I’m running into similar issues and my primary care provider has been a lifesaver. She’s the one who has prescribed all of my meds so far, and only one ortho has felt the need to change one of the medications. The pain specialist agrees with my primary care provider’s recommendations.
I’m sorry if I missed it, but are you doing physical therapy? If not, that’s something I’d highly recommend. I think it’s really helping keep me mobile and more fit.
Regarding meds, I think the prevailing thought is that opioids aren’t very effective for nerve pain. Some of the more commonly-prescribed meds for nerve pain are pregabalin or gabapentin, anti-inflammatories, and muscle relaxers for severe spasms. One caution about the pregabalin and gabapentin is that they can cause weight gain, which is not helpful.
In my case, my neck/back problems cause muscle tension, muscle spasms, and myofascial pain. I’m not usually enthusiastic about unusual modalities but my PT practices dry needling and I’ve been amazed at how much it helps some of my pain. For me, it either works very well to temporarily (or long term, for at least two areas) alleviate pain or it doesn’t work at all, and it works far more often than it doesn’t. It isn’t legal in all states but if you’re in a state where PTs are allowed to practice it, it might be worth trying: https://my.clevelandclinic.org/health/treatments/16542-dry-needling
I’m nowhere near a solution for my issues so I’ll be interested in reading the other responses. And I’m so sorry to hear that you’re having such a rough time. Back problems can be awful.
That’s a good point. If I didn’t have my horse I would have been much more sedentary especially in winter. It was a big weighing of positives and negatives to decide to move. The current barn has an indoor so I was able to go ride in any weather and there are people there so it was really good for me socially. But my horse hates the indoor, there are no real trails and while it’s nice to have people there all the time there’s very little space with no one riding to be able to do groundwork. The new barn has a nice outdoor ring with his field surrounding it so he’ll be happier seeing horses. There are lots of times with no people so I feel like that gives me a better chance to work on the ground and use my PIVO and maybe just build our relationship by ourselves. There are still people to meet and ride and short local trails I can ride by myself and 400 acres of trails that the group there will ride out too on a regular basis.
Thank you all of this is really helpful. How painful is dry needling? I’ve had it recommended but also had a few people say it was super painful and they’d never do it again. I also pass out from needles usually lol
I haven’t been doing PT I needed my insurance to actually cover it. Previously I had a high deductible plan and basically everything was out of pocket. This year we have no deductible and it’s either a co-pay or I pay 10%. It is going to open some doors to see what works for me and what doesn’t.
It is legal in your state? If it is, my recommendation is to go to a dispensary and talk to one of the bud tenders about how you feel. If it’s only medically legal only, you’d need to get a card first.
Personally, I like edibles and tinctures. There is a stat that is something like 30% of people don’t metabolize them in a way to feel the effects. I am not one of those people thankfully as smoking anything isn’t something Im interested in. Too many health downsides there. Ive not used topicals, so I can’t speak to those.
A lot of it is trial and error right now unfortunately. Keep a log of what you try and what dose. I was hesitant at first to try any sativa strains because they tend to be categorized as more of an “upper” and that doesn’t help with my heart issues. With that said, I did give it a try and that specifically what makes my chronic fatigue manageable.
Most of my time at my PTs office is spent with needles in my back!! Its the best. @stargzng386 I can feel my muscles spasm and release and sometimes its uncomfortable but its very short lived and not any worse than anything else I have going on.
Maybe if you don’t see the needles, you won’t pass out? I do think dry needling might be a challenge if you were to literally pass out. Though, maybe sleeping through it wouldn’t be such a bad thing?
Honestly, it is sometimes very painful. There are usually at least a couple of spots that are intensely painful for me, and sometimes the pain travels to other areas. But as @FjordBCRF mentioned, it’s a temporary discomfort and has never been more painful than what I’m already feeling. And the relief is wonderful. Definitely worth it, as far as I’m concerned!
