Pinched nerve in neck, advice pls.

[Smithson]

In Australia I was diagnosed with a pinched nerve in my lower neck. The symptoms are pain in the shoulder, upper right side and arm (including pins and needles/numbness).

Overtime it has been getting worse, now there is significant pain in my neck when sitting or laying (moving is not too bad). At night the pain can be extreme to the point that pain killers and anti-inflammatory have almost no effect, ice is very useful though.

If it doesn't improve soon I will see a doctor, however my guess is they will send me straight for an MRI, followed by recommending an operation.

Has anybody else suffered from this and if so do you have any advice? Thanks in advance.

[FBN]

Pins and needles certainly indicate pressure on a nerve but the region you describe is more mid rather than lower neck; perhaps C4,5 level.

MRI is definitely indicated to get a clear idea of treatment options. This may or may not include surgery, which should always be the last option.

A course of physiotherapy with perhaps intermittent traction may be an option.

This perhaps due to an old whiplash injury?

[Sheryl]

Dr. Wicharn at the BNH Hospital Spine center is best specialist for this in Thailand.

[Smithson]

Pins and needles certainly indicate pressure on a nerve but the region you describe is more mid rather than lower neck; perhaps C4,5 level.

MRI is definitely indicated to get a clear idea of treatment options. This may or may not include surgery, which should always be the last option.

A course of physiotherapy with perhaps intermittent traction may be an option.

This perhaps due to an old whiplash injury?

Thanks for the replies.

Pins and needles is only one of the symptoms, the main thing is serious pain, especially when lying down, sleeping is very difficult. The physio in Australia identified the location, C4,5 or something like that are familiar. There is no existing injury, although due to a knee problem I have switched to sleeping on my stomach after sleeping on my stomach all my life.

I will try and see a physio here, but have't been impressed with the ones I've visited so far.

Dr. Wicharn at the BNH Hospital Spine center is best specialist for this in Thailand.

Thanks for help Sheryl and your contribution to this forum.

I am sure Dr. Wicharn is an expert in his field. I am also sure an important part of his job is bringing revenue to the hospital. This is based on over 20 years of living here and having Dr.s suggest expensive tests and operations for relevantly minor ailments. The worst offenders have been those at the 'best' hospitals. It's a shame they don't just charge more for the consultation and spend more time talking.

I am considering an appointment to see him when I am next in Bkk, Being informed of the various options for treatment would be helpful when talking to him.

[tfc]

I don't know how bad your neck situation is so YMMV but the McKenzie Method exercises especially the "sitting chin tuck" helped me significantly though it was a slow but sure progression over about 6 months.

This site has the exercises that I used:

http://www.fultonmassagetherapy.com/?p=948

My physio in Oz gave the exercises to me as "homework."

[Sheryl]

In terms of options, it really depends on the underlying cause - for which an Xray and quite possibly an MRI will be needed to determine.

If the pain is due to pressure solely from a protruding disc, and there is sufficient space otherwise for the nerve root to exit the spinal canal, then conservative treatment with medication and possibly physio will suffice.

If however there is pressure on the nerve from a bone spur and/or a narrowing of the space where the nerve exits, frankly nothing is going to help but surgery.

I have sent many people to Dr. Wicharn over the years and also consulted him myself. He most definitely does not always recommend surgery, nor does he send people for unnecessary tests.

[dddave]

"I am sure Dr. Wicharn is an expert in his field. I am also sure an important part of his job is bringing revenue to the hospital."

I was a fortunate recipient of Sheryl's advice to see Dr. Wicharn at BNH this past summer for a condition very similar to yours. My "pinched nerve", actually "Meralgia Parestetica", was causing great discomfort in my right thigh and was defying diagnosis by other hospitals I had visited.

Dr. Wicharn absolutely did not in any way try to encourage any unnecessary tests, including MRI. He accepted the X-ray and Ultrasound copies I had done at another hospital and after a thorough examination and consultation, suggested I undergo a nerve function test wherin the affected nerves; in my case in my leg, are electrically stimulated and mapped. This test confirmed Meralgia Parestetica and an ultimately successful treatment plan was set for me. Within one month I was pain free. The cost of the test was B10,000. Medications, hospital and Dr's. fees added another B6000...Thats about $500 for the complete diagnosis and treatment of a complex condition.....In the USA, you can't get an aspirin in a storefront clinic for that.

Both Dr. Wicharn and Dr. Krisna who administered the nerve test were trained in prestigious US hospitals and speak excellent English.

Listen to Sheryl:..she knows!

Edited November 12, 2014 by dddave

[Sheryl]

It is also completely inaccurate to say that part of a private doctor's "job is to generate revenue for the hospital".

In private health care in Thailand (as in many places), doctors are not employees of the hospital.

They are independent practitioners who have an arrangement with (usually more than one) hospital to admit patients there and make use of their OPD facilities. For the top doctors especially, the hospital needs them far more than they need the hospital.

[uptheos]

"I am sure Dr. Wicharn is an expert in his field. I am also sure an important part of his job is bringing revenue to the hospital."

I was a fortunate recipient of Sheryl's advice to see Dr. Wicharn at BNH this past summer for a condition very similar to yours. My "pinched nerve", actually "Meralgia Parestetica", was causing great discomfort in my right thigh and was defying diagnosis by other hospitals I had visited.

Dr. Wicharn absolutely did not in any way try to encourage any unnecessary tests, including MRI. He accepted the X-ray and Ultrasound copies I had done at another hospital and after a thorough examination and consultation, suggested I undergo a nerve function test wherin the affected nerves; in my case in my leg, are electrically stimulated and mapped. This test confirmed Meralgia Parestetica and an ultimately successful treatment plan was set for me. Within one month I was pain free. The cost of the test was B10,000. Medications, hospital and Dr's. fees added another B6000...Thats about $500 for the complete diagnosis and treatment of a complex condition.....In the USA, you can't get an aspirin in a storefront clinic for that.

Both Dr. Wicharn and Dr. Krisna who administered the nerve test were trained in prestigious US hospitals and speak excellent English.

Listen to Sheryl:..she knows!

Do you mind sharing what the actual treatment was that had you pain free in one month?

That seems an awful lot for a Nerve Conduction Study, I had four limb extremity done last year at Sripat Hospital Chiang Mai and the cost was 1,100 baht.

[ding]

May as well get dialed in... what are ya gonna do... golf, somersaults?

I like AnatomyZone. Helps me ask seemingly informed questions to my doc- lol. She probably sees right through me anyway.

Wish I could help. I have been there and all it took was several weeks of chiropracter visits and it never came back. My GP and a DO had nothing to offer so I tried a chiro and it worked.

Best of luck!

[dddave]

"I am sure Dr. Wicharn is an expert in his field. I am also sure an important part of his job is bringing revenue to the hospital."

I was a fortunate recipient of Sheryl's advice to see Dr. Wicharn at BNH this past summer for a condition very similar to yours. My "pinched nerve", actually "Meralgia Parestetica", was causing great discomfort in my right thigh and was defying diagnosis by other hospitals I had visited.

Dr. Wicharn absolutely did not in any way try to encourage any unnecessary tests, including MRI. He accepted the X-ray and Ultrasound copies I had done at another hospital and after a thorough examination and consultation, suggested I undergo a nerve function test wherin the affected nerves; in my case in my leg, are electrically stimulated and mapped. This test confirmed Meralgia Parestetica and an ultimately successful treatment plan was set for me. Within one month I was pain free. The cost of the test was B10,000. Medications, hospital and Dr's. fees added another B6000...Thats about $500 for the complete diagnosis and treatment of a complex condition.....In the USA, you can't get an aspirin in a storefront clinic for that.

Both Dr. Wicharn and Dr. Krisna who administered the nerve test were trained in prestigious US hospitals and speak excellent English.

Listen to Sheryl:..she knows!

Do you mind sharing what the actual treatment was that had you pain free in one month?

That seems an awful lot for a Nerve Conduction Study, I had four limb extremity done last year at Sripat Hospital Chiang Mai and the cost was 1,100 baht.

I was prescribed both LYRICA and METHYCOBAL; I forget the exact dosages. The nerve test (Sorry, I do not remember the exact name) took more than an hour and a half of the Doctors and two technicians time with some major technology involved so B10,000 did not seem unjustified. Granted that BNH is a "5 Star" medical facility and that there certainly other less deluxe options to be found with lower fees. I did try other hospitals but felt like I was spinning my wheels in the sand. I was in constant severe pain and had lost mobility: unable to walk 50 meters without having to stop and rest ten minutes, allowing the pain to subside.

Sheryl has long advocated an approach that emphasizes finding the right Doctor for a person's specific condition. The frustration of vague and unfocused consultations at other hospitals with Doctors with whom I could not clearly communicate led me to decide that her approach made the most sense.

It certainly worked for me.

Edited November 14, 2014 by dddave

[Markaic]

Find a pain mgmt doc, treatment for neck issues post physical therapy are facet injections

[Smithson]

I visited Dr. Wicharn and was very happy with him, thanks for the tip and sorry if I came across as unappreciative.

Unfortunate the diagnosis was not good, Dr. Wicharn has recommended with artificial disk replacement surgery. Does anybody have any experience with this?

Also, he suggested traction for pain relief in the meantime and said it is easily available at any hospital. Does anyone know more on this? Thanks.

Edited March 12, 2015 by Smithson

[Sheryl]

I visited Dr. Wicharn and was very happy with him, thanks for the tip and sorry if I came across as unappreciative.

Unfortunate the diagnosis was not good, Dr. Wicharn has recommended with artificial disk replacement surgery. Does anybody have any experience with this?

Also, he suggested traction for pain relief in the meantime and said it is easily available at any hospital. Does anyone know more on this? Thanks.

Most hospital physical therapy departments can do cervical traction; you can also purchase simple home devices online that work just as well provided you use them regularly. Basically it is like a balloon thing that inflates around your neck pushing head up, shoulders done and thus stretching the vertebra apart, giving some temporary relief.

The advantage of the artificial disks vs a fusion of the vertebra (alternative approach) is that you retain more flexibility. Usually if it is just a single fusion the loss of flexibility wouldn't be particular noticeable anyhow so the added expense of the artificial disk may not be worth it, but if it is more than one it becomes more advantageous. Although a fusion without artificial disk remains an option if cost is a concern (the artificial devices are expensive and many insurance plans won't cover them).

[Smithson]

Thanks.

There are two discs, hence the implants, which cover more than half the cost. I am checking regarding insurance and will need to find out just how limited movement would be if I went for fusion.

Regarding the traction devices, Dr. Wichard recommended 5 days in a row. As I spend most of my time outside Bkk, it's worthwhile to buy one. I already have this, however it doesn't help http://i.ebayimg.com/00/s/MTYwMFgxMjM3/z/KZAAAOxy4t1Sj3T6/$_35.JPG

There are several types available with a wide price range. Can anyone make a recommendation?

[Sheryl]

I can't open that link to see what it is you have, but this is what I use http://www.amazon.com/Cervical-Traction-Device-Decompression-Herniation/dp/B00IGYL3ZI/ref=sr_1_3?ie=UTF8&qid=1426242549&sr=8-3&keywords=cervical+traction+device

[Lazy Sod]

Dr Wicharn performed this same surgery on my wife 2 weeks ago (one herniated disc in the neck). It was only one disc and he explained the cheaper option (fusion) is probably best in her case, so there was no hard sell of the more expensive flexible disc. She is delighted with the result.

[Lazy Sod]

Here's the result. She is totally pain free now.

[Sheryl]

My sister likewise had a fusion with Dr. Wicharn with excellent results but she too had just one disk involved. When it is 2 disks there is more advantage to the artificial disk though until recently they were not available and everyone just had fusion.OP is asking the right questions i.e. how much loss of flexibility and would it be worth the extra cost to avoid.

[Lazy Sod]

My sister likewise had a fusion with Dr. Wicharn with excellent results but she too had just one disk involved. When it is 2 disks there is more advantage to the artificial disk though until recently they were not available and everyone just had fusion.OP is asking the right questions i.e. how much loss of flexibility and would it be worth the extra cost to avoid.

Dr Wicharn explained there would be around 5% loss of mobility but it wouldn't be noticeable (true). He also said it depends on which disc, the one my wife had done doesn't move as much as some of the others so fusion is fine. She seems slightly taller now with better posture, the previous x-ray showed a curved profile but now it's straight.

[Sheryl]

OP's situation is a bit different as 2 disks involved

[ammagic]

Yes, I have the same problem. Long term epidural shot of steroid works really well for 3-4 months. Mine is caused by a bone spur pressing on the nerve. Soon I will go to Chiangmai Ram hospital for laser therapy to treat the bone spur. It rather depends on what is causing your pinched nerve. Better find that out first & then decide what next

[bill1369]

Have pinched nerves in C4&5. At one time, pain was quite severe, esp laying down (means no sleep!!). Saw US spine specialist. After MRI, he gave me a steroid pack of decreasing strength - first day 8 tablets, next day 7, next 6, etc. Pain was gone in few days. But came back after several months. Not wanting surgery, I opted for pain Dr who did a couple spinal cortisone injections. They finally did the 'trick' and have had no pain in years.

BTW: If you end up with a Dr who wants to give you any type of opiate, he doesn't know what he's doing. Opiates do not help nerve pain, steroids do. Only use as medically directed and, if you're diabetic, be sure and tell Dr as steroids will play havoc with your glucose levels.

[Thailand J]

It may worth a try to see a physical therapist. A few simple stretching exercise completely relieved the pain arount my neck and shoulder area which I had for years.

[FBN]

Fusing 2 disc levels in the neck causes increased stress of movement of the level immediately above and below the fused levels with increased wear and tear on those discs. Hence the recommendation for a disc "replacement" which will not have this side effect as it allows for more mobility.

The disc is a colloidal sort of structure that will absorb fluid and "swell" again to a relatively normal size if pressure on that level is relieved by traction or taking the weight off that disc in case of the lower back. This, however, may last only temporarily depending on the amount of wear on that disc. So intermittent traction with perhaps a neck brace after to protect the neck and support the weight of the head somewhat may relieve symptoms and perhaps delay the need for surgery a while.

[papa al]

It is also completely inaccurate to say that part of a private doctor's "job is to generate revenue for the hospital".

In private health care in Thailand (as in many places), doctors are not employees of the hospital.

They are independent practitioners who have an arrangement with (usually more than one) hospital to admit patients there and make use of their OPD facilities. For the top doctors especially, the hospital needs them far more than they need the hospital.

S:

1.No. You cannot truly believe your first sentence.

If a doctor doesn't help a hospital generate revenue, he'll no stay.

The understanding is implicit, not explicit, usually.

2. Sheryl, your second bold passage proves it: Hospitals need doc referrals...to generate revenue.

But they need each other.

As granny say: 'One hand washes the other.'

These are, after all, 'for profit' enterprises.

This is abundantly clear to anyone who has ever worked in hospitals.

Even 'non-profits.'

OP.

Imaging & conductive studies are swell,

but IMO a neuromuscular physical exam by a highly qualified doc or therapist is impotent.

[Michael8511]

You probably need a MRI with contrast to see exactly what's going on. I have gone thru this with my neck, lower back and hips. It's a lot of pain involved so it better to take care of it sooner then later.

I have refused surgery my self, had a lower back surgery for a pinched nerve years back, it went well but are now back and don't know if I personally will take the risk with a surgery again. It's no guarantee it will work. Good luck