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annular tear pain treatment (Page 1)

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I have an annular tear in my L4 L5 and 3 bulging discs. It looks like the one right above my tear is about to tear also. Long story short my doctor got me into physical therapy (that made it worse), I tried that for 3 months with no real results to speak of. So my doctor and I decided I would receive steroid injections in my back and until then threw pain meds at the problem until I got the back injections. This was about 3 months ago. I felt ok, got off those god-awful pain meds and was feeling pretty good. Well, the pain has reared its ugly head again and I don’t know what to do. The injections I received cost $12,000, my insurance only covers 70% of that. On top of all that I refuse to get back on any sort of medication for them again. If I wanted to be a do nothing zombie that would be great but I don’t. I don’t feel like I have any options right now. I don’t have the money for the injections (which didn’t really work in the first place), and I own my own business that doesn’t afford me the time to leave work for a long period of time if I have surgery (not that I could afford it anyway.) I’m so...so...mad. I’m only 28, this crap is horrible. Anyone out there have the same situation with some type of better results that I might be able to bring up to my doctor.
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replied September 3rd, 2008
Extremely eHealthy
Have you had more than one ESI? They are usually given as a series of 3 injections over a period of 8 weeks or so.

If you only had one ESI injection, you might want to consider trying a second one, but if you have had the series of 3, then you will have to wait as most doctors will not give more than that without waiting at least several more months.

Since you have tried all the conservative measures without having much success or long term success, it would seem that your only option left would be spinal surgery.

I would discuss with your spine surgeon, what surgical options he suggests and what kind of financial arrangements could be made for payment with both his services and that of the hospital.

Then I would seek several other opinions from other spinal surgeons before I decided on any surgery and with which doctor I would use.

If you don't want to use any pain meds right now, have you been given the option of some meds that directly decrease the nerve pain you are feeling?

Also if you have discs that are pressing on nerves, and you do not do anything to release that pressure on the nerves, you run the risk of permanent nerve damage that can result in all kinds of serious complications.

Complications such as total loss of bladder and/or bowel function, loss of sexual function, damage to your ability to walk and permanent nerve pain that no surgery will be able to fix.

You are in a tough situation but it sounds like your alternatives are suffering in pain and risking permanent damage or surgery and being out of work for a period of time to recover from the surgery.
How long you would be out of work depends on the type of spinal surgery you have as well as how quickly you recover and that is an individual thing. It also depends on what type of work you do.

Good luck

Fran
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replied February 11th, 2009
Same Thing...Always Looking for Answers
I too have annular tears in my C4/5, and L4/5, as well as bulging herniations to my C6/7, C7/T1, T3/4, and T4/5. Took a 65-75mph rear end collision by a drunk....I was stopped.

I have been through the same frustrating process, of trying to find relief/healing from the pain in my neck and back, and the radiating pain, burning, and tingling in my jaw, arms/hands, and legs/feet. I have seen many doctors who are just not educated with the specifics of this type of injury.

I have tried physical therapy, chiro, accupuncture (DONT TRY ELECTRO-ACCUPUNCTURE!!), TENS, and all of the meds (neurontin, vicodin, norco, zanaflex, flexeril, ultram, naproxen, tylenol, motrin). The only thing I haven't tried is the epidurals, because I know several people who have had no success with them, plus all the negative possible side effects, and the risk of further injury due to strain when you can't feel the pain.

I do use a personal TENS unit, especially while at work. (I am a law enforcement officer, and currently confined to desk work in the 911 call center of our county, not the direction I imagined for my career!) The TENS does not make any of the symptoms go away, and does not have any effect once turned off, but it does distract from the back pain while on, and provides some relief. I have found nothing to relieve the pain/burning/tingling in my limbs. I use a heating/massage chair/pad at home, which provides minimal (better than nothing), and hot baths. Nothing takes it away, but cold certainly exacerbates the symptoms.

I have read good things about the microdisckectomy, and know two guys who have had it done. Both swear by it, saying it instantly relieved and removed every symptom. My problem lies with being able to find a doctor familiar with the procedure within my HMO (Kaiser).

I would readily appreciate any tips/suggestions anyone might have !
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replied May 5th, 2009
Annular tears
I too have annular tears in my T2 and L4-5 region. I suffer from chronic pain daily. I can not function without medication because the pain is so severe. I have had an MRI of my back and now I have an appointment with a spinal specialist.

