Injured Back at Work

Patient

Q: I injured my back at work in Jan 2010. I have pain from the middle of my back down my right side. It is hard to get up from sitting and very hard to stand for a long time. I have takenphysical therapy with no success.My right leg is drawn a inch and a half. Every time it is pulled back into place it draws back up. I have spasm in my back also. I done this at work, so I am seeing a worker comp doctor, but I feel like I am getting the run around. All I get told to do is take a pill. I can't live the rest of my life on pain pills. What do you think the problem is?

Doctor

A:   Chronic low back pain (LBP) is the most expensive benign condition in industrialized countries and the most common cause of activity limitation in persons younger than 45 years. It is defined as pain that persists longer than 12 weeks and is often attributed to degenerative or traumatic conditions of the spine. Mechanical or activity-related spinal pain is most often aggravated by static loading of the spine (prolonged sitting or standing), long-lever activities (vacuuming or working with the arms elevated and away from the body), and levered postures (forward bending of the lumbar spine). Pain is reduced when walking or constantly changing positions, and when the spine is unloaded (reclining). However, a persistent, relenting pain requires further investigation, as follows: evaluation by a physician, imaging studies (MRI, CT scan) and sometimes even functional studies as electromyography.
Your case may be managed as chronic low back pain (LBP), you might benefit of a longer course of Physical Therapy and anti-inflammatory medication (“Aleve”, “Motrin”). Some antidepressants are useful in chronic LBP to alleviate insomnia, and pain In addition, these medications may improve the patient's ability to cope, and they may reduce depression, anxiety, or fatigue associated with chronic LBP. Local anesthetics, corticosteroids, or other substances may be directly injected into painful soft tissues, facet joints, nerve roots, or epidural spaces.

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