Word: paines
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...Anna has burning pains in her legs, pain around her hips and some low back pain. The crucial part of her story, for me, is that her pain is particularly bad when she lies in bed at night. On X-rays she has a little hip arthritis (a red herring) and quite a bit more spinal stenosis - a narrowing of the passages through which the nerves go from the spine to the legs...
...very common set of symptoms - you would think we had the cure. But we have little that really works well for spinal stenosis. Even the practical, surgical approach - "just get in there with some good steel tools and make those passages bigger" - doesn't always seem to make the pain go away...
...seen physiatrists and had physical therapy, epidural injections, nerve medications (gabapentin), pain medications (always a dangerous sign) and of course, anti-inflammatories. A couple of neurologists have seen her and given her oral steroids. A reliable neurosurgeon simply told her she was "not a good candidate" for the operations typically used for her problem. The other neurosurgeon recommended the big, dangerous operation but did say her chances of not getting better or even getting worse were at least as high as her chances of being cured by the surgery...
...thank you" said Anna. A chiropractor and an acupuncturist have not helped. Her medical doctor put her on a diet and she did feel good about losing some weight - but the pains continued. She even went to a famous back doctor in the city who told her the problem was actually in her head; not surprisingly, this information also failed to relieve the pain. And so she finally made it to the "most famous orthopedic surgeon" - in my house at dinnertime anyway - trembling with the expectation of my bold new treatment plan and a rapid cure...
...anything the other doctors have had to say about her and there's been no major screw-up in her treatment. I am amazed at how little Anna (and her family) actually understand about what's wrong with her though. We spend a long time discussing arthritis, stenosis and pain. The only addition I can make to her treatment is a basic explanation of the anatomy of the arthritic spine, and some really simple advice based on this; we tell patients with stenosis to try and keep the low back more rounded. Slouch a little and keep your hips flexed...