I struggled with the worry of surgery because so many people had said that they had no relief and some even got worse afterwards. Recently I have spoke with several people whohave been been to the spine surgeon that I am getting ready to go to and they had a 90% improvement rate in their pain after he had done surgery. I do not know where everyone is but this doctor is in Richmond, Indiana. His name is Dr. Hellwarth and he is an awesome doctor.

I would do anything to be relieved of thispain so that i can do simple things like sit long enough to watch a movie with having to reposition and get up and move around to try to eliviate the pain. I am giving this doctor a shot and if surgery is necessary then I am going forward.

I wish everyone the best of luck being relieved of these pains. I can truly sympathize with you.
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replied May 5th, 2009
Experienced User
From Dr. Brian Hainline M.D.'s book "Back Pain Understood":
"Those patients who have straightforward pain that correlates well with the level of the spine for which surgery is recommended are more likely to develop pain relief following surgery. Prior to surgery, these patients generally can become comfortable in certain positions (for example, lying down), and develop pain in other positions (for example walking). In addition these patients have pain that has persisted for months, as opposed to years.
On the other hand, some patients present with chronic pain of many months or years' duration, and the pain is seemingly independent of any activity. The patient may be diagnosed with a degenerative or herniated lumbar disc, and he may be offered the hope that corrective surgery will alleviate pain. However, herniated and degenerative lumbar discs should not cause chronic, essentially constant pain. Patients with chronic pain require intense nonsurgical treatment with a pain medicine specialist or within a pain center. Surgery for such patients usually is not only disappointing, but may lead to a marked worsening of preoperative pain."
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replied June 15th, 2009
My husband went to a UVA dr. he has an annular tear on his L5 and a severe case of arthritis from l5 to s1.Dr. said he will try pain management where they will give injections in spine where the tear and arthritis is.If that doesn't work they are going to try to put a wire with electricity going thru it in my spine to deadin the nerve.One more alternative is having a disk replacement,which i'm unsure about.
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replied June 15th, 2009
Extremely eHealthy
Backpain, what type of surgery is the doctor doing on you?

Microdisectomy is extremely affective.


Dons36

Injections into the spine can be quite helpful for the pain and can help to heal an annular tear as well.

Your husband should also undergo a 10 week course in physical therapy to learn proper core exercises to strengthen his core muscles and continue doing them for the rest of his life.

Before any radiofrequency nerve ablation is done, IE deaden the nerves, the doctor should see what the results are from the epidural and physical therapy.

If your husband's doctor is not sending him for physical therapy, he should seek out another spine specialist.

The usual course of treatment for an annular tear is physical therapy first for at least 8-10 weeks before going for the epidurals, unless your husband is in so much pain that he could not do the physical therapy.

If that is the case, then he should have the epidural done first and then the physical therapy.
Be sure that the epidural will be done under x-ray floroscopy to be sure the injection is done into the correct area and no damage can be done.

If that is not the case, then run for your life away from the doctor that is going to do the epidural and find another pain doctor for the injection.

Before any nerve ablation is done, it must be determined where the pain is coming from.
That involves injecting a numbing agent into the suspected areas of pain to see if the pain is relieved.
The patient must keep careful records on how the pain responds over an 8-12 hour period.

Only if there is pain relief from the lidocaine is there then the possible pain relief from nerve ablation.

The results of nerve ablation can take several weeks to actually work, and until that is known, it can be increased pain for several weeks.

Also, those nerves will grow back within 12-18 months and the pain will return. The procedure can be repeated though.

Why would the doctor say that disc replacement is an alternative?

This is usually not covered by insurance as it is considered experimental still. The success rate is not really known, nor is the long term results known either.

If there are problems with the ADR, artificial disc replacement, it can be very serious surgery to have it removed and it can be life threatening to do so.

Good luck to both of you.

Fran
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replied August 31st, 2011
Hello,
I'm having the nerve ablation shots done in my back for a herniated disc L5-S1 and also have the degenerative thing going on not to mention arthritis. I've had one set of the shots done on my left side with little pain relief. The right side is set to be done next week. I don't feel the pain that goes down my leg anymore but I still have the aching feeling in my back still. If they don't work do you recommend the actual surgery and if so what surgery am I looking for as I'm going through the VA and they're not that informative?
All in all I just wanted you to know that I've found your posts helpful and I appreciate it. Have a blessed day.