I used to have needle issues, but eventually just strong armed my brain about it because I have to get a lot of bloodwork done on a regular basis. I dont like it. I dont look. I tell them not to tell me how many tubes they are taking.
For dry needling, they are much much smaller and it doesn’t bother me to know what they look like. I also never really see them unless I ask since my view on the table is of the floor getting them in my back!
Good to know about the dry needling I can def give it a shot. I need to research some PT places near me that take my insurance. I’ve been ok getting blood drawn and thought I would be ok for the back epidural because I couldn’t see them but that was a big fat nope. I could feel massive pressure and knowing it was a needle my brain just noped me out of that situation. I was able to say hey I’m going to faint, then I was out and the Dr had the sense to not actually wake me up until he was done the procedure. It’s the after affects of feeling all wobbly and woozy that really suck.
I’ve been told that so many times over the years, but I know it’s not true, at least for me. I have severe neuropathy in my feet and quite a bit in my hands. I take gabapentin and it helps, but what saves my sanity is tramadol. If I don’t take tramadol before I go to bed, my feet keep me up all night. When I take it, they calm down just enough so I can sleep.
My situation is now complicated by being very limited on how much gabapentin I can take, due to being on dialysis and trying to preserve the little bit of kidney function I have left. But even when I took a huge dose of gabapentin every day for many years, I still needed tramadol to push the pain back more.
I have a slew of injuries, arthritis, and auto immune diseases I won’t bore you with. I also have a rampant addiction gene that’s been passed onto me, so I avoid all opiods. I stick to an anti-inflammatory diet, something I’ve really been able to hone in on through elimation dieting - my sister has ulcerative colitis, so i have her as a sound board. I don’t drink. I stretch daily, even when it’s painful. I use resistance bands for low impact strength training. I swim a few times a week to keep my core strong. Fortunately I have a stupidly high pain tolerance, so I can push through a lot, but when I am having a really hard time, I do have flexeril on hand so I can rest. I do see a Chiro, but not for aggressive manipulation - we utilize the Cox technique which is much kinder to my spine and has really helped alleviate some of my pain. I also work with a nutritionist who developed a supplement protocol that helps my body balance the pain. I would go the MM route if I could, but even as a teenage dirtbag I always had a bad trip. I have talked to several specialists and tried different blends, but I personally have not had any luck.
Like you, I push through pain. I find it’s the only way to have a life, and it’s given me a better outcome with my RA and fibromyalgia. I bike daily; if there is snow on the road and I can’t ride outside, I ride my stationary bike. I always say I’m powered by cussing. I was really cussing up a storm earlier today because one of my hips suddenly decided not to play well with others while I was out riding. But it was a gorgeous day, and I was so happy to be outside, so of course I kept going.
I live in Colorado. When pot was first legalized here, the only pain med I took was an NSAID. I tried adding various pot strains, and felt it never did anything for my pain. I worked for a company that followed federal law (of course!), and it wasn’t worth risking my job for something that wasn’t working.
But I had to give up NSAIDs altogether when my kidneys started failing, then had to cut way down on gabapentin. That’s when tramadol became my friend. I come from a family of alcoholics, but somehow those genetics missed me. If I’m busy or it’s inconvenient, I have no problem postponing or skipping a tramadol dose. I just know I’ll hurt a lot more.
Ok so I"ll be honest, I didn’t read everyone’s replies but I wanted to chime in as I feel your pain. 13 months ago, I was your average under 30 rider with average back soreness. Then my L4-L5 blew in epic fashion. Two surgeries (did the right side and then had to do the left 5 months later), somehow avoided needing the joint fused, and 13 months later I am a mostly functional adult again, minus some sensation in both feet and with reduced achilles reflex… back pain can be manageable with the right support system.
The biggest thing that I credit to my general recovery is the physiatrist I saw who went above and beyond to get me in with a good surgeon and the surgeon who was willing to operate based on my weakness, not my pain level.
