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  • Q&A with Australian Health Practitioners

    Chronic pain after spinal fusion and multiple laminectomies. What are my treatment options?

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    Back & Neck Pain Musculoskeletal Health Orthopaedics
    Spinal fusion and 4 laminectomies July 2015. Fine for six months but then pain increasing since December. Pain is in hips, back of legs and buttocks. Numbness in 4 small toes right foot. Pain in back of legs feels like cramp. Pain is so severe that I can't sit on the loo for more than a minute. Also have pain in neck not associated with this surgery but this is radiating out to both shoulders severely limiting movement of my arms. Normal analgesics have no effect. Cortisone has given much relief for two weeks but I have had to stop using this in view of potential side effects. Neurosurgeon cannot find any problem after having multiple MRI and CT scans. Referred to pain management specialist who is talking about sticking a battery and wires up my back. Is this a viable solution? I am not a sook and have put up with severe pain for many years, but this is starting to get me down as I can't see any solution happening soon.
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    Ben Strachan

    Physiotherapist

    Ben Strachan graduated in 2007 with a Bachelor of Physiotherapy from Charles Sturt University. He has over 15,000 hours experience working as a physiotherapist. During … View Profile

    Hello, 

    It sounds like your injuries are very complex. A fusion and multiple level lamintectomy is a surgery generally reserved for people with multilevel degeneration and nerve root compression. 

    Have you tried hydrotherapy?

    I have been providing private and group hydrotherapy consultations for people following lumbar surgery for a few years. I have found gentle and slowly increasing exercise in the pool very helpful. Many people report improved activity tolerance and lower reaggravation. 

    Sometimes hydrotherapy is limited in really complex injuries, although I would definitely recomend a trial. 

    Good luck 

    Ben Strachan 

    Physiotherapist. 

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    David Hughes

    HealthShare Member

    I have tried basic swimming in a heated pool but as the pain in various parts of my body has increased I have been reluctant to continue. I am considering acupuncture.

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    Ben Strachan

    Physiotherapist

    Ben Strachan graduated in 2007 with a Bachelor of Physiotherapy from Charles Sturt University. He has over 15,000 hours experience working as a physiotherapist. During … View Profile

    Thanks for the reply David, 

    Thats unfortunate swimming was aggravating. I would suggest trying a lower intensity movement. The decreased weightbearing in warm water should provide mild relief. Try a noodle under arm and float.

    Fingers crossed acupuncture is effective! 

    Pain management by electrical stimulation to spinal cord is a relatively new technique. I haven't seen many clients following this proceedure so I can't comment. 

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    Dr Frank Thomas

    Pain Medicine Specialist

    Dr Thomas studied medicine at the University of Otago in New Zealand, graduating with distinction in 1992. He subsequently trained in anaesthesia and pain medicine, … View Profile

    The electrical stimulation that Ben is referring to is called Spinal Cord Stimulation. This therapy has been in use for almost 50 years but recent technological advances have dramatically increased the effectiveness of the therapy. For example the Nevro Senza system has been shown to reduce baseline pain levels from an average of 7.4 to 2.4. We have implanted over 100 of these systems and mainly in patients who have had spinal surgery. 80 to 90% of patients who trial the therapy find it effective and decide to proceed to have a permenent system implanted. See for example www.nevro.com

    Frank

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    David Hughes

    HealthShare Member

    Hello Frank

    Not sure if I thanked you for your advice about my problems.

    I am seeing Nathan Taylor at Northern Private Pain Clinic at Royal North Shore Hospital in Sydney. It is a bit of a problem because I live almost 400 km from there.

    However I am going to go ahead with a trial of Spinal Stimulation and have checked out various web site relating to the topic as well as taking his advice.

    We have tried the spinal blocks without success so nothing ventured nothing gained.

    You might like too see my reply to Rob Nash.

    Thank you for your interest.

    Kind regards

    David

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    Dr Frank Thomas

    Pain Medicine Specialist

    Dr Thomas studied medicine at the University of Otago in New Zealand, graduating with distinction in 1992. He subsequently trained in anaesthesia and pain medicine, … View Profile

    Hi David

    I note your comment about spinal blocks with nerves being burned. This is only applied for suspected facet joint pain or sacroiliac joint pain. As for spinal cord stimulation, there are different stimulation paterns ie low-frequency (produces a tingling sensation), high-frequency (no tingling), burst etc. Recent studies have shown the high-frequency option to be the best, although we are awaiting the results of the Australian Saluda system. So for example if you were given a trial that produced tingling, and it was unsuccessful, you would also want to try the high-frequency type. 

    Good luck

    Frank

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    Lesley Rogerson

    HealthShare Member

    I know exactly how you feel.  I couldn't believe what l was reading when l read the pain your enduring.  My pain is so very much the same.  I am in pain everyday and want a better quality of life back.  I wish you the best.  Hoping to find answers myself.

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    Rob Nash

    Exercise Physiologist

    Hi David (and Lesley),

    It is common for pain to persist post orthopedic surgery, despite the surgery being a complete success in terms of 'fixing' the structure.

    The fact that an MRI has shown no physical abnormalities in your back, and your pain has persisted and is getting worse, it sounds like you have what is called, central sensitisation. This is when the nervous system is locked in a heightened, continuous pain cycle. This condition is not caused by your back, but your central nervous system. As mentioned above, the spinal cord stimulation method could be an effective way of interfering with the pain output, but I would ask your pain specialist about treatments focusing on the psycho-social aspects of your condition.

    A couple of books you might find useful:

    Explain Pain - David Butler and Lorimer Moseley

    Beyond Pain - Anjelo Ratnachandra.

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  • David Hughes

    HealthShare Member

    Thanks Rob,

    I have been up hill and down dale since my original post. Cortisone tabs 25mg per day just about killed most of my symptons except for the pain in my hips after walking just short distances. However they had the potential to kill me as well as bunging on 10 kg.

    I have since had spinal blocks to see if they could identify the nerves causing the pain with the intention of burning them off. Didn"t work. Back to square one. All this has been compounded by neck pain which I thought was radiating out to my right shoulder.

    So I called a temporary halt on further pain mitigation remedies and had MRI's done of my hips and shoulder. There is very little wrong with my hip in a mechanical sense, just a negligible sign of OA. My shoulder has just about every evil except a rotator cuff split.

    So I am back to considering spinal fusion for my hips, legs and buttocks and we will se what happens.

    Very much appreciate your suggestions and I will check out the books.

    Regards

    David

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    Rob Nash

    Exercise Physiologist

    Sounds like you've been through a lot there, it must be very tough to deal with.

    I'm glad the cortisone tabs have helped, but like you said, probably not a long term solution due to side effects. 

    The fact that the nerve blocks also failed to provide answers again tells me that there is a central nervous system driver to your pain. This, along with the fact that your MRIs show a fairly normal looking hip and lumbar spine suggests that surgery isn't an immediate option.

    I do hope you find the right course of action, and I do believe those books will help clarify your options.

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