Possible Diabetic vasculopathy, neuropathy and spondylosis

Patient: My husband was in a car accident in May 2010; was hit from behind. No immediate injuries; however, for the past year or so, he’s had back and leg problems. He’s diabetic and has had a triple bypass, so the leg pain was attributed to the diabetes. The pain in his back and leg are now almost debilitating for him. He has seen orthopedic surgeons (nothing shows on MRI, CT scans and EMG’s except for arthritis in his lower back, a couple of small bone spurs and a blockage in his legs shown by the tests on his legs), pain management drs. (ablation, epidurals, not sure what else), chiropractors, water therapy, etc. The orthopedic surgeon said that he saw nothing that would cause this pain in his lower back and down the back of his right leg. Because the blood flow test showed blockages, he referred him to a vascular surgeon. The vas. surg. ordered a CT angiogram to see how bad and where the blockages were in his legs. The scan showed that there were some slight blockages, but not enough to warrant angioplasty or stints on his legs as this wouldn’t “fix his problem.” He said that he obviously has a problem within his lower back. He called and spoke with my husband’s ortho. surg., the orth. surg. rechecked his file, and called and said that he still didn’t see anything that would cause this pain. He just had another epidural on Feb 24 which eased the pain through sometime on Monday, Feb 27. The pain is back in full force and affects his mobility, sitting, and sleeping. He found one day at work that a certain way he sat caused the pain and that if he shifted or lifted his right buttock, the pain went away. Any suggestions as to what he should do now? It’s very frustrating for him and I’m afraid it will soon affect his emotion and mental states. Thank you for any assistance you can give. Sandy

Doctor: The bone spurs seen at the MRI are degenerative bone changes related to the aging process: spondylosis. Neuropathies and vascular problems are the most common complications of diabetes mellitus (DM), especially type 1(insulin-dependent). Neuropathies related to DM affect up to 50% of diabetic patients. The nerves and blood vessels in the diabetic patient are affected because the high levels of glucose circulating in blood, glucose accumulate in the wall of the blood vessels producing a multifocal vascular disease that in turn, reduces nerve blood flow causing nerve damage, that’s why it is very important to keep a strict control of glycemia at all times to avoid continued deterioration. Possibly this explains your husband’s pain, in the view that the MRI and other studies to rule out spinal nerve compression came back negative. The symptomatic relief of the pain is the most difficult therapeutic problem in these patients; however, tricyclic antidepressants and anticonvulsants have been used alone and together with varying success.