First thing, back spasms are no joke, and sometimes a round of steroids is really what you need for it. A week (or two) of prednisone and I went from crying in pain if I did more than lay flat, to being able to ride my horse. Even now, my upper back will be sore at the end of the day but that is something some advil actually helps, unlike the unrelenting muscle spasms. This is something urgent care or your PCP would be willing to prescribe. This is not the long term fix obviously but you have to get everything to calm down before you can start the healing process.
If you have a hard time in appointments advocating for yourself, write a list before you come in and if your doctor doesn’t listen, find a new one. My physiatrist was fabulous and worked hard to get me seen asap. I am lucky, also, that my PCP has a fused S1-L5 and lives with chronic pain from that, so he is more than happy to prescribe me gabapentin for my nerve pain.
A note about gabapentin, the dosing range is quite big. At it’s worse I was taking 900mg a day (300 3 times a day), now I am down to taking 300mg at night to help me sleep over the lingering pain I have. It’ll make you a little ditzy at first but your system adjusts pretty well. It has never made my feel overly groggy or unable to function.
Do your PT! Number 1 thing is core strength. A good PT can teach you how to use your body better to protect your back. Pilates is a great tool, I actually bought a reformer so that I could more easily strength train while protecting my back.
On the riding side of things, proper saddle balance is going to be your best friend. If your back hurts in the saddle, check the saddle’s fit and balance for you and the horse. A few degrees can make all the difference in the world.
That’s actually very interesting. I have massive food allergies and a few times in the past years was prescribed prednisone and it did really take my pain away. I literally feel like a new normal person on steroids. Obviously not helpful long term but good to have in my back pocket.
When my back started hurting I ended up switching saddles. My saddle is like sitting on a cloud and lines up my shoulders, hips and ankles perfectly so that I actually sit up straight and don’t hunch. As much as it helped initially I’m still only ok walking or cantering. I just think the impact from posting the trot even as light as my seat is just isn’t working.
First, regarding the MRI results, I have all sorts of degeneration, bulging/herniation, bone spurs, weird mini-fractures, and shifted vertebrae and almost always, the discussion with my various doctors has started with some variation on, “MRI results don’t necessarily correlate with the sensations/pain that a patient is seeing, so some people with MRIs that are much “worse” than yours don’t feel any pain at all.”
Which often feels to me as if the doctor is calling me a wimp. I don’t think that’s actually the case, so don’t get discouraged if you hear something similar from your doctor. MRIs provide useful info but they’re only a snapshot and they don’t tell the whole story. Be patient and focus on communicating what your symptoms are, the severity of the pain, and on finding out how that pain can be mitigated or managed to the greatest extent possible. And be persistent!
Next thought … I have multiple related issues going on and I don’t think that’s uncommon. Which might be one of the reasons why some drugs are more effective in some people than in others. For example, there may be muscle aches or joint damage due to compensating for the back pain. (This would be a torn tendon, rotator cuff wear, and myofascial pain syndrome for me. Sigh.) Maybe identifying the fixable issues will help decrease the overall pain and provide some general relief?
Last thought … physical therapy has been mentioned but also, possibly occupational therapy? This is related to the paragraph above because in my personal experience (YMMV), my posture and general way of moving is affected by neck and back pain, which is leading to other problems. Occupational therapy can be useful in teaching more comfortable ways to do things, and how to set things up in an ergonomic way that minimizes further deterioration, in some cases.
All great points that I’ll keep in mind. I’m actually doing a big walkthrough of all of my activities at home to make everything as pain free as possible. I have some plans for my garden to make things easier. I also noticed I have a gate I have to slam to get the latch to close which made my back twinge. I’m going to replace that asap.
We’ve already automated a lot of things like the chicken coop doors and built nesting boxes outside so we didn’t have to walk in the coop every time.
