Excruciating back pain - what to do next?
September 2, 2017 3:03 AM   Subscribe

After a few episodes of sciatica over the last year, I started physical therapy. After 2 months and not much relief or change in pain and frequency, I was sent to get an MRI and to a physiatrist. The MRI showed 2 herniated discs in the lumbar region of my spine. More details inside

The physiatrist told me time (and proper exercise) was the primary cure. He also gave me an epidural injection, which relieved the pain for about a month. The pain came back, though, and so I scheduled another epidural for this past Friday (yesterday), as my wife and I are going on a 12 day vacation the UK in 11 days from now, and I wanted to make it more enjoyable.

Coincidentally, and I guess fortunately, I woke up yesterday morning (2 hours before my epidural appointment) in agonizing pain, no matter whether I was laying, sitting or standing, Just a few positions offered the slightest bit of relief. My first attempt to get out of bed left me lightheaded from the pain, with pins and needles shooting down my leg, as well. I was incredibly anxious and confused, as I've never experienced anything like this before.

My wife drove me to the epidural procedure (I was in the back seat, on all fours) and I told the doctor what was going on. He told me my back was spasming and aggravating the nerve. He said the epidural would hopefully offer relief, as it had for my pain the first time, told me to ice the area often, and prescribed hydrocodone. I have a few cyclobenzaprine left from when I had the sciatica, which he told me I could take, also.

The rest of the day was unpleasant, and I had to shift positions between various ways of laying and standing. Sitting normally in a chair is still difficult if not impossible from the pain. It's also now 6am, and I was only able to sleep on and off for a few hours, total. I'd wake up from pain, or from my body wanting me to change positions, which is incredibly difficult and painful.

So I'm now here, hoping for some stories of recovery from something like this. Can I expect this to clear up in a day or two? What if it doesn't? Should I go to the ER or urgent care for some sort of additional pain relief? I'm just feeling panicked, upset and helpless. If it comes down to it, we may have to cancel our trip to the UK. That would be incredibly upsetting but at this moment, all I want is for this pain to go away.

I'm 33 and in good health aside from this. My mom had herniated discs in her 20s and would throw her back out many times during her life. She told me yesterday she opted not to try surgery, and in most cases her episodes would go away in a day or two. I'm now terrified of this not only not going away but of it recurring again in the future. What advice can you offer to lower the chances of that happening? I can work from home if needed, so I have some relief as far my job goes, but a quick google search reveals some people can be like this for weeks or months, and that scares the hell out of me. I don't know how I'd handle that with my employer.

Greatly appreciative for any advice or positivity you can throw my way.
posted by arm426 to Health & Fitness (20 answers total)
Have you called your doctor yet? Because that should be your first-line reaction--call and tell them that the epidural hasn't offered relief, that the pain is so intense that you can't sleep, and you'd like further instructions. I wouldn't go to the ER or urgent care without speaking to your doctor first, because they're likely to treat you as a drug seeker and refuse to help. If you call your doctor first, even if they can't or won't help, they might be willing to call the ER to alert them that you're coming in, which, in my experience, does a lot to mitigate the lots of pain on a holiday weekend = drug seeker effect.
posted by mishafletch at 4:15 AM on September 2, 2017 [2 favorites]

My experience with L5-S1 was I elected not to have surgery. After six months the sciatica started to subside. Physical therapy was essential. Also essential is to find that wee neutral spot where your pain remits and then use pillows or what have you to find that "spot" for intermittent relief which the physical therapist helped me locate. Sorry to say, but recovery is a slow process, or at least it was in my experience, my pain finally was gone in about three years. Fortunately I was able to use Vicodin or hydrocodone for the pain and at the back end weened off with no problems transitioning to naproxen.

My activity consisted of standing (relief) or laying down (relief), sitting was a bear. It's best to try to remain active as possible or as directed by your doctor or physical therapist.

Try not to panic; this is a recovery process that is going to take time.

I vigilantly held to lifting weight limitations set by the doctor and physical therapist 20lbs. I use a dolly to move anything with excess weight, rolling luggage at all times or hire assistance; modify your life to your heart's content - you have too. At work I had no problem declining to renew the water dispenser with a new jug for instance. No beyond your limit lifting, ever, don't chance it.

