6 months, and now pain is back??

[Judi]

Hi,

I thought I was improving and getting better, and then a few weeks ago I seemed to be flared up and it isn't getting better. Can discs dislodge after 6 months? Would facets start to hurt more at 6 months? Very frustrating...Just really low back pain and going into my groin and right butt.

[annapurna]

This sounds exactly like what Laura went through. If you'd like, you can contact us by PM to set up a time to talk on the phone.

[Rosie]

Hi Judi,

As I told you, I started having problems right after my 6 mths check-up. Similar pain as you describe.

How can we define facets problems? Anyone out there has any idea? I was told by the surgeon to bend if possible backwards. If I am able to do that even a little without pain then it's not the facets.

Any activities which becomes longer than usual i.e. walk, bycicle etc... gives me problems. Tightness, stiffness, burning etc... Trying to put any pressure on the waist, hips, SI brings tenderness.

Alastair may be right by saying "the body needs time to heal after such a major surgery".

Any more info out there would be helpful.
Thks.

[livjoyful]

Rosie,
I'm sorry to hear about the return of pain. If you read my post you'll see that I too have had more pain recently. Alot of it feels like my presurgery pain. i did the bend back test and have some pain with it. hmmm... i dont know. Its not as if I can just call up my surgeon and go see him. First he's in London and second he's busy. Its seems to be my waist, hips and butt that are giving me the pain also.
keep up the PT and I'll be praying for you. I know how disappointing it is to start feeling pain again. As realistic as i was I still reallly hoped I'd be painfree after the surgery.
Best to you.

[Alastair]

Folks,
a good thing always is if you get into trouble go back to basics heat, cold, Tens Machine, it up on the exercises and just give yourself a bit of TLC.

If you're at six months you've done well and you've been through the worst of it.

Here's something to try with your PT person, and it was written by a UK patient had exactly the same situation as yourselves.

I have over developed the 'outer layer' of big muscles like the glutes etc and my abs and back muscles are in a constant state of tension, only relaxing when I lie down. And apparently I'm not using the smaller 'inner layer' of paraspinal muscles at all. The result is supposedly too much pressure on the spine and hence pain. Improving my paraspinus muscles might just do the trick.

Please try this and let me know how you get on
Best
Alastair

[Rosie]

Hi Alastair,

Thks for your adv. I can't follow PT. Surgeon adv to let it go. If I can walk every day, try to keep that which I do. If I go over my time (+ 30') in 1/X then the pain starts once I am seated.
I go for massage 1/wk. Afterwards for 2/3 days I can't do any activities otherwise, the pain is intense. BUT I notice slowly very slowly, massages are helping my deep burning/sharp cutting pain which was intolerable few wks ago and made me go back to Neurontin.
Meanwhile waiting to get a CT/dye to check if any nerve damage.
Trying to coop with this pain. Could this be "distraction pain"?

[Alastair]

Hi Rosie,
Yes this could be "Distraction Pain", the thing is that if you could develop those paraspinal muscles (which are not big), it might just help to stabilise your spine and this could be your problem.

However you must just go at your own pace - -- we all must- - -we all are different

We have a UK surgeon doing ONLY Mavaerick and it seems to be going well for his patients
Take care
Best
Alastair

[annapurna]

Six months really seems to be a problem time for so many of us. I had a return of pain at six months that was similar to part, but not all of my pre-ADR pain. In general, the big, central, ache from the disc disappeared post-ADR and never came back. Additionally, most of my leg pain and general odd nervy sensations never returned either. What did return at six months and perhaps even intensify was the sharp, spasm-type pain just the side of center-back and more or less overlapping with the SI joint.

As much as is stinks to have pain come back when we all thought that we were through with it, we all know that there are a zillion pain generators in the spine and ADR only fixes one or two of them. I started going right back to the diagnostic check lists that I used pre-ADR. An advantage to having gotten an ADR is that you know that your discogenic pain is very likely to be gone, and you know that you have (or should) have "liberated" traversing and exiting nerve roots at the ADR level as your disc space has been restored and surrounding nerves thoroughly decompressed (hopefully). So, we need to ask what's left? Candidates include:
*Discogenic pain from another level
*Nerve roots not adequately decompressed
*Facet joint pain including entrapped meniscoids, capsule irritation, etc.
*Spasming muscles from long-standing trigger points recently activated
*Inadequate ligaments and other connective tissue - especially in the SI area.

