Consult with your primary medicine doctor - methadone can help in low back pain.

And about surgery possibilities, its varies very much. Depends what is source and cause of your pain (annular tear, bulge, facets, etc).

Let us know if you have more info or MR images.

Sorry to hear of your pain.

What discs are damaged? Pain is usually associated at L4/L5/S1 and not L1, etc.

Have you tried GENTLE decompression? I mean only 10 pounds. You must do this in a neutral pelvis position or one which will not pull apart even more whatever you have torn. Decompression can suck the herniation back in.

Massage, especially core distorion release can help.

I've had good sucess doing menus egoscue gave me. Egoscue has their main clinic right in Del Mar. I would very strongly suggest to stop in at the Egoscue clinic and see if they can help. I couldn't sit for over 15 minutes for 3 years until starting Egoscue.


Discs can easily take 1 year to heal. That's with being careful like not sitting too long and removing core distortion which could be pushing the disc onto a nerve. In one study:
2/3 of people with a diskectomy were happy after 7-20 years, 28% complained of significant back pain, 7% had a repeat operation, the authors comcluded that the long-term results of a standard dicskectomy were not very satisfying.

If you enjioy enduring PAIN, a discoogram is a great way to go.

If you would like to suffer a lifetime of pain, I would recommend covering up your symptoms with meds to allow your injury to progress unabated. But I agree you've got to get the lack of sleep thing under control or you will be too stressed out to get on a path of healing.

You wrote:
"I've went from getting 10-12 hours of sleep a night before the accident to 6 hours after to 4 hours as of 2 months ago, now to 2-3 hours and for the last 2 nights I haven't slept at all"
Have you any ideas as to why you are getting worse even though the accident was months ago?

What discs are damaged? Pain is usually associated at L4/L5/S1 and not L1, etc.

I have had MRI's done. they show all disc in my lumbar spine are messed up. I do not have the results infront of me but I know the middle 3 disks are bulging. The doctor never said which discs he seen were torn and could not be 100% sure if they were torn thats what the discogram is for. I've read they are very painful and would rather not get it if there is another option.

Have you tried GENTLE decompression? Massage, especially core distorion release can help. Egoscue.

I will have to try these or atleast ask my doctor what he thinks about these.

I'm not trying to cover up the pain for ever with meds. I'm just trying to releave some of the pain till I can get it fixed. As you stated I do need to get the sleep thing under control.

Have you any ideas as to why you are getting worse even though the accident was months ago?

To be honest I have no idea why I am getting worse. The pain level in the last 2 months has trippled. I never had leg pain or the burning sensation until about a month ago now I get it 2-3 times a day.

Hey, if you need surgery, you need surgery. I will assume it can be handled without ( and thats a big if) and give suggestions along that route.
As your condition is getting worse, I would guess:
1) Your body is stil reacting to the injury by tightening up the muscles. Muscular compression tightens to protect damage discs but that continual compression can make discs bulge even more so it's conterproductive. For example, the psoas muscle connects from the femur to all lumbar discs L1-L5 and T12. If that muscle is tight it will continuously compress your entire lumbar spine. That's why I suggested Egoscue. They do a supine groin stretch or progressive supine groin stretch which will gently release this muscle in a way that will not cause further damage.
Other stretches is the Cobra where you just lie face down, let your stomach relax and your lower back arch. Egoscue's static back and also wall sit. Try a google search as I'm not allowed to post links here.

or

2) Your back cannot handle the "normal" life you once had before your injury. Once it heals you can go back to sitting, impact from running, etc. But not right now. That could take a year. From what I've read, surgery patients are doing better after one year that non-surgical. Longer than that, they are about the same.
But you have so many discs messed up, I don't see how surgery can effectively treat your entire back. That's why I like whole back treatments like decompression or muscle stretches. As you heal, you can docompress up to 1/3 your body weight which is all even healthy people need to get a good decompression. I still do it for 15 minutes up to 4x/day with 50-60lbs, right after I walk or exercise.
As your symptoms are progressing to leg stuff, you've got to be proactive as just waiting for things to heal is not working for you.

As for sleeping, can you lie on your back or stomach without pain? If you sleep on your side you can put a small pillow or towel 1) between your knees 2) just below your ribs to keep your back from sagging which will put a lot of stress on the discs and ligaments. You want to keep your back in a straight line so it does not sag or twist.
It would be worth it IMHO to try and find some way to sleep comfortably with as few pills a possible so that way your can help to help your back heal.

