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I Have A Rough Spot In The Left Side Of

Posted on Thu, 6 Aug 2020

Question: I have a rough spot in the left side of my lower back that when applied pressure to feels like a “crunching” sensation. It has a constant pressure in the area and I have a sensation of electrical impulses running down the left side of my back and left leg without ceasing. I have had multiple MRIs which have shown no spinal degradation but have indicating minor discomfort bulging in this area. I have seen several doctors including neurologist and physiatrist but have had little to no relief. The sensations keep me from sleeping and it is heavily impacting my life. What actions can and should I take , and what could this be an indicator of?

Answered by Dr. Sudhir Kumar (4 hours later)

Brief Answer:
Symptoms are suggestive of a radicular neuropathic pain.

Detailed Answer:
Hi,

Thank you for posting your query.

I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.

I have noted your clinical details. I am glad to note that MRI spine was normal. This rules out any kind of surgical intervention. There could be minor irritation/pressure over the nerve, which sometimes can not be identified in the MRI as MRI has resolution, maximum up to 1-2 mm, not lesser than that.

In your case, the mainstay of treatment would be medical. Various drugs are useful, which include pregabalin, gabapentin, duloxetine, amitriptyline, etc. Please get back with information of medicines that you have used and their doses.

I sincerely hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.

Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Sudhir Kumar (32 minutes later)

Thank you for your reply.
I have been taking 300mg of gabapentin daily for about a month now but it hasn't really helped. What would a good next step be?

Answered by Dr. Sudhir Kumar (13 minutes later)

Brief Answer:
I have found pregabalin and duloxetine to be more useful in this situation

Detailed Answer:
Thank you for getting back.

I have found pregabalin to be the most effective. In my patients, I usually start a dose of 75 mg twice daily. If there is inadequate response, I gradually increase to 150 mg twice daily. Increment should be of 75 mg after at least one week intervals. Indians usually do not tolerate higher does than 300 mg per day, however, Americans do tolerate higher doses too.

Those who do not show adequate relief with pregabalin or have adverse effects (such as dizziness, drowsiness, etc), I add duloxetine.

Best wishes,

Dr Sudhir Kumar MD DM

Above answer was peer-reviewed by : Dr. Kampana