On researching surgery versus conservative therapy (no surgery, but rest and physical therapy) I saw reports where, after five years the outcome was essentially the same, though surgery can lead to more complications down the line, i.e., bones spurs, etc. at surgery site. My physical therapy lasted almost nine months and "saved my life" really. Follow up PT is also helpful with flares.

Of note though, if you find no improvement in the sciatica after months and especially if you have progressive severe persistent numbness in your lower extremities or your feet, or worse, start losing continence of the bladder, surgery is likely essential to relieve those symptoms.

I am not a doctor, your mileage may vary. This is my experience only.

Oh, and I hate to advise this, but I would likely postpone the trip to the UK; give it a try next year.
posted by WinstonJulia at 4:23 AM on September 2, 2017 [4 favorites]

I was you a few years ago. I had a herniated disc (l5 s1) that progressively got worse until I could only sleep a couple hours a night, could barely walk and was only marginally able to function at all. I was 32 at a time and tried everything to avoid surgery. Eventually when I couldn't take it anymore My wife drove me to the neurosurgeon's office where I had an MRI a month prior. They scheduled me for surgery the next morning--laminectomy/discectomy. The intense pain was immediately gone when I woke up from surgery. I still have to do a lot of stretching and exercise to keep my back muscles strong or my back will get sore. But overall I'm good and am even back to running again.
posted by unreasonable at 4:28 AM on September 2, 2017 [2 favorites]

I had two lumbar herniated discs that were treated with exercise and epidurals for about five months. I had some really intense sciatica during this time, but it did improve somewhat before it got worse again. I had the microdiscectomy surgery one year ago, and that was basically a cure. As it was explained to me by my surgeon, it's a pretty simple procedure with not a lot of risks. Although I was in a lot of pain for about a week after surgery, I was back to swimming three weeks after surgery and commuting to work by bicycle about 4 weeks after. The sciatica was about 95% gone after two months. Today, I can still feel it at times with certain positions, but it's not really painful. More like I just notice a little static in my leg with those positions.

I'd highly recommend that you talk to a spine surgeon about this procedure if conservative treatment hasn't worked for you. I've met other people who've had the surgery and so far I haven't met anyone who has regretted it or didn't get better. It's supposed to have a 95% success rate.

Anyway, I know I sound like an ad for spine surgery, but it really helped me and I think it's good to share success stories. It seems that everyone has misconceptions about back surgery and thinks it is the worst thing you can do to yourself, when in my experience that is definitely not the case.
posted by crLLC at 5:29 AM on September 2, 2017 [1 favorite]

I had an epidural 17 days ago for 3 damaged/slipped disks, and the pain only went away after 13 days. My doctor told me it could take a week to work, I wasn't in as much pain as you are however. I've been told that here in France, the surgery is rare.
posted by ellieBOA at 6:23 AM on September 2, 2017

I was off work for 10 weeks with an L3-L4 herniation. For the first 5 I was in excruciating pain unless I was on my back. I had two injections, took a bunch of painkillers, gabapentin, and did a ton of physical therapy focused on my core (that PT went on for six months). The injections were not the instant relief that some others report, and my second doctor set that expectation with me.

I couldn't have taken a trip to the grocery store, much less gone on vacation, and solely focused on recovery.

I have a few very minor twinges every now and again since then (~4 years ago), but I'm back to running and cycling, and consider myself fully recovered.
posted by Gorgik at 6:36 AM on September 2, 2017

I work on people with herniated discs regularly (I am a registered massage therapist). I usually have a good outcome regarding pain relief and mobility. Things like muscle spasms and chronic pain can typically be addressed pretty readily with massage therapy. You probably need work on your low back, hips, glutes and possibly abdomen. I don't know treatment protocols in your area so I don't know how much you can expect to get done.

Massage, physical therapy and time improves people's symptoms quite often but can also become an ongoing maintenance requirment for some. The type of herniation will have an impact on the effectiveness of manual therapy.

On the other hand surgery can offer permanent relief, but I also get people who are still suffering after surgery, or from complications or side effects.

These kinds of surgeries, to me, should be a last-ditch effort because surgery is risky, traumatising to the body and doesn't always work, and for these issues is often not needed. However, ultimately only you can decide.