The best thing I’ve ever done for my back is spinal decompression in a weird machine that kind of pulls and releases your back. Amazing difference. I need to do another round now actually. PTs sometimes have it and some chiros do too. I don’t let the chiro touch me other than to use the machine though!
The second best is stretching my hamstrings, quads, psoas and calves religiously every day and using the stair stepper/ hiking hills. I also have a massage gun I use on them when I have time. There are hamstring stretches that do not stress your lower back, ask your PT.
Add me to the list that has a messed up back thanks to falling off a horse years ago but it taking about 15 years for a proper diagnosis. Interestingly according to one of my (female) pain management specialists, women are so much more likely to be ignored when it comes to pain and it takes them much longer to get a proper diagnosis than men.
I’m an example of one of those who have horrible imaging that is relatively asymptomatic. When I finally got my MRI and met with my pain/rehab medicine doctor for the first time when he walked in he said “Based on your MRI I’m not quite sure how you can walk normally.”
I’ve got a Grade 2 spondylolisthesis at my L5/S1. This means that my L5 vertebra has slid forward about 10mm. It has caused “severe neural foramina narrowing bilaterally” which means that the little window/opening on the side of the spine where the sciatic nerve roots branch out of the spine has become teeny-tiny. On most people this would impinge on those nerves and cause severe sciatic pain, muscle weakness, diminished foot usage, etc. Up until very recently I’ve had no issues with this.
I also have advanced degenerative changes in the vertebral bodies and moderate facet arthropathy.
What is your pain like? Is it limited to your low back area, or does it radiate to your buttocks or legs?
For the most part mine has been limited to my low back - very localized to my L5/S1 area on either side. Twisting motions like turning over in bed became almost unbearable. The most likely culprit for this is the facet joint arthritis, so I tried facet joint steroid injections.
I will always remember getting home after having them done. They inject some anesthetic in addition to the steroid so you often feel some immediate relief. As I walked down the hallway to my bedroom I felt my lower back “release” and I was able to do a pelvic tilt/tuck in a way that I hadn’t for about 10 years. I burst into tears because I was so happy and then I got angry and started sobbing. This whole damn time I had been ignored/misdiagnosed - this could have changed 10 damn years ago.
As others have said - GET TO PT AND STRENGHTEN YOUR CORE. That is my lifeline now. My local PT clinic happens to have some therapists that are certified in Pilates and has some reformers. I specifically requested one of those therapists. After a few months I graduated from PT but was able to continue with a weekly reformer class taught by a physical therapist. She is able to tailor the workouts specifically to my needs (such as no moves that put me into a back extension).
My instructor was on vacation for 2 weeks and I had a horrible flare up. A woman I take classes with has a reformer at her house and she let me come over and use it - within a day I was feeling a thousand percent better. I’ve told my husband that I’m getting a reformer for home now. It would do him some good to use it as well.
Within the last year or so I have started having some intermittent issues that I’m guessing means I’m starting to have nerve root impingement. It’s progressed so I have an appointment next week to discuss that. What really sucks is that you really need to be your own advocate. Keep a pain journal and make sure to let the doctor know what your definition of pain is, or maybe focus on how it’s impacting your daily functioning/quality of life.
I’ve found The Spine Guy to be a fantastic resource for all things back related pain. While he’s a spinal surgeon, he always presents the minimally invasive/non-operative treatments so he’s not one that pushes surgery. He is also very honest in what conditions should NEVER be treated with surgery, like facet joint issues.
Where you sit can be huge. Both in the car at home. Bucket seats in a car or any seat that raises your knees and throws your weight back onto your lumbar spine are deadly. Think Adirondack chairs, but many, if not most, seats are built like that. My PT told me that when you sit, you need to have your hips higher than your knees. That can be accomplished with wedge cushions in your car and at work. Standing desks can be a blessing, too.
I went out and sprung for an expensive Zero Gravity Recliner, and it has been a lifesaver.
