I am able to walk 1.5 to 2 km comfortably. Urination appears normal. There is no problem with urine. I am able to walk in toes and heels with a mild imbalance. There is no numbness in the perineal region, numbness only in the bog toe of my right leg and a little bit in the back side of the leg (behind the knee).
Hi,
Welcome back to icliniq.com.
As far as the medication part is concerned, we need to start medication only for your numbness. So, start with tablet Duloxetine (Dulane) 20 mg once at night. See for a day or two. If no improvement in numbness, then make it twice. Still no improvement, then, one in the morning and two in the evening. Like this, you have to increase dose till you feel there is 90 to 95 % improvement in your numbness. The maximum you can increase is three in the morning and three at night (maximum 120 mg). Now along with medication, you have to give time to general conditioning exercise. Start with normal walking. You are able to walk for 2 km. Start with this distance and increase gradually over days. Target is 4 km. It should be regular. At least six days a week. I will tell you some more exercises but first become comfortable and regular with walking. Your 90 % problem will be solved. It will take you around 2 to 3 months to become normal. Continue with the dose at which you feel better. This medication can be taken for long with no side effects. Contact me again after two weeks or before if any problem or if you feel that full dose is not giving any relief.
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Spine Surgery
Orthopedician and Traumatology
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