Terry
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replied August 31st, 2011
I have an annular tear as well and that was the surgery advice that I was looking for.... Just trying to clarify....


Terry
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replied August 31st, 2011
I have an annular tear as well and that was the surgery advice that I was looking for.... Just trying to clarify....


Terry
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replied June 18th, 2009
Readytoscream!
I have the same problem...L3-4 and L4-5 disc herniation and an L3-4, L5-S1 tear. Ouch. This has caused Sciatica to set in, and now I can't even sit long enough to even type this...my leg is all tingly, all the way to my toes, it's also losing feeling all the time and my whole left side feels half numb. The pain starts in my left "butt cheek" and continues down my leg. I've started going for physical therapy, and that is helping a little, and had an MRI a few weeks ago. Finally, now the Dr. referred me to a pain specialist who is probably going to be doing cortizone injections. My DR. had been giving me Percocet..but refuses to give me anymore cuz it's a (gasp)...NARCOTIC...well, if she could only feel the pain I'm in, she'd want to be high constantly too. Anyway, she has me on Meloxicam now, which is used to treat arthritis, and is an anti-inflammatory. It works MOST of the time, but taking it as perscribed, once a day, I'd say it only works REALLY well for a few hours, but then a dull annoying pain comes back after that. I'm hoping that this pain guy can help me out on Tuesday with some injections. If not, I'll be on a search for Percocet off the street becuase I just can't take this anymore.
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replied June 18th, 2009
Extremely eHealthy
Re: Readytoscream!
backpaingrrrl wrote:
I have the same problem...L3-4 and L4-5 disc herniation and an L3-4, L5-S1 tear. Ouch. This has caused Sciatica to set in, and now I can't even sit long enough to even type this...my leg is all tingly, all the way to my toes, it's also losing feeling all the time and my whole left side feels half numb. The pain starts in my left "butt cheek" and continues down my leg. I've started going for physical therapy, and that is helping a little, and had an MRI a few weeks ago. Finally, now the Dr. referred me to a pain specialist who is probably going to be doing cortizone injections. My DR. had been giving me Percocet..but refuses to give me anymore cuz it's a (gasp)...NARCOTIC...well, if she could only feel the pain I'm in, she'd want to be high constantly too. Anyway, she has me on Meloxicam now, which is used to treat arthritis, and is an anti-inflammatory. It works MOST of the time, but taking it as perscribed, once a day, I'd say it only works REALLY well for a few hours, but then a dull annoying pain comes back after that. I'm hoping that this pain guy can help me out on Tuesday with some injections. If not, I'll be on a search for Percocet off the street becuase I just can't take this anymore.




Your doctor should have given you a prescription for a nerve pain medication such as Neurontin or Lyrica. Those can be quite good at relieving nerve pain, pain meds are not that effective for nerve pain.

Be sure that the pain doctor uses floroscopy when giving your epidural injections, if not, don't have them done with this doctor and find another one that uses floroscopy to administer the injection. This is important so that the doctor can actually see where he/she is injecting on the x-ray machine.
Also you should be able to request sedation for the injection. You won't feel anything during it with sedation.

Also you can ask the pain doctor for a prescription for a nerve pain med to fill if the injection doesn't work.

You should get relief from the lidocaine that is injected with the steroid for about 12-24 hours, but it can take up to 2 weeks for the steroid injection to have full affect in relieving the pain.

Good luck and let us know how you are doing.

Fran
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replied June 20th, 2009
Thank you, I will definitely look in to these things when I see the doctor on Tuesday. I've had an epidural before when I had my daughter and I still have numb spots in my back from it. I'll update after my appointment on Tuesday! Thanks for the advice!

KL
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replied June 21st, 2009
Extremely eHealthy
The epidural that you had when you where in labor is not the same kind of epidural that is given for spine pain.
It is not given in the same are or location that an epidural steroid injection is given and the medications injected are not the same.

For pain relief during labor and delivery you are given anesthesia. When given an ESI you are given lidocaine and a steroid that is an anti inflamatory.

If you are still having some kind of numb areas in your spine, you need to see a spine surgeon for that as well.

