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How Can Lower Back Pain In A 74 Year Old Be Treated?

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Posted on Fri, 8 Sep 2017
Question: I have lower back pain (the doctor said I had a arthritic vertebrae) but the left side of my body has absolutely no pain and the pain on the right side is definitely from a muscle which tightens up. When I had an operation about 2.5 years ago, the Dr. prescribed 50 oxycodone; I took one the first night and felt all the pain going away. I have only 10 left, have used about 3, and the rest were stolen from my apartment. So, I talked to the pharmacist at Rite-Aid and he recommended the OTC ADVIL PM so I started taking two at night and in the a.m. one 650 mg pain killer OTC pill which works well in the daytime and then I got an email from Aleve trying to sell TENS units and found out they had a ADVIL PM WITH SLEEP AID. So, now I take one ADVIL PM and one ALEVE PM at night and most of the pain goes away. I have found out that I cannot sleep more than 8 hours in bed as the pain will come back. A while back I noticed in the CONSUMER REPORTS HEALTH MAGAZINE, there is some question whether ATORVASTATIN (20mg per day) may be responsible for back pain. I take this from the VA for cholesterol. So, if OXYCODONE tabs are so bad, won't I become dependent on ADVIL PM and ALEVE PM? Another question for a neurologist: Back in mid-1995 I was diagnosed with secondary cervical dystonia aka spasmodic torticollis. I was prescribed generic KLONOPIN, ARTANE and VOLTAREN. I initially took 2 mg of the KLONOPIN and ARTANE in the a.m. and p.m. and 1-75 mg VOLTAREN. I had my dosage of KLONOPIN and ARTANE increased to 3-2 mg TABS in the a.m. and again in the p.m. In XXXXXXX of 2010 I had a bad bicycle accident and had to have dialysis - the doctor in charge said to stop taking VOLTAREN as it would migrate to the kidneys. At the end of 2016 there was a new doctor at the local VA clinic who wouldn't renew my KLONOPIN generic prescription. I have now reverted back to the same lack of neck muscle control which was sufficient for SSA to put me on disability effective November 2000. Is there something out there that would replace the CLONAZAPAM? I voluntarily quit driving vehicles due to lack of neck muscle control and only ride my bike and when necessary, take the local bus. I quit driving my XXXXXXX when I was going home and was in the fast XXXXXXX and my neck suddenly jerked to the left (I was in the fast lane) and had to force my head to the front with one hand and drive the XXXXXXX with the right hand and got in the slow XXXXXXX and got home safely.


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.
doctor
Answered by Dr. Neeraj Kumar (49 minutes later)
Brief Answer:
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
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Neeraj Kumar (21 hours later)
I have had a series of BOTOX injections by Dr. XXXXXXX Truong (easily found on the internet). It was very painful as he would inject botox in to the back of the neck and he had two instruments which helped him find the muscles involved - one instrument made loud noises and the other was like an oscilloscope which spiked when a conflicted muscle was found. Fortunately for me, my HMO at the time refused to pay any more of his fees and I had to stop going and one day I woke up and all of the outrageous pain in my neck disappeared. It was like that noise in your ears and one day you wake up and the problem has disappeared. The question I have, actually, is why would a VA doctor terminate my use of clonazepam? What would be his reason? Is there some medical literature which indicates clonazepam is bad? I've taken this prescription since 1995 and to have it withdrawn suddenly reverting my neck muscles back to when the problem started is really outrageous. Regarding back pain - I can feel the muscle which is attached to the backbone vertebrae and it goes to the right and I can feel it by hand manipulation and am able to determine whether it is sore or has been tamed by the use of the OTC meds I take. And, since there is no pain on the left side of the spinal column, the suggestion of arthritis of a vertebrae is not acceptable to me.
doctor
Answered by Dr. Neeraj Kumar (3 hours later)
Brief Answer:
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

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Neeraj Kumar (17 hours later)
I ride a Mountain Terrain Bike (MTB) even during the winter when there is snow and ice on the roads, as the bike has knobby tires and normally has good grip and I am quite careful. However, there was a period of about 3 years when I would stop and just fall over a number of times each winter on to my right side. I've never fallen over on my left side. I believe each time I fell over it was on the hip and I didn't fall over going fast just as I was going real slow and stopping for traffic. So, I think that was a precursor to my lower back pain. Anyway, I started to get abnormal pain in my lower back and it got so bad that many nights I just went to bed and stared at he ceiling unable to sleep. The doctor I see outside of the VA clinic refused to help with pain prescriptions and much later on when I had found ADVIL PM and ALEVE PM he indicated I had an arthritic vertebrae. The pharmacist at the Safeway supermarket pharmacy said that ALEVE PM was known to cause bleeding, but he didn't know if there would be blood in the urine or stool or I would bleed out internally. This doctor I saw outside of the VA system had written a lengthy "letter to the editor" of our local newspaper indicating anyone who takes medicines/prescriptions/OTC is a "drug addict and would sell the pain medicine or overdose" which I thought, and still do, as being a libelous statement.
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.
doctor
Answered by Dr. Neeraj Kumar (5 hours later)
Brief Answer:
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

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
Dr.
Dr. Neeraj Kumar

Neurologist

Practicing since :2006

Answered : 2259 Questions

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How Can Lower Back Pain In A 74 Year Old Be Treated?

Brief Answer: 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