One note:
Discs get their nutrition by being "pumped". There's no blood flow and discs get their nutrition by being squeezed and them released. So just decompressing and lying around will not let discs get the nutrition they need to heal. For that I suggest gentle walking, within your limits. Alternating leg stuff is better that chi-kung where you keep standing on two legs as the discs never get pumped as when you keep transferring weight from one leg to the other.

Honestly I have tried almost every position I can to sleep but none are comfortable. After about 10-15 minutes of laying I start to get leg burns and shocking pain in my back. I've tried sleeping on my back, on my stomach, on my stomach half off the bed (sideways), on both sides, on both sides with a pillow between my knees but they are all about the same. I've even tested out atleast 6 other beds thinking mabe more expensive beds made differently and with different material might help. I've tried a memory foam mattress twice and that has little to no effect. And thank you all for your replies, help, and suggestions.

I would suggest that before you get a discogram, you seek out another opinion from a spine surgeon, either an orthopedic surgeon that specializes in spine or a neurosurgeon that specializes in spines.

You list quite a bit of damage to your spine from an auto accident. It sounds like you may have already been suffering from some degeneration of your spine to have that much going on in your spine as a result of the accident.

I would venture to guess that the increase in your pain is worsening of the discs that are damaged, possibly disc material is leaking out and now irritating the nerves, the bugles have finally compressed the nerves enough to increase the pain are just some of the possibilities as to why the pain increase.

Narcotic pain meds help some people with nerve pain, but not a lot of them. The usual choice of drugs for nerve main are one of 2 anti-convulsants; either neurontin/garbapentin of Lyrica. They are very good a relieving nerve pain.

You might want to ask your doctor about trying one of those to help ease the nerve pain and inflammation and then try physical therapy again with an experienced physical therapist that is trained for spine issues.

Whether surgery may or may not help you depends on what your specific issues are with the discs, where the pain is coming from and what type of surgery would be done.

Without knowing that information it's hard to give any info about surgery.

Microdisectomies are very successful.

Bulging discs do not always cause pain or a problem, so determining where your pain is coming from is important.

Can you post where the pain is that you are feeling, can you describe the pain that you are getting and where it is.

When lying in bed, try sleeping on your side with a small pillow between your legs to give balance.

For some pain relief, try using ice packs and if that doesn't work, try moist heat.

Discs can take a year to heal, but if you have tried all conservative measures to treat your pain and you are not getting relief, but rather only getting worse, then surgery may be your only option.

The key to surgical success is to determine where the pain is coming from and having the right surgery for the pain.

That is why it is important to get more than one opinion before even thinking about surgery.

Since you don't have copies of your MRI reports, that is also important to have as well as the MRI films too. You will need the films for other opinions.

Also, did your present spine doctor look at the MRI films and was he able to read them or did he just go with the MRI reading?
If your present doctor can not read the MRI pics, you want to get away from that doctor as fast as you can. You would never want someone to treat or operate on you based on someone else's opinion and not his/her own opinion.

Post the MRI reading and I will try to add more info for you.

good luck

Fran

Can you post where the pain is that you are feeling, can you describe the pain that you are getting and where it is.

Ok the pain is more less like a pulsing pain that starts in the lower back going out about 3 inches from my spine. When I aggravate my back it radiates first out the the side going as far as love handles and then works its way up to my shoulders then it works its way down to my but then I get burning pain in my legs. If I tilt at the hips to my left or right I get a horrible shocking/stabbing pain (it feels like it in the the center of the spine in the lower back about 3-4 inches above my crack). If I lay down for more than 10 minutes the pain starts, sit for more than 20-30 minutes, or stand from more than 30-40 minutes roughly it also starts.

Post the MRI reading and I will try to add more info for you.



Also, did your present spine doctor look at the MRI films and was he able to read them or did he just go with the MRI reading?

Yes my present doctor looked at the MRI film. He had his orthopedic spinal surgeon look at them as well.

Got a copy of my mri I was told I have 2 angular tears and I believe they are in L3 and L4 or was it L2 and L3 I'll have to re check on this one.

L1 Degenerative disc disease (early)
L2 Nucleus degeneration (minimal)
L3 Bulging(minimal), Degenerative disc disease (mild)
(Believe an angular tear)
L4 Bulging (minimal 2mm)(Believe an angular tear)
L5 Nucleus degeneration (minimal)
S1 Bulging (early 3mm)

I have noticed that soaking in the tub in hot (hot hot) water helps for a temporary fix also ice can help to lower the pain a bit but only works for as long as I keep the ice on and only for about 30 minutes (ie. if I take the ice off after 5 minutes the pain jumps back up.)

