Private medical care for spinal disc degeneration
September 1, 2024 4:07 PM
I have been in need of medical care for years for life-altering hip and back pain due to sciatica and disc degeneration. There is socialized medicine where I live but it's broken now due to politicians gutting it deliberately, to "show" it "doesn't work". It used to before this. What are my options for private care, globally?
I already know this is potentially contentious so please be kind. Over the past few years I've spent literally thousands of dollars on different physio that made it worse, even with the best possible practitioner, please trust that assessment. I've paid for acupuncture and chiropractic, which I don't even believe in.
I paid thousands out of pocket for an MRI, as there was no chance of getting one in the next two years otherwise. The MRI showed arthritis and disc degeneration.
I've spent much more even on mattresses and other equipment together try to alleviate the pain. At this point I may as well have been paying for private care, cost wise.
As the latest example, I've now been waiting on a physiatrist appointment for 11 months. It was going to be 8 when originally referred which was fine, I do understand the prioritization in this system, but at the 9 month mark the clinic responded to my GP that they had no room, so now I'm back in a waiting period for another clinic. Who knows how long this cycle will continue.
I recognize this is privileged but it's also desperation. I haven't been able to exercise in seven years and I haven't been able to sit at a desk for the last three (I stand, but this makes things worse in other ways). Sitting for a long period for meetings or flights puts me in pain for weeks.
I am not looking for books, or for stretching recommendations. I need a medical solution to a worsening medical condition.
What are good options for private care in Canada, or anywhere else in the world? What are even the search keywords to find something that isn't sketchy? There are lots of options out there but how do I select one if I don't know what treatment is appropriate and want to be fully assessed and given options?
Barring that, what is the name of the medical intervention that worked for you or someone you know, so that I could maybe investigate? I'm not looking for medication (already on gabapentin and can't take pregabalin, and I don't want opioids) or cortisone shots, I'm hoping to find a lasting solution.
I already know this is potentially contentious so please be kind. Over the past few years I've spent literally thousands of dollars on different physio that made it worse, even with the best possible practitioner, please trust that assessment. I've paid for acupuncture and chiropractic, which I don't even believe in.
I paid thousands out of pocket for an MRI, as there was no chance of getting one in the next two years otherwise. The MRI showed arthritis and disc degeneration.
I've spent much more even on mattresses and other equipment together try to alleviate the pain. At this point I may as well have been paying for private care, cost wise.
As the latest example, I've now been waiting on a physiatrist appointment for 11 months. It was going to be 8 when originally referred which was fine, I do understand the prioritization in this system, but at the 9 month mark the clinic responded to my GP that they had no room, so now I'm back in a waiting period for another clinic. Who knows how long this cycle will continue.
I recognize this is privileged but it's also desperation. I haven't been able to exercise in seven years and I haven't been able to sit at a desk for the last three (I stand, but this makes things worse in other ways). Sitting for a long period for meetings or flights puts me in pain for weeks.
I am not looking for books, or for stretching recommendations. I need a medical solution to a worsening medical condition.
What are good options for private care in Canada, or anywhere else in the world? What are even the search keywords to find something that isn't sketchy? There are lots of options out there but how do I select one if I don't know what treatment is appropriate and want to be fully assessed and given options?
Barring that, what is the name of the medical intervention that worked for you or someone you know, so that I could maybe investigate? I'm not looking for medication (already on gabapentin and can't take pregabalin, and I don't want opioids) or cortisone shots, I'm hoping to find a lasting solution.
I know you said that you don’t want medication but I have had success for my hip pain with low-dose naltrexone. It is not habit-forming and has fewer side effects than steroids.
Look into radio-frequency nerve ablation for sciatica.
posted by mai at 5:26 PM on September 1
Look into radio-frequency nerve ablation for sciatica.
posted by mai at 5:26 PM on September 1
It sounds like you maybe at the point of being interested in medical tourism.
The CDC includes this information to help patients look up credentials for international medical facilities. Hope this at least helps you get started on finding a workable solution!