I'm sure that there are more, but, these are the ones my pain management doc and I tend to focus on with me. As far as which one(s) are causing pain, the best way to find out is with diagnostic injections. Imaging studies can tell you if there is an abnormality, but only injections can tell you what hurts. There are special types of diagnostic injections specific to each of the above-listed structures. For instance, selective nerve blocks are effective for identifying individual irritated nerves. Trigger-point injections can identify and even disable painful muscular trigger points that cause muscle spasms. Sacroiliac injections can diagnose general SI joint pain as well as some SI ligament pain. Specific injections into ligament attachement points can identify painful ligaments and associated connective tissue. If you've had ADR, I'm sure you're familiar with discograms which differ from the other injections in that they identify painful structure by provoking rather than removing pain.

The need for specific diagnostic injections is especially true for facet pain. I have heard more myths concerning facet pain manifesting one way or another. My pain management doc has told me that he sees it all - arthritic facets that are totally painless, normal-appearing facets that are painful, facet pain on extension, facet pain on sitting, you name it. Every reliable journal article I have read has said that facet pain can only be conclusively diagnosed with diagnostic injections. A good set of medial branch blocks applied under fluoroscopy takes about ten to fifteen minutes per level per side (or less) and generally hurts less than getting a tooth filling. Medial branch facet blocks block the nerves serving the entire facet joint and, therefore, tend to be very good indicators of whether the facet joint in question is a real pain generator or not. I like to get them with no sedation as it's not really needed and also because it's easier for me to see if my pain has decreased if I'm not woozy. I also like a long-acting local anesthetic block that gives me time to walk around, bend, sit in the car, etc. and determine how my pain level has or has not changed.

This is not to say that imaging is not a good idea. I like to use both imaging and diagnostic injections, personally, as that seems to strike the best balance between invasive (injections) and non-invasive (imaging). A good MRI operator and radiologist should be able to "throw" the metal artifact of your ADR forward and get a great image of your facet joints and some nerve roots at the ADR level. My local radiologist has helped me track the condition of my facet joints since my ADR surgery. We now have annual MRI's of my L5/S1 (ADR-level) and L4/L5 facets for the past three years. Although they are arthritic, they show no evidence of advancing degeneration over this time-frame. Additionally, they show no evidence whatsoever of swelling or synovitis, both of which are typically associated with painful arthritic joints. My radionucleide bone scan says the same thing - no "hot spots" that would indicate bony activity associated with active degeneration. My diagnostic facet injections have repeatedly turned up dead-negative or inconclusive. Putting all these different studies together, my pain management doc and I have concluded that, for the time being, the majority of my pain is coming from somewhere else. We're focusing on ligament and muscular pain sources as we've already ruled out nerve root issues the same way we did the facets.

Hope my example gives you some ideas of how to work with your doctors to root-out your current pain generators and deal with them appropriately. Pain stinks, and the more we understand about what causing it, the better we are able to make it go away.

Prayers and good wishes to all.

Laura

[Rosie]

Dear Laura,

Thk you very much for your wonderful explanation. I can see my pain is very similar to what you describe.

This really applies to my case:
- spasming muscles from long-standing trigger points
- Inadequate ligaments ... - especially in the SI area.
I had a laminectomy 9 yrs ago. B/4 ADR/fusion my lower right had a constant nagging pain and I could feel a small "hole" from the back right area.
Post-ADR the "hole" and this constant nagging had totally disappeared and to date never returned.
At present I sense my spinal structure is back to its place (balance) and good posture but now my left has taken a toll b/c for yrs it has compensated for its work.
Does this make sense to you? I could be wrong.
My constant complain is around the SI area. I wonder if the CT/dye will be able to detect the complete image. Have you had one?

How long ago was you ADR? How do you coop with your daily function?

I have heard people saying "give yourself at least 1 yr for recovery" etc...

Livjoyful, it has not been 6 mths for you! Am I correct? We all had this dream to have "a pain free" life post ADR! Never thought pain would return in 6 mths time.

Once again thk you for sharing this with us.

[Rosie]

Alastair thk you for your tips. They say "distraction pain" could last up to 2 yrs!
I notice if I go at my own pace, I can control my pain but it does not seem to get better as the month goes by.