Sounds like you are doing all the right things with sleeping. When you lie down, your discs fill with fluid. that is why you will be 1/2-3/4" taller in the morning than the evening. That extra fluid increases pressure in the discs so just the act of lying down, in any position, can cause pain. Maybe sleeping in a recliner.

Annular tears can be greatly aggravated by twisting of any kind. This may be happening when you sleep.

L1 is at the base of your ribcage.
You can find L4/L5 yourself. Put your hands on your lower back. The top of your hip bone is the iliac crest. L4/L5 is about 1-2 inches below your iliac crest. Sounds like this is where you get pain. The sacrum is the triangular shaped bone belwo that.

It sounds like, from you description of your pain, that you have nerves compressed in your lumbar spine.

Your MRI info that you posted is saying you have disc problems.


L1 Degenerative disc disease (early)

you disc is showing signs of wear and tear at an early age, very early.

L2 Nucleus degeneration (minimal)

again the same thing


L3 Bulging(minimal), Degenerative disc disease (mild)

the disc bulge can be the result of the auto accident and causing some degeneration in the disc
(Believe an angular tear)

An annular tear can be causing the pain going down your leg, the burning, numbing pain and would be felt in the front of the thigh.

L4 Bulging (minimal 2mm)(Believe an angular tear)

Same as above

L5 Nucleus degeneration (minimal)

if this is pressing on the nerves you would feel the pain in the butt and down the lower leg, back of thigh and down to your feet.


S1 Bulging (early 3mm)

Same as above.

It would be great if you could post more info on the MRI reading. You will find out if there is any narrowing of of the vertebral space that the nerves pass through, if there is excess bone growth and many other things.

The pain that goes up your back, to your shoulder, I'm not sure of.

When you are standing, do you bend forward to ease any of the pain you are feeling?

If you do, that is a strong indication of spinal stenosis, narrowing of the canal that the nerves pass through in all the vertebrae.
By bending forward you increase the canal space and pressure on the nerves, which then will ease some of the pain.
It can just be the bodies instinctive response to ease the pain and you may be unaware that you are even doing it.

If you are bending forward like that, then you are putting strain on your upper back and shoulder and that would inflame the muscles, causing pain in that part of your spine and shoulder.

Those with spinal stenosis have serious problems standing, walking and lying down. Hunched over a table, bending forward when standing is one way that the pain is somewhat eased.

IF you find moist heat really can ease the pain, again, common with spinal stenosis that is causing nerve pain, along with annular tears, there is an easy way to make a pack to provide moist heat.

Take a long white tube sock and fill it about half way or a little more with the cheapest white rice you can find. DO NOT USE INSTANT OR MINUTE RICE, IT WILL EXPLODE WHEN HEATED.

Once the sock is filled, tie the open end in a not, way at the top of the leg part of the sock.

Heat for 90 seconds in the microwave. Take it out and spread out the sock on a hand towel to smooth out the rice inside it. Wrap the sock in the towel and place on the area that hurts.

Be careful to not leave it on to long at a time, you don't want to burn yourself.

You can keep reheating the sock any time. Every so often, untie the sock and toss the rice out. It will look really brown. wash and dry the sock, refill with fresh rice and start all over again.

I do think you should get another opinion before considering any surgery.

Good luck

Fran

There is no narrowing at all. um I do have mild facet osteoarthritis on two of my facets. When you are standing, do you bend forward to ease any of the pain you are feeling? no its usually the other way around.

I do think you should get another opinion before considering any surgery. And as always before any surgery I will consider 2 or 3 second opinions before having surgery.

Questions that comes to mind:

Do you think your back can heal on its own?
.........and...........
Do you want to put in the time and effort to heal your back or not be bothered and just get the surgery?

If you choose surgery, there is no going back. You cannot undo surgical problems without having more surgery.

You say it hurts to bend forward and feels better to arch back. Your body is telling you something. Hate to tell you what to do but, it might be a good idea to listen to your body. The current medical industry with its pills, injections, and surgery wants you to do just the opposite. Shut off what your body is telling you. They must be onto something as this is what the majority of people choose to do.

One year ago I was in bed 14 hours/day, couldn't stand for over 1 hour, walk for less than 1 mile, could only work 2-3 hours/day at best, with x-ray and MRI's much worse than yours. I was told I needed a 3 level fusion or 3 level disc replacement. Yet 1 year later I am sitting up to 5 hours, work 6-12 hours/day, dead lift 150 (only when necessary ...for now...- but I can). I walked 6 1/2 miles yesterday and felt great! That's because I ignored the doctors and helped my body to HEAL. A concept that has been lost on today's doctors.

