Disturbing pain after bone biopsy

Dear Ask The Doctor: I am suffering from bone TB with infection and inflammation in my left sacral bone. The diagnosis was done after open biopsy. Therapy: Taking antibiotics from last two months. Started with Rifampicin, Isonizid, Pyrazinamide and Ethambutol. As the organism was found as fully sensitive, Ethambutol was stopped after two weeks and the therapy continued with three medicines mentioned above. As, I have completed two months, now the plan is continue with Rifampicin and Isoniazid and stop Pyrazinamide. Observation: I felt a lot of improvement in the first two weeks of treatment but the condition detoriated rapidly after discontinuation of Ehambutol. Pain retuned back and much higher this time. However, new MRI and CT scan showed that the infection was not spreading. So, I was advised that the TB therapy is correct and I should continue with the three antibiotics. Now after completing two months of therapy, I am still in pain and way behind the improvment I was noticing after first two weeks of treatment. Bone abscess: Abscess is formed at the infection site, which is supposed to be treated by the immune system of my body and no external interference is done. Nerve involvement: I have severe pain and weakness in my left leg due to the pressure on the nerve roots caused by the inflammation at the infection site (left saclral bone). I took a lot of pain killers and was on a steroid (prednisone) course also for 20 days but pain and weakness returned back once I stopped taking the steroid. Can you please tell me whether the TB therapy is correct and how long will it take to get relief from pain? Also, how long the bone inflammation will last so that my nerve can get a relief and my left leg will feel better? Thanks a zillion in advance.

As for the pain, it will be hard to tell how long it will last; it may persist for a very long time (months). The pain you are having is due to the inflammation, not due to infection unresponsive to antibiotics. Prolonged steroid use is also not a good thing because it has numerous unfavourable side effects. You can request your doctor for medications to treat neuropathic (nerve) pain; these are prescription meds. The TB therapy you are having is correct. It is a general protocol that pyrazinamide is discontinued after 2 months of treatment AND the bacterial isolate is fully susceptible. There is no need to continue Pyrazinamide since this will do more harm than good. I do hope I have answered your question and take care always.