Severe Back Pain and MRI Interpretation

by Jenn

Should I be in this much pain according to my MRI result?

I'm 33 years old have been an active runner for about 5 years. I have always been a skier and I have a strong core. Almost 2 years ago I began suffering with back pain so bad that I sometimes limp, and I am unable to run.

I've been in pain mgmt since March and the pain medication does help significantly. Within the last month my pain has progressed to unbearable. Pain medications help but wear off after 3.5 to 4 hrs, which leaves me in a lot of pain for 2 to 3 hrs until I'm allowed my next dose.

I had an MRI last week and it shows mild facet degeneration and ligamentum prominence. There is minimal disc bulge and no significant stenosis. The impression paragraph says mild degenerative changes particularly at L4-5 but no evidence of significant stenosis.

From what I have researched, I shouldn't be in as much pain as I am in. I am very frustrated and miss running terribly, because it helped me emotionally and spiritually.

I also eventually want a second child but obviously not while on narcotics. Should I have this much pain just from minimal dis bulge? Any thoughts would be so appreciated.

My pain management appointment is in 12 days and I am debating if I should call about my pain getting worse. I spend a lot of time angry and crying when I hurt.

Hi Jenn,
sounds like you are pretty miserable. I know it can be frustrating when you are having so much pain and all of the tests don't show very much. The good news is that the MRI doesn't show anything disastrous or anything that can't be treated.

MRIs are great studies and they show us a lot, but MRIs tend to under-estimate the severity of what they show and they can sometimes miss things. What they really show is a picture of horizontal slices through your spine. The slices are generally 5-7mm apart and if there is something going on between the slices it gets missed.

The other thing that needs to be said is that there is not always a good correlation between what the MRI shows and how much pain people are experiencing. Even with all of the money that is spent on x-rays, MRIs, and other imaging studies, we cannot always explain why people are having pain.

But, if you are having pain it needs to be treated, and there are some things that can be done.

Have you trialed a strong anti-inflammatory medication such as naproxen, diclofenac, or meloxicam? These can be helpful for relieving the inflammation and pain of degenerative conditions. If you have not tried these you should discuss them with your pain management doctor.

You mentioned that you were using a narcotic pain medication. For a young and otherwise healthy person like you narcotics should be considered a bridge. Just something to use until you can find other ways to manage your pain.

Physical therapy can often be helpful. If you are a runner and the skier you are most likely in pretty good condition already. But, when you have chronic back pain you compensate and change the way you do many things, this can lead to a muscle imbalances and postural changes that exacerbate the problem. Evaluation by a physical therapist can teach you specific exercises to correct these conditions.

If anti-inflammatories and physical therapy do not control your pain and allow you to wean off of the narcotics you may need to consider epidural steroid injections. Placing a steroid medication into the spinal canal can help to relieve inflammation and swelling.

Your pain management doctor may do these treatments or he can refer you to someone who does. You can learn more about epidural steroid injections at Back Pain Injections.

Chronic pain can also lead to depression. If you find yourself crying a lot and having difficulty getting motivated and enjoying your life; you should talk to your doctor about an anti depressant medication. Depression is like a magnifying glass on pain. A little bit is pain that you would normally just shrug off can turn into a big overwhelming problem when you are depressed.

Well Jenn, that is all that I can think of for right now. When you see your pain management doctor talk to him about these ideas, and if you think you are suffering from depression talk to your doctor about ways to control that as well.

You may not be able to make your pain go away completely but you should be able to find a way to control it so that you can live your life and do the things that you want to do.

Good luck, and drop us a note after you see your doctor to let us know how you're doing. We care about you and your progress, and we may have some other ideas, depending on how these work out.


Comments for Severe Back Pain and MRI Interpretation

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Thank you
by: Jenn

Hi Dave,
thank you so much for your reply. I appreciate all the advice.

I didn't mention it before and maybe I should have but I also suffer from auto immune illness. Right now it looks like primary Sjogrens. I have the severe dry eyes and mouth, fatigue, etc. do you think that could be related to the back issue or do you think it's 2 separate problems? I was thinking it was 2 separate problems but I'm not sure.
Thanks in advance got your thoughts.

Hi Jenn,
Absolutely your autoimmune disorder could be related to your back pain in a number of different ways. The good news is getting your autoimmune issues under control can help to control your back pain.

You say "right now it looks like primary Sjogrens", like you are unsure. Have you seen a rheumatologist and been completely worked up to try and determine a clear and specific diagnosis? I know with many autoimmune conditions the diagnosis is not always that cut and dried, but if you don't have a clear diagnosis, or if your doctor is not working to determine a clear diagnosis, you may need to seek out a second opinion.

Once a diagnosis, or at least a working diagnosis, can be established you can begin trialling different treatments. Many of the new therapies for autoimmune diseases are very effective, and I would expect that they could make a big difference in your back pain.

Unfortunately, some of these drugs can also have unpleasant side effects. You may find yourself in a situation where you are trading one problem for another, and you may have to decide which is the lesser of two evils, or titrate your treatment to maximize the benefit and minimize the side effects.

All in all, I think you are right; there is a relationship between autoimmune disease and back pain. I also think that aggressive treatment for your autoimmune disorder may go a long ways towards controlling your back pain. So, get in to see your rheumatologist, and if he doesn't want to get busy with a treatment plan, find a different rheumatologist.

Good luck Jenn, and keep us posted, we care about you and how you are doing.

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