Back pain is a journey in self-discovery.


For some reason, I can't seem to express this thought so people "get it" but I will say it anyhow:

Focusing on the MRI, you are completely missing the cause of your pain and injury. MRI's are to tell the surgeon where to cut. That is all! They have NO correlation with the cause of your pain. Clinical studies have found people with bulging discs, herniated discs, facet joint arthritis etc.,etc. with absolutely no pain. Clinical studies have found virtually no correlation between MRI findings and the source / cause of people's pain.

Why is this concept so hard to grasp?

You are completely right.

MRI with clinical findings and pain-source eliminating treatments (like ESI, RF, or even some less-invasive sugery methods) are key to successful spine treatment.

An MRI is only a tool, one of many tools that should be sued to diagnose and treat a patient who has spine issues and back pain.

If an MRI is used as a guide on not the "be all, that ends all" diagnostic tool, then the results of an MRI can be very valuable in aiding a spine surgeon in diagnosis and treatment of the patient.

An MRI, in the hands of a skilled spine surgeon is not just a route to surgery.

Various conservative measures can be used and can be very successful in healing disc problems and pain.
It can take time, up to a year to heal, TRUE, but a key to whether conservative measures will help is seeing and exhibiting some direction of improvement.

Physical therapy is important, building core muscle strength is vital.

BUT,

If a patient is in so much pain that they can not do physical therapy, then something needs to be done to relieve some of that pain so that physical therapy can have a chance to work.

ESI do not always work, nor does any other conservative treatment, and if the patient continues to deteriorate, then, and only then is a surgical option an appropriate course to consider.

Sometimes when an ESI doesn't work to relieve pain, a nerve block will and be enough to relieve the pain to allow the patient to give physical therapy, ultrasound and time a chance to heal an annular tear.

When the MRI is used as a tool, along with physical exam of the patient, seeing if the patient's symptoms can match the images on the MRI, the MRI can be useful.

If a doctor looks at an MRI image, and/or just reads the MRI reading done, and then diagnoses from that, and that alone, it's time to find another doctor.

Just because there are bulges or degenerative changes, doesn't mean anything. It is what the patient is exhibiting in symptoms and feeling that is the telling feature. The MRI films only give guidance.

There are far to many spine surgeons that are ready to operate at the "drop of a dime" and that is wrong and bad. Those results halve poor outcomes and the patient suffers.

When spine surgery is performed for the correct reason, using the correct surgery for the condition, then the surgery becomes a good outcome for the patient.

It's finding the right surgeon that really does know what he/she is doing that is the problem.

My own experience showed me that even in some of the most prestigious hospitals in the country, with some of the most prestigious spine surgeons, you don't always get the best care or have the best spine surgeons.

Too many of them where ready to do major spine stuff, fusions on 2-3 levels, huge incisions, major vertebrae removal that would have eventually caused spinal instability.
When they found a patient in front of them that had plenty of knowledge and questioned their findings, had a patient that could read an MRI and new they where full of crap, they where not very pleased. They were actually quite insulting, to say the least.

Obviously none of them did any surgery on me, as their knowledge was lacking and it was obvious they couldn't read an MRI as the images showed the obvious serious problem at only 1 level, not 2 or 3. Only 1 level showed any problem, all the others where perfectly normal, and there was no way I needed a fusion.

A simple decompression, laminotomy and decompress the lateral recess area of the L4/L5 was all that was needed.

I was a bit more complicated because I'm so short, and 1 spine surgeon agreed with my original one that endoscopic was not a good idea for me, because my vertebrae are so small because of my height. It would have been too difficult to see with an endoscope and risky that nerves could be damaged.

So it was a 1 inch incision muscles spread, a laminotomy done on one side of the vertebrae, widening of the lateral recess, closed up, with 1 stitch on the outside. Less than 10 hours later, I was up on my feet, walking like a normal person, no pain, and the total loss of bladder function was gone. Total control returned. Never took any pain meds, did PT and was on my way.

As i said, when the tools to properly diagnose and treat a spine patient are used, surgery if needed, including with the aid of an MRI lead to sucessful results for the patient.

It's in the hands of the wrong doctor that things become a problem.

Keano16, how about eliminating the cause of the pain as a successful way to treat the back?
Maybe I'm not understanding you. Here is an example to illustrate my point. I am writing here more for chronic pain which is defined as pain lasting over 3 months. That's what him1984 has.
Acute pain is up to 3 months and doesn't much matter what you do to treat it. Clinical studies show the back will heal on its own.