Facilities
Accrediting organizations (e.g., The Joint Commission International, Accreditation Association for Ambulatory Health Care) maintain listings of accredited facilities outside of the United States. Encourage prospective medical tourists to review these sources before committing to having a procedure or receiving medical care abroad.
posted by forkisbetter at 6:04 PM on September 1
The CDC includes this information to help patients look up credentials for international medical facilities. Hope this at least helps you get started on finding a workable solution!
Facilities
Accrediting organizations (e.g., The Joint Commission International, Accreditation Association for Ambulatory Health Care) maintain listings of accredited facilities outside of the United States. Encourage prospective medical tourists to review these sources before committing to having a procedure or receiving medical care abroad.
posted by forkisbetter at 6:04 PM on September 1
I have had back issues since I had my first lamenectomy (sp?)when I was 15. Now, I ha ve had a lumbar fusion and cervical fusions. I have a long history of degenerative discs. I am not sure there is a magical solution even if you can afford to seek it out and pay for it. Surgery helps in the interim period. As I have gotten older, surgery that helped me when I was younger (L4-L5 fusion) now is working against me as it has put pressure on L5-S1 and I could need a fusion there soonest. I totally get that you do not want opioids, but my experience is that they have helped immensely during periods, short periods of great pain. The thing that seems to help is keeping my core strong. The problem is that often when working the core, you are putting pressure on the lower back. If I can fight through that pain, the outcome is a stronger core and less pain down my leg.
I don't know anything about the Canadian healthcare situation. If you were in the US, I would recommend as a next step, seeing a pain specialist and getting an epidural. The success rate is lower than you would want if you were paying for it yourself, I think around 75%, but when it works, it works. Pain gone. Mine (4) have lasted months to years.
As far as I know, there is no magical solution to degenerating discs. Most solutions such as fusions help with the pain, but they are not permanent solutions. They may last a decade or longer, but they mostly address the symptoms rather than reversing the cause.
posted by JohnnyGunn at 6:41 PM on September 1
I don't know anything about the Canadian healthcare situation. If you were in the US, I would recommend as a next step, seeing a pain specialist and getting an epidural. The success rate is lower than you would want if you were paying for it yourself, I think around 75%, but when it works, it works. Pain gone. Mine (4) have lasted months to years.
As far as I know, there is no magical solution to degenerating discs. Most solutions such as fusions help with the pain, but they are not permanent solutions. They may last a decade or longer, but they mostly address the symptoms rather than reversing the cause.
posted by JohnnyGunn at 6:41 PM on September 1
University of California Television: Osher Mini Medical School: Future of Back Pain Management. Here is a link to a library of different back pain specialists talking about different treatments. The lectures are free and offer reliable medical information from doctors on the faculty of UC San Francisco and other UC Campuses, which have top notch medical facilities. You can pick and choose what sort of treatments and issues are of interest to you. I hope you find some helpful resource information and get the effective medical treatment to relieve your issues.
posted by effluvia at 6:48 PM on September 1
posted by effluvia at 6:48 PM on September 1
I've heard the fellow who wrote this a number of times and he's very highly regarded. I wonder if there's anything in there that would help you navigate. I'm so sorry you're going through this -- I had a bout of sciatica that lasted maybe a month? decades ago, and I wouldn't wish it on my worst enemy.
posted by kate4914 at 8:36 PM on September 1
posted by kate4914 at 8:36 PM on September 1
https://www.arthritis.org/diseases/degenerative-disc-disease
Yeah surgically it’s pretty much spinal fusion - or if you have **significant** bone spurs that are causing neurological symptoms, those being shaved down. A relative had emergency cervical fusions done… like Johnny Gunn said, there’s never just one surgery, because of how stress transfers to other vertebrae. Revisions and further fusions are common.
Alternatively it has to be pain control and strengthening muscles in your back.
I went to a pain clinic for a slight fracture in one vertebrae. Like you was offered gabapentin which I did accept. Cymbalta (low dose antidepressant) was another option I rejected.
Additionally, **if there are no other medical conditions** (like GI problems, kidney or liver issues), you could try alternating Tylenol and Robax Platinum (has Advil in it plus methocarbamol, a muscle relaxant). If you can’t have Advil for GI reasons you can do Robaxacet (which is Tylenol plus methocarbamol, instead of Robax Platinum), and maybe Naproxen + omeprazole).
