Spondyloarthrosis in a 62 years old female

Patient: I am 62, active in family, home, church, and volunteer activities, and enjoyed the happiest year of my life in 2010. I looked forward to an even better one in 2011. But in early January, I began to experience frequent pain in my lower back, often accompanied by nausea and lack of energy. When I don’t have back pain, I have a high energy level. When my back hurts, however,my only effective recourse is to take a hot shower, use my back machine, lie on a heating pad, and eventually go to sleep. An x-ray of my lower back showed degenerative arthritis. My family doctor prescribed physical therapy. He also prescribed Metaxalone and Clonazepam. But because the closest physical therapy facility to my home is 25 miles away, I bought an exercise machine made specifically for the back. I also take a low impact exercise class at my nearby church twice a week. (I cannot do regular exercise, walk extensively, or use a regular exercise bike because all hurt my knees, on which I had surgery 10 years ago.) Did I make a mistake by not taking physical therapy, and is this likely the reason I still have the pain? But I don’t understand the nausea and the alternating periods of sleepiness with no energy or sleeplessness with high energy, and no medium. Also puzzling is that I sometimes get sleepy when I drive, which is only short distances, and have run off the road several times. Could all 4 of these be connected? Thank you for your advice.

Doctor: Basically in your case what you are doing instead physical therapy will work fine, the only difference is that you are not having the physical therapy resources to manage pain, meaning: TENS, ultrasound, diathermia and superficial hot/cold, anyway, it seems that you are taking already “Aleve” which is anti inflammatory medication and works good controlling pain, also the local heat (shower and heating pad) and massage/ exercise machine are very helpful in your case.  On the other hand, you will need an evaluation by an internal medicine doctor to determine the cause of the lack of energy, sleepiness and nausea because it is not likely that these three are connected to the spondyloarthrosis (degenerative arthritis in your back).