How Can Lower Back Pain In A 74 Year Old Be Treated?
Actually, I need advice from the neurologist for the secondary cervical dystonia problem and need advice from a different specialist about my lower back pain and what am I supposed to do about that.
Get imaging done and examined by a neurologist
Detailed Answer:
Hello,
I have gone through your question and understand your concern.
Low back pain at this age can be disc prolapse or vertebrae involvement.
Less likely it can be renal stone related or sacroiliac joint disease.
Examination by a neurologist or imaging of spine will be helpful in diagnosis.
Cervical dystonia needs to be managed by antispasmodic medications.
Trihexyphenydl and clonazepam are the best options available. Botox injection is another alternative which can be discussed with a neurologist or movement disorder specialist.
Long term pain killers are not advisable.
Use of pregabalin or gabapentin can be supplemented.
Hope you found the answer helpful.
Do get back to me for further information.
Regards
Dr N Kumar
Neurologist
Hello take treatment as advised earlier
Detailed Answer:
Hello,
If you have not good response to botox then medications for spasm may be used like trihexyphenydl or tolperisone.
Clonazepam is not harmful at low doses but has addictive potential on prolonged use. The effect also lessens with time.
More likely back pain is disc related but sacroiliac joint is not in midline and can be involved on either side of spine overlapping buttock area.
Continue treatment as advised previously.
Wishing you good health and early recovery.
Regards
Dr N Kumar
Neurologist
I have noticed recently that if I bend or turn my back the wrong way there is a hurtful spasm and I immediately correct my posture and the hurt goes away. I had asked the doctor to set up a scan at the hospital so we/I could find out what was wrong and he refused to do that even though I had coverage by social security and medi-gap insurance to pay for everything. It is interesting to note that the neurological disorder doesn't manifest itself when in bed, only when up and about and the sore back muscle is modified by the two OTC meds at night and by 1 650 mg tab in the a.m. (GoodSense Arthritis Pain, Acetaminophen Extended-Release Tablets, 650 mg - Pain Reliever/Fever Reducer). The prescription I got on 02-11-2015 for 50 OXYCODONE ACETAMINOPHEN 5-325 as a result of surgery worked, as mentioned before. Unfortunately, this was about the time everyone cried "chicken little, the sky is falling" regarding the use of opiads/opiates which is a bit funny since a whole lot more people die from car accidents and hundreds of thousands suffer injuries from car accidents, but no one stops building and selling cars. It's hard to get good medical professionals in this area of eastern Oregon and the "professionals" that are here, probably wouldn't be at the same standard of excellence as those in the larger Oregon cities.
Oh! I forgot to mention that a number of years ago I woke up one morning and landed on my feet and both feet soles felt wet. I mentioned this to the male nurse at the VA clinic and he asked if I walked barefoot in my apartment and I said yes, and he said well you have a staple in your feet (well, I checked and didn't have staples in my soles). But the problem seems to be progressing and I have noticed here and there that this polyneuropathy (which the doctors said my dad died from) could be the onset of diabetes. Naturally, the outside doctor didn't do anything about this complaint.
You don't need to reply unless you have a good suggestion or two to provide. Thanks for your time.
Get examined by a neurologist and get investigated as advised
Detailed Answer:
Hello,
Back pain with symptoms of lower limbs can be due to cauda equina syndrome secondary to disc prolapse and canal stenosis. Lumbar spine MRI is required.
The possibility of neuropathy can be ruled out on basis of Nerve conduction study and clinical examination by a neurologist.
Investigations for suspected neuropathy comprises blood sugar, thyroid profile, vitamin B 12, renal and liver function test. Immunoelectrophoresis for myeloma should also be done at this age.
Tapentadol, aceclofenac, etoricoxib can be taken for pain.
Pregabalin or gabapentin can be used for neuropathic symptoms.
Physiotherapy under guidance should be started.
Wishing you good health and early recovery.
If adequate facilities are not available near your residence, then you should visit a major city for such a consultation.
Regards
Dr N Kumar
Neurologist