A relatively safer combo (my dad aged 91 does this for severe DDD ) is max dose Tylenol plus Voltaren (a topical NSAID) which should be easier on your organs.
Some people do cannabis, you should know it (specifically the CBD in it) potentiates other meds especially blood pressure medications if you’re on those.
A TENS machine might be useful for non drug pain control.
For back strengthening see Stuart McGill’s book Back Mechanic. If you’ve done all that PT you can probably adapt it with some understanding of your pain points.
Key point from that book. Consider ALL your ergonomics in your daily life. I know you’ve looked at mattresses. For me, comes down to minutiae like I can only wear one specific super light bag, at a certain weight, with the strap at a certain length. Light as possible. If the strap buckle slips and it’s too long, I double over in pain. It’s that nitpicky. I have one super light and super well balanced backpack I can wear with a limited load.
SHOES. High heel drop. I wear orthotics too. Heel lifts under the orthotics. For many people with back pain this helps. Tilts the pelvis forward a little and opens up the spaces between the vertebrae. My engineering here may not work for you, you should see someone who does orthotics and get advice and then see for yourself.
But this is what I mean, you have to be mindful of everything that touches or weighs on your body.
With my shoes, orthotics, heel lifts, 2 usable bags, I am MOSTLY off the pain meds I had to take for a long time. The pain meds were necessary to get me through yo this biomechanics homeostasis. Also to desensitize the pain loop my nerves were committed to. Sometimes if the overall pain level is tamped down for a while things can chill out.
Also not sure where you’re located but I’m a regular at Athlete’s Care. There are docs I would recommend over others - memail me if you’re in the GTA.
posted by cotton dress sock at 10:11 PM on September 1
Yeah surgically it’s pretty much spinal fusion - or if you have **significant** bone spurs that are causing neurological symptoms, those being shaved down. A relative had emergency cervical fusions done… like Johnny Gunn said, there’s never just one surgery, because of how stress transfers to other vertebrae. Revisions and further fusions are common.
Alternatively it has to be pain control and strengthening muscles in your back.
I went to a pain clinic for a slight fracture in one vertebrae. Like you was offered gabapentin which I did accept. Cymbalta (low dose antidepressant) was another option I rejected.
Additionally, **if there are no other medical conditions** (like GI problems, kidney or liver issues), you could try alternating Tylenol and Robax Platinum (has Advil in it plus methocarbamol, a muscle relaxant). If you can’t have Advil for GI reasons you can do Robaxacet (which is Tylenol plus methocarbamol, instead of Robax Platinum), and maybe Naproxen + omeprazole).
A relatively safer combo (my dad aged 91 does this for severe DDD ) is max dose Tylenol plus Voltaren (a topical NSAID) which should be easier on your organs.
Some people do cannabis, you should know it (specifically the CBD in it) potentiates other meds especially blood pressure medications if you’re on those.
A TENS machine might be useful for non drug pain control.
For back strengthening see Stuart McGill’s book Back Mechanic. If you’ve done all that PT you can probably adapt it with some understanding of your pain points.
Key point from that book. Consider ALL your ergonomics in your daily life. I know you’ve looked at mattresses. For me, comes down to minutiae like I can only wear one specific super light bag, at a certain weight, with the strap at a certain length. Light as possible. If the strap buckle slips and it’s too long, I double over in pain. It’s that nitpicky. I have one super light and super well balanced backpack I can wear with a limited load.
SHOES. High heel drop. I wear orthotics too. Heel lifts under the orthotics. For many people with back pain this helps. Tilts the pelvis forward a little and opens up the spaces between the vertebrae. My engineering here may not work for you, you should see someone who does orthotics and get advice and then see for yourself.
But this is what I mean, you have to be mindful of everything that touches or weighs on your body.
With my shoes, orthotics, heel lifts, 2 usable bags, I am MOSTLY off the pain meds I had to take for a long time. The pain meds were necessary to get me through yo this biomechanics homeostasis. Also to desensitize the pain loop my nerves were committed to. Sometimes if the overall pain level is tamped down for a while things can chill out.
