Vol. 63 March 28, 2012 “Low Back Pain…Oh, NO!”

All I said was, “My back pain is a little worse”, in response to the casual “how are ya?”

Suddenly I was engulfed in four other back pain stories. Just try it yourself at the next cocktail party, political rally, or “wherever three or more are gathered”. At least 80% of us Americans have back pain at sometime in our life. Almost 30% of us have it at the same time. (1)

About three years ago I decided to actually do something about mine when I found that I couldn’t complete the short walk from Fenway Park to the MBTA station with my grandson. I suspected that my back pain and stiff, wooden-like, sore thighs were side effects from Lipitor. I stopped taking it, but after no improvement in a month, I went to my primary care doctor. He quickly sent me to a neurosurgeon, passing “lumbar MRI for $1300.”

The neurosurgeon said he could fix my gait by straightening out the “rubber band tangle of spinal nerves” of spinal stenosis by chipping away a little of my backbone. After surgery on L4 and L5 (just in case you are taking detailed notes) my thigh muscles were no longer stiff, wooden, and sore after 100 yards of walking. But, I still had a funny walk, and my low back pain remained. I walked funny because I couldn’t get up on my toes, and my balance was off. The neurosurgeon sent me back to the neurologist saying “I fixed him above the knees, but have no idea what is going on below them.”

The neurologist performed his medieval-torture test called an electromyogram (involves sticking needles into muscles and shocking them with electrical pulses), and sagely announced that I had “diabetic neuropathy”. As diplomatically as I could, I told him that I didn’t have diabetes.  I also blurted out, “ …and I don’t know where the stolen microfilm is hidden.” Several tubes of blood later, the neurologist had ruled out all but two diagnoses, “a peculiar gait” (thanks, but I already knew that) and CIDP (“Chronic Inflammatory Demyelinating Polyneuropathy” or “Chronic Idiopathic Demyelinating Polyneuropathy”). “Idiopathic” is the cover term for “I don’t know”. I am repeatedly impressed by how well we physicians can cover up our ignorance of causation with such lofty sounding terms.

At least CIDP was a diagnosis that had a treatment. Three months after starting monthly intravenous infusions of gamma globulin, I ended up in the hospital in the middle of the night with a pulmonary embolism, a “known but unusual” side effect of the infusions. So I went off the gamma globulin and onto coumadin for a year. I still walked funny and had back pain. By this time my neurologist had joined my children in recommending physical therapy and more exercise, but my children had since moved on to recommending Pilates, Yoga, and meditation.

“I’m an American. Just give me a pill” was my plea to my rheumotologist. He had struggled over 20 years to place me in the correct category of arthritis diagnoses. Whichever one of my three “revolving” diagnoses was the correct one; it had caused both hips to need replacement 10 years before my back pain started. Replacement resolved the hip pain, but one leg ended up an inch shorter than the other.

Many of my friends assumed that my funny walk was from my hips. I grew weary of repeatedly trying to explain things while standing in a bathing suit on the dock, sot that summer I started handing out this card.
.                                 “Yes, I walk funny. My hips are fine. I have some back pain.
.                                   My spinal stenosis was fixed in April. The muscles in my
.                                   lower legs and feet have grown weak because of a rare nerve
.                                   condition, a peripheral neuropathy. No, I am not diabetic.
.                                                         Thank you for caring.”
The card was not entirely true. I have discovered since then that peripheral neuropathy is NOT a rare condition at my age.

My rheumotologist did not think that my back pain had anything to do with my underlying arthritis, whatever that was. He suggested I go back to see the neurosurgeon. Much to my surprise the neurosurgeon said that my repeat MRI looked great, and “he couldn’t see anything else to operate on.” He also said, “You probably should get more exercise.”

Desperate for relief I then turned to Pilates and Yoga, much to the amazement (and joy) of my daughters. Pilates aims to strengthen your core while Yoga seeks to relax it. Both use poses and exercises that mimicked those of physical therapy and the self-help back exercise book one of those afore-mentioned cocktail-party-story-tellers recommended. (2) My flexibility and general well-being improved, but I still woke up with a stiff, sore back that usually resolved by my second cup of coffee, only to return in the evening after walking and standing for the day.

My best friend asked, “So, is this what you are going to settle for for the rest of your life?” By chance, I had my annual exam with my primary care physician the next day. I entered the office determined to get relief. He read my lumbar spine MRI report out loud to me. It sounded like a fly over of the Bad Lands or the Grand Canyon. He followed with, “You are not on anything for degenerative arthritis. What has worked in the past?” Restraining myself from punching him in the mouth for calling me a degenerate (back pain can make people cranky) I responded that my rheumotologist had tried several different ones in the distant past and that Indocin helped the most. “Well, let’s try 50mg. a day and see how that goes.”

Two days later I woke up without back pain.   Thank God, I’m an American!

References:
1. Arch Intern Med. 2009 Feb 9;169(3):251-8. The rising prevalence of chronic low back pain. Freburger JK
2. The Egoscue Method of Health through Motion, Pete Egoscue, HarperCollins 1992.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: