How to be sure of pain source ?
 

I had ADR surgery six months ago which has not worked. A clearly degenerated looking disc was replaced and my pain is exactly the same now as it was before the operation. Apart from the possibility of the facet joints, (which look fine on film) and a different disc (all of which also look fine) surgeons don't seem to have an idea what the pain source is. I am surprised my description of the pain.....ie location, causes and nature.......do not give them a better chance of knowing where it is coming from. In other words it seems that the nature of facet joint pain and disc pain is very similar........is there any resource which attempts to describe the placement and kind of pain associated with these two different pain sources..........and have I overlooked any other possible pain sources to account for the hot, burning pain next to my buttock and coxcyx (right hand side) which is fine when walking but awful on sitting and not good when lying or standing ?

Diagnosing back pain is very difficult and imprecise
 

William,

I assume you had a discogram done on your diseased disc before you had it replaced? Discography is an imperfect science and the source of much debate in the spine community, but most surgeons agree it is still a good tool to verify the diseased disc is indeed the pain source. Have you had injections in your facet joints, to verify they are not a pain generator (even though they look fine on film)? Most agree the only way to be sure the facet joints are not a pain generator is to have a diagnostic injection, if you get no pain relief then you can rule out the facets as a pain source.

Spine surgery has such a low success rate (about 60%) compared to surgeries like knee, shoulder and hip because it is so hard to diagnose with real certainty where the pain is coming from. Sadly, the world is chock full of people that had back surgery (fusion or ADR) for a diseased disc, and their pain did not go away. My surgeon told me that the nerves in the spine do not operate like those in your fingers for example, and so back or neck pain can be from literally dozens of possible sources.

Don't give up, consult with as many specialists as you can and get diagnostic injections or other tests (Myelogram, CT Scan, MRI with contrast) until you can find the pain source. I know all too well what it is like to be in pain every single day, I wish you the very very best.

Good luck,

Thanks for reply Charles in charge. As a matter of fact I did not have a discogram. My surgeon was so convinced by the pictures of the pain source (a distinctly degenerated disc with annular tear in evidence) and nothing else remotely suspicious including healthy looking facet joints, that he suggested bypassing the discogram as he maintained they often give 'false negative' results in any case and are not reliable. Yes, in retrospect I should have insisted.......I have since had diagnostic injections into the facet joints which have offered some relief but not utterly convincing......next week however, as a result of these injections and their partial success, I am having some nerves severed to give longer pain relief. This may or may not work......I am slightly anxious that by removing pain signals, I will be unknowingly exacerbating the pain source so that by the time the nerves grow back, my situation will be even worse. Anyone any thoughts on this ?

William,

I am sorry your disc replacement has not relieved your pain, I know you did much reserach before undergoing the surgery and it must be devastating to undergo the operation and it to have no effect. I got three plus years great relief but I have gone on to develop further DDD at the three levels above my prostheses and facet arthrosis at the level of my ProDiscs. I, too, got relief from facet injections. I was offered radio frequency nerve ablation last year as the next step in providing longer relief, but when I researched the procedure, I was put off as some research seems to suggest that when the pain returns it can be worse. When I discussed this with my surgeon he agreed that sometimes ablation can cause neuroma and we/I decided not to persue the ablation at this moment in time. This sort of fits in with your idea that the ablation doesn't treat the cause and when the nerves grow back the pain may be worse...could it be due to progression of degeneration?? The treatment can be repeated though. If I can find the article I will forward it to you.
Saying that there are members here who have significant relief following ablation.

As Charles has said, finding the pain generator can be very difficult and the spine truly is complex.

Please let us know how you get on William, I have not ruled out ablation, I'm just not ready for it yet as I'm unsure.

Best wishes

Lynda

William and Lynda,

Although I have not ever had the ablation on my lumbar area, I do get it performed on my cervical area, about once a year. I swear by it on my neck. I typically get close to a whole year of relief. That's a lot of time. I just had one done again a few weeks ago, no probably closer to a month ago, and my neck feels great. I can't say I've noticed the pain to be worse when the nerves grow back. I just know it's time for another radiofrequency rhizotomy when the pain comes back full force. Hope this helps some.

Thanks Cindylou,

Its reassuring that the pain didn't worsen for you when it returned and a years pain relief is substantial.

Perhaps I'll ask again for them at my next appointment. Do you know if they can be continued on an as needed basis indefinatley?

Regards

Lynda

lynda,,

To the best of my knowledge, yes.

William, sorry for not replying earlier. If you are still scheduled for treatment this week, good luck with the procedure. Good luck and let is know how it goes...

:)