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What treatment discipline follows pain management specialists?

Posted by laughlin1947 @laughlin1947, Jun 12 1:30am

I am 78 years old, male, with several diffuse disc bulges ranging from 2 mm to 6 mm, along with 23-degree scoliosis. Also, I have two sets of vertebrae that exhibit complete degenerative disc space collapse (bone on bone). Pain management specialists have not been successful in reducing/treating daily pain, so I must take ibuprofen/Tylenol approx. 5 to 6 times a day, plus Voltaren cream on the back before bed. So far, blood tests do not show liver or kidney abnormalities. Which discipline should I see next - neurologist, orthopedic specialist, neurosurgeon, or? I want the least invasive treatment possible, and I am ruling out major surgery due to recovery time. Is Radiofrequency ablation the next option?

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gilkesl | @gilkesl | Jun 22 5:57am
In reply to @laughlin1947 "Yes, I was thinking a spine neurosurgeon would be the next specialist to see. I wait..." + (show)
Profile picture for laughlin1947 @laughlin1947

Yes, I was thinking a spine neurosurgeon would be the next specialist to see. I wait to get a recommendation from the pain management doctors I've been seeing, but they seem to only want to prescribe some type of pain reliever.
As for epidurals I have had several of them over the past 3 years and the duration of pain relief has been very short each - 2 or 3 weeks at best. The doctors usually just say to come back to them in 3 months for another epidural. I wish it were that easy. The back pain resumes in a matter of days. A few days ago, I got a lower back "more precisely directed" injection (4 shots in a small area) that has now dissipated in terms of benefit.
It seems I'm headed for minimally invasive spine surgery, but there are several options there...Different Types of Minimally Invasive Spine Surgery, as follows: Microdiscectomy; Cervical Arthroplast; Minimally Invasive Laminectomy; Minimally Invasive Laminotomy; Percutaneous Fusion; Kyphoplasty; Minimally invasive scoliosis correction. I think I need to head to another hospital-based spine institute with a full staff of doctors and specialists.
Many thanks for your reply!

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@laughlin1947 Try the Mayo Clinic. They won't see you unless you have had imaging studies, have failed PT, epidurals and pain management and been referred by a doctor, but it can be a PCP. I would recommend trying to see a neurosurgeon.

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jlssurplus | @jlssurplus | Jun 22 6:34am
In reply to @laughlin1947 "So what is that therapy like? Is it specialized physical therapy targeted at scoliosis or something..." + (show)
Profile picture for laughlin1947 @laughlin1947

So what is that therapy like? Is it specialized physical therapy targeted at scoliosis or something else? I have 2 separate sets of vertebrae that are bone on bone, so I think physical manipulation of that part of my spine is only going to cause me more pain.

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@laughlin1947
Therapy is targeted at increasing core strength so that the vertabrae can be held in place so they don't slide around and affect the nerves.

Also they work on stretching out the muscles and retraining them to work the way the are supposed to. After years of everything deteriorating they try to compensate for your lost disc space and react in a way that affects your nerves.

I also found some relief from the traction to help open the disc spaces, although it was temporary.

It is worth trying as it doesn't involve a knife but is a longshot for your condition

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laughlin1947 | @laughlin1947 | Jun 22 10:38am
In reply to @annie1 "@laughlin1947 Where is your pain? Is it your back or your legs and I was wondering..." + (show)
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@laughlin1947
Where is your pain? Is it your back or your legs and I was wondering where you live and who said they would do that mild procedure? I'm 74 and I was told I'm not a candidate for mild. They said I need something much bigger which I'm extremely husband to do after reading all the complications that can happen. So I'm looking for people in their 70s who are getting minimally invasive surgery and where they're going. Thank you

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@annie1 My pain is mostly lower back pain, because I have at least one set of bone on bone vertebrae, i.e. my L4/L5 set. If I don't take ibuprofen when I feel the pain 's first mild onset, then the pain curls around to my side and abdomen. Then, it takes more ibuprofen and Tylenol to make that pain go sway. I'm 78 years old, male. I live south of Los Angeles in Orange County/Tustin. I'm very close to the Hoag Hospital set of specialty practice buildings. When I look at what the option to spinal fusion looks like, with an onerous mechanical device, I'm not so sure I like the way that looks. I may be relegated to just pain management options, such as radio frequency ablation. But I'd like to get off pain meds so my life is not regulated by the general timing of each dose. I do not have leg pain, but my legs will feel weak at times, and I just nap for an hour for my legs to recover. Then I can work out for an hour on my recumbent bike or preferably take an hour walk where I can practice proper walking technique.

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Retep51 | @peter51f | Jun 24 3:30pm

I too have problems with spine and disc with a lot pain. I looked into surgery to fix this but due to other health issues I cannot have the surgery. For a couple years I did the back steroid shots via my pain med doctor. This year those shots did not work very well. A MRI showed my problems got a bit worse. The pain doctor suggest the Radio frequency ablation as the next option? I had it done in March and it did relieve a lot of my pain. The doc said it should last 6-9 months and if needed he can do another one then.

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laughlin1947 | @laughlin1947 | Jun 24 7:46pm

That's good news. There was a full page writeup of a local woman who suffered with lower back pain terribly so. She found a spinal specialist who did the radio frequency ablation procedure, and it was a tremendous success for her. That may be the option for me. I have those 2 sets of bone-on-bone vertebrae, and I'm betting that's my problem. Thanks for the tip!

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stevenla313 | @stevenla313 | Jun 25 8:11am
In reply to @jenatsky "@laughlin1947 once recent MRI, CT studies are done then either one or both a neurosurgeon or..." + (show)
Profile picture for jenatsky @jenatsky

@laughlin1947 once recent MRI, CT studies are done then either one or both a neurosurgeon or orthopedic surgeon can do the job. I’d be sure to get a second opinion too. At 74 I too have scoliosis 22 degree lumbar right and 20 degree thoracic left plus OP, OA and multiple disk bulges of both spinal areas. I had fusion L4-S1 in 1990 after a fall. The recovery will be challenging especially if you’re debilitated before hand. You’ll need to see what the doctors suggest and I agree with others in the MILD procedure can fix you by all means do it. My fusion is with stainless steel plates and screws which have their own issues. These days titanium is used instead with great results. Good luck.

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@jenatsky just from personal experience, I suggest seeing a neurologist/neurosurgeon rather than an ortho. I’ve had 2 back surgeries done by a neurosurgeon that lasted over 20 years. And then (because my neuro retired), I’ve had an ortho do a 3rd surgery on my back & 1 on my neck.
This last back surgery has done NOTHING to help the pain that I have been experiencing for going on 4 years, so I have been referred to a Pain Specialist for a Spinal Cord Stimulator trial. (Which btw I have been pleasantly surprised at how much it does help!)

I also have had the a lot of the pain in my neck return in less than a year.

I wish you all the luck in the world in finding a solution that helps!

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