1a) You bash your thumb with a hammer.
1b) MRI shows fluid, joint inflammation, and tendinitis.
1c) Doc prescribes anti-inflammatories, maybe some P/T to get the thumb working correctly again.

2a) You take the pills, follow the P/T exercises but also keep bashing your thumb with the hammer.
2b) Pain is getting worse and you get another MRI. This time it shows a broken bone, joint arthritis.
2c) Doc recommends surgery to set the broken bone and medication for the arthritis.

3a) You keep bashing your thumb with the hammer and despite the doc fixing you up, the pain and injury keeps coming back. Now the pain is chronic not acute and a different method of treatment is required as you can't keep on pills or getting more surgeries every 6 months.

The doc did a good job. He followed the correct procedures for acute pain and then the progressive injury. But no doc can fix you up if you don't stop hurting yourself. Some people want their money to solve all their problems, other don't understand a very complex injury like back pain. Understandable as it's not as obvious as hitting your thumb with a hammer. But the concept is still the same.

It is a great tragedy but many doc's are preoccupied with a film and don't bother looking at the patient standing right there in front of them. Some only use the "roll down" test as a way to evaluate spine injury. I don't understand where along the way the information on how to heal got lost. Maybe it's that everyone is in such a hurry nowadays. Maybe doc's aren't selling that info anymore because no one is buying. No one has time to put in the effort to get better is my guess. Just give them a pill, injection, or surgery. Fine, except for the people I know who have done all this and are STILL getting worse. For them, finding the cause of the pain and fixing it is not just an option, it's the ONLY option. Then they finally start to listen. Not everyone gets to this point. Lucky for them, I guess........

Him1984 is getting progressively worse despite the accident being 8 months ago. I could be wrong, but I'm guessing (from mine and others experiences), that he is beating himself up but doesn't understand how. I'm all for surgery if his injury warrants it but unless him1984 gets to the ROOT CAUSE of his continued pain, I'm afraid the pain will come right back. That is unless he lives the life of a blob. Which seems to be okay for many people and may be okay for him1984 too. It's totally a personal choice.


Does this make any sense???????

I will take a shot at the "annular tear" diagnosis. Ask a doc and see if he agrees with what I say. I would be interested in what he says.

Radial tears progress from the inside to the outside of the disc. Annular tears go "round and round" the outer circumference of the disc.

Discs are made of an inner nucleus and outer annulus. The annulus is made of fibers which crisscross and then attach to the vertebrae (bones) above and below the discs. So half the annular fibers go in a clockwise spiral and the other half go in a counterclockwise spiral.
Because of this geometry, the disc is only half as strong when twisted as compared to compressed or bent where ALL the fibers take the load. The injury is more severe, or at least severly felt for two reasons.
First is in a twisting injury, only half the fibers are there to take the load. So it is likely more damage will be done as compared to disc annulus damage from straight compression of bending.
Second, when a disc is twisted as compared to compressed or bent, the outer fibers are the first to go. That is exactly where most of the nerves in the annulus are. So you are going to really feel the pain! It is a cruel act of fate but science says there are only nerves in the outer 1/3 of the annulus. So if you tear fibers from the inside out like a compression or bending (long term like slouching when sitting that is) injury, you have to tear up 2/3 of the disc before you even realize you've done yourself damage.

Damage form twisting the spine can be reversed by untwisting the spine but also taking the twist out of the hips. Most P/T's have you spiral the upper torso which can hurt, cause more damage, and doesn't get to the problem. In my case, I had to release the right psoas and simultaneously get the left psoas to turn back on. This was most effectively treated by Egoscue's progressive supine groin stretch and gently untwisting my back while walking. I have eventually gotten loose enough where I can untwist L4 and feel the injured, overworked annular fibers go slack, while the healthy fibers which twist in the opposite direction get tighter and take up the load.
Since discovering this, I can now walk pretty much as long as I want. 7 1/2 miles today vs 3 6 months ago.

I am glad you mentioned annular tears, as I have one (grade 4) and I have studied all about them.

Google for "sinu-vertebral nerve", s-v n irritation, and similar terms (if you already didn't looked) like chemically-sensitive disc.

That fact is, you have 8 nerves endings in your disc, their location and size is NEVER 100% the same as your other disc or others person disc.

So, your grade 2 tear can cause higher pain level then some elses grade 4 tear.

If nerve is under direct pressure, then your (and some doctors) theories about twisting work. But, if nerve is chemically under pressure, you will feel constant 24/7 pain.