I'm now terrified of this not only not going away but of it recurring again in the future

Yeah. It will probably improve, but unfortunately the thing with herniated discs is like the thing with dislocated joints. Once it happens, it's more likely to happen again. You can try to coax the spine into a functional position and then stabilize it by strengthening the correct muscles. You can relieve the inflammation and decrease the pain with ice and medications. You can decrease the pain by increasing the intraarticular space via tractioning the spine (e.g. with an inversion table). You can relieve the muscle spasms and assist in muscle strengthening with massage.

You can probably get better without surgery, but without surgery the possibility of it happening again will always be there, especially if you become lax about exercising and maintaining your spinal health.

Please go to your doctor and explain your worsening symptoms. Don't try any of the interventions I've mentioned without their ok.
posted by windykites at 7:28 AM on September 2, 2017 [1 favorite]

I was your age when this happened, many of the same issues. I did have a series of three injections, and they were not all three equally helpful, if at all. The placement of the needle has to be very precise and even guided by ultrasound I think some doctors are better at it than others. If they offered you the standard series of three I'd finish it out.

If you are trying to sit normally at work through this pain, PLEASE stop, it will never heal through the continual punishment. Lying down or standing is the only way to be, including once the crisis passes (and you can just put your computer on a stack of stuff to raise it up, you don't need to bother your work for fancy equipment.) If standing hurts just as much, try for disability leave.

good news is I am still in my thirties, but I can sit down now, although I am never taking a job that doesn't let me have a standing desk ever again and neither should you (or anybody). I also run most days, just to spite Nature and God and it usually doesn't hurt. bad news is the worst of it lasted for a couple years and every once in a while I have a couple of horrible days when I can't walk. My doctor told me I would have continuing episodes but at gradually reducing frequency and intensity until they were very rare and very mild or until I grew old and died, whichever comes first. something about how the disk junk dries up as you get older, which you would think would be bad but apparently is good? because less of it can pop out and punch your spinal nerves? whatever.

so anyway, last time I tried to consult studies, it looked like long-term results were much the same whether you did injections, surgery, or nothing at all. Never underrate the mental relief that comes from knowing you are Doing Something, though. and if a physical therapist tries to make you do something that feels very wrong, just say no. I was always afraid to say no when I could tell they were wrong and I suffered for it.

You may have to cancel your trip. I am sorry. If you wake up pain-free tomorrow and stay that way every single day for the next week, you could risk it, but I wouldn't. You would be ok once on vacation, where the worst that could happen is you'd have to stay in the hotel all day while your family had fun. but what if you can't physically get on the plane when it's time to leave? I really wouldn't. Being trapped in any vehicle was and still is the absolute worst thing and posture for my back, and the stress of knowing you can't get off if it gets bad makes any exacerbating muscle tension much worse as well.
posted by queenofbithynia at 7:33 AM on September 2, 2017

I'll offer a more optimistic story than the other commenters... I herniated a disc (probably L5-S1) about 20 years ago. I've had several episodes of excruciating pain, first starting a few months after the initial injury (like, so bad that going from sitting down to standing up, I nearly fell over from the pain). The most recent was a few years ago and it was so bad that lying motionless was the only way I could approach comfort. During that episode I went to a physical therapist who told me that, while there wasn't much he could do for me, the good news was that usually the acute phase only lasts a week or two. (And, lo and behold, he was right.)

Since then, I haven't had a recurrence, which I mostly chalk up to a dedicated strength training regimen. I find that deadifts are the single best thing I can do (and at this point I can easily lift half again my bodyweight, so I'm not talking light weights). Obviously you shouldn't do them without checking with your doctor first, but I will say that doctors are often far more conservative about strength training than is necessarily warranted.

Keeping mobile is also key; whenever I end up sitting for a long period of time my back always starts acting up, even if it doesn't get to the point where I can't walk. And foam rolling/self-massage is really useful too, particularly in places that aren't necessarily obvious. At one point when my back was being balky I (at my personal trainer's recommendation) did some self-massage on the *front* of my hip, and like magic I could feel the muscles in my back release all their tension.