Also not sure where you’re located but I’m a regular at Athlete’s Care. There are docs I would recommend over others - memail me if you’re in the GTA.
posted by cotton dress sock at 10:11 PM on September 1
^^ those OTC med combos were suggested by doctors to me or my dad, btw, but obviously you should be evaluated by someone even for that. Not sure someone a lot younger than my dad would get max dose Tylenol for years on end for example.
posted by cotton dress sock at 10:23 PM on September 1
posted by cotton dress sock at 10:23 PM on September 1
It was an orthopedist who found the arthritis in my neck. That orthopedist also gave me a prescription for meloxicam, which was an amazing lifesaver. 4 months on that and I haven’t been in severe pain since. He also referred me to a pain management clinic, which is another term you might want to search. I haven’t been yet - the meloxicam worked that well.
Anyway, I recommend you start your journey with a consult with an orthopedist. Here’s a link I found - cannot speak to whether it’s true or not. I would guess that coming from Canada you probably want to start in the US. This link is somewhat dated but may also give you a few places to look. The Mayo Clinic, for example, apparently has an orthopedic unit and they are presumably accustomed to international patients.
posted by mygothlaundry at 8:00 AM on September 2
Anyway, I recommend you start your journey with a consult with an orthopedist. Here’s a link I found - cannot speak to whether it’s true or not. I would guess that coming from Canada you probably want to start in the US. This link is somewhat dated but may also give you a few places to look. The Mayo Clinic, for example, apparently has an orthopedic unit and they are presumably accustomed to international patients.
posted by mygothlaundry at 8:00 AM on September 2
First of all, I'm so sorry. As someone who has had chronic back pain for more than two decades I know how horrible this can be. Like you I have tried all kinds of physio, osteo, needling, acupuncture etc. I have actually made it in to see a physiatrist (was not helpful). MRIs show a bunch of degeneration and stenosis.
My back pain is mostly managed these days so I just wanted to give you a little bit of hope. I'm not saying it doesn't hurt (it does, always), but it is very manageable and I live a very good, active life. In my case I have been able to mostly manage it through religiously exercising (daily, though I had to work up to this over a period of years, and I keep active in a number of different ways) and keeping a strong core, doing reading and exercises about chronic pain and the relationship to the brain/personal history (pain reprocessing therapy basically), avoiding sitting on chairs as much as possible, and pain/sleeping medication immediately whenever I hit a flareup period (I have pregablin but will also alternate over the counter NSAIDS, heat, baths and hanging in a harness when it is really bad). I also do some stuff that I'm not sure helps but can't hurt (super hard mattress, turmeric and ginger for inflammation, make sure to keep digestion working well). I try to avoid thinking about the pain as much as possible (I realize this probably sounds totally impossible but it has helped me enormously).
To answer your question, I would have your GP refer you to a pain management clinic and be as open as you can to the biopsychosocial model of pain management, even if you think you have already tried everything.
posted by Cuke at 10:41 AM on September 3
My back pain is mostly managed these days so I just wanted to give you a little bit of hope. I'm not saying it doesn't hurt (it does, always), but it is very manageable and I live a very good, active life. In my case I have been able to mostly manage it through religiously exercising (daily, though I had to work up to this over a period of years, and I keep active in a number of different ways) and keeping a strong core, doing reading and exercises about chronic pain and the relationship to the brain/personal history (pain reprocessing therapy basically), avoiding sitting on chairs as much as possible, and pain/sleeping medication immediately whenever I hit a flareup period (I have pregablin but will also alternate over the counter NSAIDS, heat, baths and hanging in a harness when it is really bad). I also do some stuff that I'm not sure helps but can't hurt (super hard mattress, turmeric and ginger for inflammation, make sure to keep digestion working well). I try to avoid thinking about the pain as much as possible (I realize this probably sounds totally impossible but it has helped me enormously).
To answer your question, I would have your GP refer you to a pain management clinic and be as open as you can to the biopsychosocial model of pain management, even if you think you have already tried everything.
posted by Cuke at 10:41 AM on September 3
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posted by shock muppet at 4:36 PM on September 1