Suggest treatment for lower back pain
Patient: i wonder if you can advise? i have a long history of back problems.  i have been a midwife for 10 yrs and recently changed working areas after being placed in an area with reduced clinical input due to my back.  in april i was told i had to return to the ward area and by may i was again experiencing severe back pain, leg pain and what i can best describe as sharp toothache continually.  i have not slept in months and the medication doesnt work if i done have enough and when i take it i am in the equivalent of la la land and cannot function. i had an mri last week and will find out what the results mean in 2/52.  the report says as follows, what would this mean?  i am struglling on the ward area and in antenatal clinic with partially clerical duties i have coped well with no problems in 3 yrs.  the report says Clinical history: Previous discectomy in 1997. Recurrence of severe low back pain in May 2010 with right lower leg symptoms and suspicion of altered bladder function. Sequences: Sagittal T1 and T2 weighted images of the lumbar spine have been acquired with axial T1 and T2 weighted images. Post gadolinium sagittal and axial images have also been acquired. For the purposes of this report the L5/S1 disc is assumed to be at image 701-03. Findings: The L1/L2, L2/L3, L3/L4 and L4/L5 discs are within normal limits. Mild facet joint hypertrophy is seen at L4/L5 but there is no evidence of significant canal or neural compromise at this level. At L5/S1 the disc is degenerate with significant loss of height. There is a small annular disc bulge and there is minor narrowing of the lateral recesses but no evidence of significant root compression. No significant canal narrowing is seen. The visualised spinal cord returns a normal signal and the conus terminates at L1. Conclusion: Degenerate disc at L5/S1 but no evidence of significant neural compromise. please would you be able to explain and even advise what a reasonable plan of care, treatment and options i may consider. many thanks denise Doctor: HiThank you for asking HCMI have gone through your query.Your MRI gives impression of intervertebral disc herniation with out neural compression.For such problem in patients i treat with NSAIDs like aceclofenac and muscle relaxants like cyclobenzaprine and neurotropic drugs.I also send them for regular physiotherapy and muscle strengthening exercise along with this.Wearing lumbar supporting belts also will be helpful.Hope this may help you.Let me know if you have any further query.