Good luck!
posted by asterix at 11:15 AM on September 2, 2017 [1 favorite]

One thing that has helped to stop my lumbar spasms is to lay flat on my back. Bend my knees so my feet are flat on the floor and tilt up my pelvis (lift my bum from the floor) while "sucking in" my lower tummy to make my lower back touch the floor. I've often found that this gives instant relief. If it works for you, you can then slide a pillow(s) under the lower part of your bum so that you can "relax" in this position. This SLYTV is a decent demo.
posted by saradarlin at 12:06 PM on September 2, 2017

I had the same thing a few years ago, although it took a year of excruciating pain before I was diagnosed with herniated discs. Nothing helped at all - no pain relief, no PT - and finally I was referred for a microdiscectomy. It was pretty much a total cure - as others have said above there is still some soreness/stiffness in my lower back depending on what I've been doing, but the sciatica is 99% gone and that had destroyed my quality of life. Now I go hiking and play golf and generally do things that I was afraid I'd never do when I had to drag myself up the stairs by the handrail or lie on my office floor. The surgeon told me that when they freed up the sciatic nerve from the bulging disc it was blue from being squashed for so long, but that they had seen the blood start to move through it again so that was a good sign that it would recover. I had been reluctant to go for surgery but that convinced me that if I had gone on without surgery it wouldn't have recovered on its own and eventually the nerve would have been damaged beyond repair. (That's my opinion anyway). So all I can say is that it worked for me and I'm glad I went in that direction.
posted by billiebee at 12:07 PM on September 2, 2017

Can I expect this to clear up in a day or two?

No. Sorry.

Feeling you.

My physio advised three weeks flat on my back in bed for as many hours as humanly possible, then gentle stretches for a couple of weeks, then gentle gentle exercise for a couple of months, then ongoing regular exercise and total avoidance of performing twisting lifts.

I took the advice.

My back mostly stopped spasming after a couple of weeks of bed rest, and the physical reminders that there will always be something vaguely wrong with it slowly faded over the next six months.

The next time it went out was maybe ten years later. I stepped down out of the laundry door onto the porch, turned to replace a torch on a shelf next to the door and BAM. Pain. Fuck it, I thought, I don't have TIME for my back to be fucked again, maybe it will go away in an hour or two.

It didn't, of course. And after a night's sleep I ended up spending most of the next day trapped on the floor of the bathroom, unable to get even slightly vertical or move until the ambulance crew arrived with the green whistle, then six days in hospital and another three weeks flat on my back at home.

Herniated discs are shits of things, and not really compatible with jetting off on holiday.

What advice can you offer to lower the chances of that happening?

By letting the sheer agony of the experience persuade you that giving your body enough rest and time to heal properly is more important than every other thing you've got going on right now.

This will cost you time and be horribly inconvenient. However, the rotten choice you face now is essentially between suffering that much inconvenience right now, or suffering maybe ten times as much of it distributed over the rest of your life plus some degree of permanent physical incapacity.

My best advice to you is the same as my physio's advice to me, which was that I should devote all my attention for the next month or two to the project of letting my back get better, regardless of whatever else might seem more pressing.
posted by flabdablet at 1:07 PM on September 2, 2017 [1 favorite]

And yes yes yes to therapeutic massage after the initial bed rest and gentle stretching part. Your muscles will lock up from trying to splint this thing, and having somebody else's skilled hands persuade them that they don't need to do that any more is just heaven on a table.
posted by flabdablet at 1:14 PM on September 2, 2017

My experience is similar to Asterisk above. Once you're back on your feet, core strength is key. For years it was Swimming and Yoga for me. Now that I'm stubborn and older, I've gone a bit off the core strength regimen and boy, can I tell. My lower back twinges and I get little shooting pains every so often to remind me that yes...the disc is still there, it's still herniated, and that I really should be building my core muscles to hold my torso upright without adding pressure to my poor lower back.

Also? Yoga WILL help. Only do what you can do. If that's just hands-and-knees-on-floor and tiny cat-cows, that's fine. Anything to build core strength and reintroduce tiny movements to your back.
posted by Elly Vortex at 3:06 PM on September 2, 2017 [1 favorite]

Oh! One other thing!

Now that you are the proud owner of a Bad Lower Back, your upper (cervical) and middle (thoracic) spinal column and the muscles around them will begin to overcompensate for the lack of movement in the lower back. Your upper and middle back may feel like they're overworked, may stiffen up or get knots, and they will need attention, too. So don't forget to give your upper and middle back some attention (massages, stretches, etc) because now they're doing a lot of extra work - mostly subconsciously - to keep pressure off your low back.
posted by Elly Vortex at 3:09 PM on September 2, 2017

I had a herniated disc between L5 and S1. I had a microdiscectomy in 2003 that provided immediate relief. Since then, I have had intermittent problems when I strain my back doing something dumb, but nothing as bad as what led to the surgery, and nothing that hasn't cleared up within a few days to a week. (And I'm not in good shape or kept up with any sort of exercise program.)

