October 5, 2012

My Doctors and Me: an Update. 3) Back Pain

This is the final installment in a three-part review of recent visits to my three most important specialists. The first dealt with the latest in the semi-annual checkups I've been having for over 16 years with my urologist, Dr. Nicolas Constantinople, to monitor my prostate cancer. The second was an interview with my neurologist, Dr. Laxman Bahroo, during my last Parkinson's checkup.

Yesterday, I met with Dr. Thomas Heckman at Sibley Hospital's Pain Center to discuss my 13-month struggle with lower back pain. I'm still not certain what has caused it, and -- to put it mildly -- I'm eager to get some relief.

The Story of My Aching Back
Like so many others, I've been bothered by lower back pain and sciatica for years. But since working with a great physical therapist, Tom Welsh, for about five years, I've been pain-free... as long as I follow the simple exercises he recommended I do every day.

Everything changed when I totaled my car in August last year. I was taken by ambulance to George Washington University Hospital, where I spent several days in the trauma unit and was given all sorts of X-rays and other tests. The doctors concluded I'd injured my upper spinal column and prescribed a neck brace.

The pain was concentrated at a particular spot on the lower left side of my back, so I questioned the neck damage diagnosis. When I got out of the hospital, I went to an orthopedist who took new X-rays that showed a fracture on the L-1 vertebra.

That specialist said it would take about four months for the fracture to heal, after which I should be pain free. I went back for a checkup after four months, and new X-rays showed the vertebra had healed. But the back pain continued to emanate from the same spot.

He re-examined the X-rays and found a heavy accumulation of arthritis in the bones where the pain was centered. As a result, the orthopedist now attributed the pain to arthritis.

From the beginning, the arthritis diagnosis just didn't seem right. I had no back pain before the crash. The pain that started with the car crash remained the same. The only change was the diagnosis. Hmmm.

The Search for the Holy Grail -- 1. Sibley's Pain Center
A friend who'd had lower back pain recommended  a pain specialist at George Washington Hospital. It turned out he and his associate worked part of the week at Sibley Hospital, just a five-minute drive from my house and my favorite area hospital. So I got an appointment in January which the associate, the aforementioned Dr. Heckman, at Sibley's Pain Center.

Dr. Heckman reviewed the X-rays, the report from my orthopedist, and my GWU Hospital file. Then he recommended steroid injections to reduce the inflammation that accompanies arthritis and causes the pain. We tried them, but without success. Dr. Heckman said about two thirds of his arthritis patients typically benefit from the injections, and suggested that arthritis might not be the culprit. The origin of back pain isn't easy to identify, he explained. And in my case, X-rays showed not only arthritis, but also age-related deterioration in the lower spine.

Next, we tried trigger point injections (TPI). Trigger points are knots of muscle that form when those muscles don't relax. The doctor inserts a small needle into the trigger point and injects a local anesthetic that often includes a cortiscosteroid. The trigger point is then made inactive, and the pain goes away... if the procedure works. It didn't for me.

The lidocaine pain-relief patch came next. It's like a big Band-Aid applied to the skin over the pain spot. Europeans get about one fourth of their pain relief from patches or creams; the Chinese relieve about half their pain that way. In the U.S., we pop pills about 88 percent of the time for pain. For me, the result from this procedure was the same as all the others I'd tried so far: nada.

Next Up: Acupuncture and Reiki
Several friends told me that acupuncture had helped relieve their pain. This spring, a new wellness center opened in the neighborhood, just blocks from Sibley. It offered acupuncture, so this confirmed neophiliac signed on. The center also had a special introductory offer for reiki, the Japanese Buddhist hands-on technique designed to transfer healing energy from the therapist's hands to the aching body. So -- what the heck -- why not try that, too?

I was intrigued to learn that both the acupuncturist and reiki therapist were formerly practicing lawyers. The reiki practitioner had even worked as a legal editor at BNA (now Bloomberg/BNA), where I worked for 40 years. Small world.

I tried both therapies for several weeks. They were interesting and relaxing, but the back pain persisted.

I may take another look at acupuncture, however, since I saw a recent research study that suggests acupuncture may help treat Parkinson's.

On to Chiropractic!
Other friends said treatment by a chiropractor had helped them. I've seen the warnings: there are a lot of quacks out there, so do your homework first.

I was given the names of several chiropractors. During my first experience, the "quack alert" went off loud and clear as soon as I entered the facility. I paid for the introductory session and hurried out of there. The second facility I saw had a reassuring atmosphere of professionalism.

Until last week, I'd been getting chiropractic treatment three times a week for several months. At first, I thought I was sensing some pain relief. But I reminded myself that I'd felt the same initial "placebo effect" each time I'd tried a new procedure. I'm so desperate for relief, I readily delude myself into believing "this time I've found the cure."

A week ago after a more-aggressive-than-usual chiropractic session, I woke up the next morning with excruciating pain, unlike anything I'd experienced before. This distress persisted through several mornings. Finally, more than a week later, the sharp pain is abating.

I'm not sure there's a cause-and-effect relationship between the chiropractic session and the pain flare-up, but I'm re-evaluating the time and money I'm spending on chiropractic, especially since there's been no clear benefit.

So, Back to Sibley's Pain Center 
I decided last week that it was time -- probably well past time! -- to get back to traditional medicine. I was surprised to find that my last visit to Sibley's Pain Center was in early March. I had spent seven months on my alternate medicine explorations. The pain was still there. My sense of well-being had deteriorated, probably because I'd cut way back on my walks and other exercises.

When I got back with Dr. Heckman last week, he took another look at the X-rays and other data in my file. After we talked, he concluded there were several other possibilities, with different treatment options.

We decided to try a medial branch nerve block. The medial branch nerves radiate from the spine and carry pain signals from the spine joints. The X-rays suggested that two joints might be rubbing together.

The  procedure required X-rays to determine the exact location of the nerve before injecting something to deaden that nerve. Again, I felt mild relief the first day but -- like before -- wishful thinking may have played a key role.

I consulted with Dr. Heckman Thursday morning, and he now wonders if something other than traditional arthritis is the culprit. To get a fuller picture, I'm going in for an MRI this morning. We'll talk next week about where we go from here.




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