Fran
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replied June 24th, 2009
Hi everyone! I went to the pain Dr. yesterday, and I have 2 injections scheduled for July and August. Those were the quickest dates he could give me. I'm going to continue Physical Therapy as well. The doctor uses the Xray machine when giving the injections, which made me feel better about the whole thing! He also gave me a prescription for Lyrica (nerve pain meds), and also one for Vicodin. (Oh no, another narcotic...LOL). BUT, I'm pain FREE right now...and it's awesome! If anyone in pain has probs with meds you're on, ask your Doctor about Meloxicam 15mg, Lyrica 50mg, and Vicodin, 500mg Smile
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replied June 24th, 2009
Extremely eHealthy
Backpaingrrl,

fantastic news. Lyrica can take some time to become fully affective, but the narcs will help as well.

Good to hear that the Pm doc uses floroscopy.

Now one more thing to find out. Will they do the injections under sedation?

I've had all of mine done with sedation. IV in, into the OR room, onto the table on my stomach and in goes the sedation meds. Out like a light, feel nothing.

within 10 minutes I'm back in a recovery room, wide awake, sitting up and feeling great.

Wouldn't do it any other way, sedation for me or no injection. They can be very uncomfortable and for some they are painful.

I'll take the sedation or not have it done.

As a matter of fact, my PM doc told me that every one in MA uses sedation to give injections. The PM docs feel it is far safer to do it this way.

With sedation, there is no chance of the patient inadvertently moving because of any kind of pain or discomfort and ending up causing the needle to go into the wrong location, which could be a serious problem.

Try and get the sedation to have your injections done.

Fran
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replied June 28th, 2009
Thank you for the advice! I will definitely look into getting the sedation. They did mention giving me something to relax me before the procedure is done, which could be just as effective for me. I'm going to look into it too, and I already have someone lined up to drive me there and home afterwards.


Kristin.
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replied July 4th, 2009
Experienced User
Backpaingrrl,

Good luck with the injections. In the future or while having these injections, you may want to have a few chiropractic adjustments performed for a herniated disc. They help me but it's a temporary fix. You need to try to get the disc off the nerve. If you experience any female problems due to the cortison injections, send me a message. I can point you in the right direction if you do... Trust me, you dont want to ignore those issues for to long. I have experienced a few and through research, learned alot. Good luck to you!
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replied October 11th, 2011
I had the injections they didn't do me anygood. The only thing they did was made my cycle go on for a bout 15 days after that I didn't have the third one. What female problems did you have? Is there anything I need to do?
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replied July 4th, 2009
Exactly what kind of female problems occur with this shot? Menstrual cycle problems, sexual side affects, etc? Let me know so I know what to expect...LOL.
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replied July 5th, 2009
I also have an annular tear (l4-5) which causes terrible pains in middle-low back.

Good treatment for annular tears is NOT developed still.

IDET can help (in less than 50% cases, very low success rate).

Until now best options are:
1. Spinal Fusion
2. ADR

3rd option just came up, my neurosurgeon will do PLDD for me. It can help, he is not guaranteeing me anything, but we will try in 1-2 months and see what will happen.

He will use laser energy to burn and close the tear. I haven't asked him too much, I fully trust him.
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replied July 6th, 2009
Experienced User
cortisone
backpaingrrrl wrote:
Exactly what kind of female problems occur with this shot? Menstrual cycle problems, sexual side affects, etc? Let me know so I know what to expect...LOL.



I sent you a private message! Check your inbox... if you didn't get it, let me know!
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replied July 15th, 2009
Hi ,

I m Willie. One year ago, i was having a L5-S1 annular tear, Since then, i hv the lower back pain and could sit for long time as i will feel uncomfortable.

I hv went through all sorts of physiotherapy, and dont seems working after one year now. And not to mention accupunture, and chiro. well, the only thing my doctor said is keep on maintaining on my swimming (30 mins at least) or walking (45 mins). And I cant even do any heavy sports like badminton ( my fav, sigh.....feels suck not to play it for one year plus now) or tennis or basketball.

I am thinking of going through the neuroplasty treatment, anyone has any advice on this ? or perhaps a better idea on helping me to solve my problem? Really hope i can get any good advice. Thank u in adv.
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replied July 15th, 2009
AS I said, PLDD is less invazive and can help in 88% cases (as per study od 44 people).

Look at abstract:
http://www.ncbi.nlm.nih.gov/pubmed/1567171 8?ordinalpos=18&itool=EntrezSystem2.PEntre z.Pubmed.Pubmed_ResultsPanel.Pubmed_Defaul tReportPanel.Pubmed_RVDocSum
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