Question
I am 54 (female); I have severe pain in right low back (including a side part of ribs) that, temporarily spreads over the whole back. I tried with Tramadol-no results at all; I抳e been given injection (niflam with dexametason)-again nothing; now I am taking Movalis injections (15 mg)-the pain is still severe (I have been given two Movalis injections so far, and I have to take 3 more, as per the doctor抯 prescription); the pain is really killing me!
Here follows the MR report, I do hope the translation is ok.
揇ehydration of the i.v. discusses from L1 to S1 with postmedian protrusion  on  level L2-3.
Postmedian and bilateral protrusion on level L4-5, and postbilateral protrusion on level L5/S1. Slight compression on spinal tunnel in front aspect.?br>
I would like to mention that I have Parkinsonism plus and I am taking Bromocriptine-25mg daily, Levodpa+Carbidopa 2 and half pills daily (accompanied with vitamins);

I would appreciate your advice as soon as possible.
Thanks a lot.
Lj. Ivanovska


Answer
Dear Lj.,

The MRI results suggest that your lumbar spine has been decaying for years now.  However, the pain you are experiencing may or may not be directly related to the findings.  The pain patterns for the anatomical locations of disk bulging and cord encroachment actually go down the legs and you have not mentioned that.  Moreover, the rib pain is much higher in location than the pain from those levels is expected to be.

It is obvious that you are in pain, but I do not see a direct correlation except for the low back pain, and the pharmaceutical management is obviously not helping.

From what you have described, there may be pain referral rather than neurological pain from the disks which can be widespread and diffuse.  Moreover, I think you probably have diffuse myofasciitis which can be extremely painful as well.  

I would recommend that you try a functional approach rather than just a pharmaceutical approach and get checked out by a chiropractic physician who can either utilize a Cox Flexion-distraction technique on your low back, or non-surgical spinal decompression to not only stretch the myofascial system and open up the joint spaces around the spine, but also pump fluid into the disk which also carries all the nutrition for healing and repair.  Otherwise you are just going to be referred for more invasive pain management, or back surgery which as been proven over the years to be marginally successful at best.

Lastly, you need to sit down with your physician and review all your medications.  If they are prescribing them for you, they need to take the time and review all of the known side effects and cross reference the drug interactions to make sure that the severe pain you are in is not due to the drugs. Some people react poorly to some medications...it should be considered.  Many pharmacists will tell you that if you are on more than three prescription meds, drug interactions and reactions are very difficult to monitor and document correctly.  Make sure that the pain is not being made worse by polypharmacy or if you can be placed on another similar drug for your previous medical conditions.  Good Luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net