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Chronic pain isn’t fun. I’ve been there.
by Dr. Matthew A. Neumann
Something happened to me that allowed me to understand my patients on a much deeper level. A couple of years ago, I overexerted myself in the gym and was left with excruciating pain in my lower back that radiated a burning and shocking pain down my left leg into my foot. After months of frustration, sessions of physical therapy and a rigorous home exercise program, I was finally able to walk more than one block without having to rest to relieve my pain.
The symptoms I was experiencing were due to a condition called “lumbar radiculopathy,” which is the medical term for a pinched nerve in the lower back.
A nerve can become pinched for several different reasons. My specific symptoms were a result of the L5 nerve root getting pinched by the intervertebral disc. Common causes of radiculopathy include, but are not limited to, a herniated disc, narrowing of the spinal canal or neuroforamina, degenerative disc disease, bone spurs, facet arthritis and ligament hypertrophy.
First line treatment for this condition involves medications, physical therapy, epidural steroid injections and resumption of activity as tolerated. Research has shown that these treatments, when used in combination, are more effective than any single treatment is alone. If symptoms persist despite these treatments, a surgical evaluation may be considered.
Medication management for radiculopathy includes non-opioid medications such as anti-inflammatories, muscle relaxers and medications for nerve pain. Many of these medications are well tolerated. Occasionally, a steroid dose pack or very brief (1-2 week) course of opioid medication may be prescribed for acute pain.
Physical therapy involves strengthening the muscles around the painful area to take pressure off of the joints or nerves that are generating pain. My best analogy for this is the muscles around the joint function as a shock absorber for the painful joint. Better shock absorbers will generally allow for more comfort and less wear and tear over time.
Epidural steroid injections deposit a powerful anti-inflammatory medication at the exact location of the source of the pain. This is administered by a physician and often utilizes guidance of an x-ray machine (fluoroscopy) to ensure the medication is in the correct location. The procedure usually takes only 10-15 minutes, and the patient is allowed to go home the same day. Normal activity can be resumed as tolerated post-procedure. Epidural steroid injections typically last 3-6 months, but can provide longer relief depending on the patient’s pathology. These injections may also be repeated if symptoms persist.
Patients are typically encouraged to continue normal activity as tolerated throughout treatment of radiculopathy. Research has shown that simple exercises, such as walking, have led to improvement of symptoms. For specific guidance regarding activity level, it is recommended to consult your healthcare professional.
In summary, you shouldn’t have to live in chronic pain as there are treatment options for low back and leg pain. Bottom line: I know that chronic pain can become a nightmare, but there is hope for healing.