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best treatment for L5-S1


CNX69

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L-5 S-1 is not a disease. it refers to 2 vertebra in the lower back, a location where degenerative disk disease is common (but other problems can happen as well).

 

There is no one "best treatment" for all issues in the location of the back. . It depends on the nature and severity of the problem, as well as your overall health.

 

Depending on the cause (e.g. muscle strain? Spinal stenosis?  Disk protrusion or herniation? etc etc) and severity of the problem, treatments can include:

 

anti-inflammatories, sometimes also muscles relaxants and stronger pain killers

application of ice or heat (depends on the nature of the problem and if there is a recent injury)

avoiding movements which exacerbate the pain, and avoiding sitting for prolonged periods

stretches and targeted exercises (physical therapy)

epidural injections of steroid

surgery (several types -- again, depends entirely on the type and extent of the problem)

 

If the problem is relatively new and there is no weakness in the legs or pain radiating down them,  then one can start with the first 4 things above.   Often thios and time are all it takes.

 

If the pain  has persisted for some time, or if the pain is radiating down the thing or leg, or the leg is weak then:  get an MRI and consult a good spinal specialist.

 

 

 

 

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Thank You for responses

Last September I had MRI (about 11,000฿)

I am currently on;

Gabapentin 300mg

Myonal 50my

ACEO Retard Cap 90my

ULTRACET(do not use often)

 

 

Since September i had 2 epidural and Lyrica 75mg(not any more)

I swim  3 times a day, do light exercise, and  try to sleep on my back

I am attaching my last x-ray

 

 

s.jpg

s1.jpg

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Did the epidural bring any relief and if so for how long?

 

I take it you still have pain? No improvement? Does the pain radiate down your thigh or leg?

 

What does the MRI report say, and what did the doctor tell you?

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Was it diagnosed as bulging or herniated.  How long have you had an issue with it ?

 

When aggravated, has your past 'therapy' and med relieved the discomfort/pain complete, then returned after aggravating it again, or is this simply on going and getting worse ?

 

Are you retired yet, or still working ?

 

I've had back issues since I was 20 / 1974, suspect herniated, but never really diagnosed until aggravated badly @ 35 yrs old / 1989.  That confirmed what it was since I was 20.

 

Finally couldn't take it any more, and had surgery in 1997 @ 42 yrs old.  T12/L1 & L4/L5, one disc up from your issue.  Since yours is last disc, gets most of pressures, if all things being equal.

 

Doc at time of surgery, said change jobs or I'll be seeing you again in couple years.   He was almost correct, as aggravated it again, and a different doc wanted to slice and dice me @ 45 yrs old, (2000).

 

I passed and decided to retire instead, and all has been good since.  Diagnosed with 5 degenerative disc, when had surgery, along with bulging, possibly herniated since, after aggravating it again, which have apparently subsided, the bulging anyway.

 

I behave myself, so they behave themselves.

 

Don't know what new tech is available now, for repairing.

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First epidural was WOW. Unfortunately I had to fly home. On the way back to Thailand, I gave my seat to an injured Thai. My Flight was 11 hours and it was very bad for my back.

 

My Doctor(an associate professor), told me it was too early for a second epidural but he gave me new medication, ordered twice a week Lumbar Traction Treatment(30minutes each time) as well as Thai Traditional massage (at government fatality and supervised by doctor) two x a week about one and half hour each time.

Second epidural was great relief BUT

 I am still going to therapy and I am on medication

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6 hours ago, CNX69 said:

First epidural was WOW. Unfortunately I had to fly home. On the way back to Thailand, I gave my seat to an injured Thai. My Flight was 11 hours and it was very bad for my back.

 

My Doctor(an associate professor), told me it was too early for a second epidural but he gave me new medication, ordered twice a week Lumbar Traction Treatment(30minutes each time) as well as Thai Traditional massage (at government fatality and supervised by doctor) two x a week about one and half hour each time.

Second epidural was great relief BUT

 I am still going to therapy and I am on medication

I'm having a bit of trouble figuring out how long relief from epidural lasted. You had 2 within 8-9 months? How far apart?  Are you pain free now?

 

And what is your age and general state of health? (Important considerations in terms of possible surgery). 

 

I had problem in the same location but in my case conservative measures did nothing, and relief from epidural lasted just a few weeks so I had surgery... minimally invasive decompression. Great results but 2 years later  I am  having some issues on the opposite side. Not yet severe, and manageable with conservative measures (PT / stretches and occadional ant-inflammatory)  but I will not be surprised if I end up needing eventual  decompression on that side as well.  

 

 

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14 hours ago, carlyai said:

Great you are exercising and trying conventional therapy.

What did the MRI show and why did they put you on Gapapentin?

That kind of surprised me also.  I took it for shingles / postherpetic neuralgia, and was just Ok.

 

"In regard to the specific diagnoses, a systematic review has found evidence for gabapentin to provide pain relief for some patients with postherpetic neuralgia and diabetic neuropathy. Gabapentin is approved for the former indication in the US. In addition to these two neuropathies, European Federation of Neurological Societies guideline notes gabapentin effectiveness for central pain. A combination of gabapentin with an opioid or nortriptyline may work better than either drug alone.

 

Gabapentin shows substantial benefit (at least 50% pain relief or a patient global impression of change (PGIC) "very much improved") for neuropathic pain (postherpetic neuralgia or peripheral diabetic neuropathy) in 30–40% of subjects treated as compared to those treated with placebo.

 

Evidence finds little or no benefit and significant risk in those with chronic low back pain or sciatica"

Edited by KhunLA
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