After the problem started, but before I had the surgery, I flew to Budapest from Los Angeles for a business conference. I basically stood in the back of the plane during the whole flight. (When I came back to my seat, the other people in my row were surprised to see me – they thought I had switched seats.) During the meetings, I was the weirdo laying on the floor or pacing in the back because I couldn't sit for long. I don't think I suffered any additional harm from the travel, but it certainly postponed any real treatment. I'm not sure it's worth taking that chance for a vacation, and you might be better off resting and pursuing treatment than going on vacation.
posted by jimw at 4:04 PM on September 2, 2017

God, I remember that feeling, that agony, the feeling that you would never feel okay again. The epidural injection did not work for me (and in fact, I was worse off afterwards) and finally opted for surgery. Best best best decision ever. The pain immediately went away.

This was about 6 years ago, and I hurt my back in the same place a few months ago. I thought I was done for, but it wasn't AS bad, and I decided to try using some other methods. What ultimately helped was the stretches in this book.

I also went to a chiropractor who maybe helped (I'm a major skeptic) but she did give me some tips that helped me sleep (basically on the floor on a thin foam pad with a tennis ball under my right hip) and within a couple of weeks I was much, much better.

I wish you the best. I wouldn't wish that pain on anyone.
posted by pyjammy at 4:13 PM on September 2, 2017

So sorry that you have to deal with that pain. This was me four years ago and if you scroll down you'll see that I finally opted for surgery. I really tried everything else for almost a year before finally scheduling the procedure. I can't claim that it's been 100% effective but It's so much better than it was. I had one bad relapse two years ago and had to go on steroids for a month and then some NSAIDs after that but that faded after a few months.
posted by octothorpe at 5:05 PM on September 2, 2017

Thanks everyone for all of these anecdotes, stories and advice. Last night was really tough and by 7am I was just too tired and finally fell asleep. I slept on my back (usually can only sleep on my side or stomach) on a towel on our hardwood floor and it was more comfortable than the bed.

It's now around 8pm and after a day spent moving between standing, walking, laying on my back and laying on my stomach, along with the pain meds, I'd say I'm at more of a 7-8 on the pain scale vs. yesterday's constant 10. So that's good. The most pain comes with trying to turn over onto my stomach or onto my back while laying down. The most comfortable position has been sitting on my knees facing the back of a large, padded chair. I know that I need to immediately change many things about my daily life, including how often I'm sedentary, spending time with exercise and stretches and generally being much more careful about how I use my back and body.

I was recommended this book (Back Mechanic by Stuart McGill)and it had same day delivery. I've scanned a bunch of it and will start from the beginning tomorrow but it seems very much in line with what many of you have advised and also a lot of what my PT had shown me in my 2 months with him.

I had requested a standing desk at work 2 months ago and it will finally be delivered and setup in the next few weeks (big, corporate companies take way too long for something like this, especially because it's not even one of the big full motorized desks. Alas.) and I think that will be hugely helpful. In the meantime I will work from home as much as possible and try not to sit for more than a few minutes at a time in the office. The two worst parts of my day are driving to and from work, which is about a half hour long but the position in a car seems to be one of the most aggravating for my lower back. I've tried shifting my position and changing the seating setup (including a lumbar cushion and/or a rolled towel) but I can't seem to find the right setup to feel comfort.

Lastly, I'm 75% sure we're going to postpone the vacation. Fortunately, my wife was smart enough to opt for the $60 travel insurance when she booked the flights, so we'll recoup the flight money and the one hotel that was non-refundable. Overall the financial damage will be minimal if not entirely insured. The only thing in my mind telling me to go ahead with it is if in a few days the decrease in pain continues and I feel that I'll be able to just stand a bunch on the plane. The vacation will have us walking a lot, but of course the possibility a foreign bed or one wrong move with luggage could be very bad. I'd like to think taking it more slowly and thoughtfully than I would have prior to this episode will make it ok, but yeah, I realize the smartest move is probably just pushing it off until next spring.

I'll try and update with any further developments regarding my pain.
posted by arm426 at 5:27 PM on September 2, 2017

I was actually going to recommend McGill's work! He's got a very good reputation in the fitness industry.
posted by asterix at 5:35 PM on September 2, 2017

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