Chronic Lower Back Pain: Seeking Solutions After 10 Years of Discomfort

Lumbar issues?

Hello, I have been suffering from lower back pain for a long time, for 10 years now.
I have visited various medical institutions and traditional Chinese medicine practitioners, and I have undergone X-rays and MRIs of the left, right, and front sides, as well as electromyography.
All results show that my lumbar spine is normal, with no scoliosis or bone spurs.
They mentioned there might be inflammation of the upper ligaments, but I feel discomfort between the 4th and 5th vertebrae, which is not pain.
I initially consulted an orthopedic specialist and later a neurosurgeon.
Sometimes I receive injections of dilators, but there has been no effect.
I have been using a topical medication (1% diclofenac), but it hasn't helped either.
I have been jogging for over two years, hoping it would improve, but it hasn't.
Doctor, what should I do next? What further examinations should I consider, or which specialist should I see?

Mr. Hong, 40~49 year old female. Ask Date: 2016/07/12

Dr. Chen Yongxue reply Orthopedics

Hello, based on your letter, if all kinds of examinations have been conducted without any significant findings, it is likely a case of simple ligament inflammation.
This is often related to the patient's work or lifestyle habits.
Generally, it is most commonly seen in patients who maintain the same posture for extended periods (such as sitting at a desk or working on an assembly line) or perform repetitive movements, especially bending.
When symptoms occur, tender points can usually be identified, or pain may be triggered by specific positions.
Please consult a trusted orthopedic physician; typically, expensive tests like X-rays or MRIs are not necessary, as a physical examination should be sufficient to determine the cause.
Thank you.

Reply Date: 2016/07/12

More Info

Chronic lower back pain can be a frustrating and debilitating condition, especially when it persists for a decade despite various medical evaluations and treatments. Given your extensive history of seeking care from multiple healthcare providers, including orthopedic and neurosurgical specialists, and undergoing various imaging studies such as X-rays and MRIs, it seems that a thorough investigation has already been conducted. However, the absence of significant findings on these tests can leave patients feeling helpless and confused about the next steps.

From your description, it appears that you are experiencing discomfort primarily in the area between the L4 and L5 vertebrae, characterized by a sensation of tightness rather than acute pain. This could suggest a few potential underlying issues, even in the absence of clear structural abnormalities on imaging. One possibility is that you may be dealing with a condition known as myofascial pain syndrome, where muscle tightness and trigger points in the surrounding musculature can lead to referred pain and discomfort in the lower back region.
Another consideration is the potential for ligamentous or soft tissue inflammation, as you mentioned that there may be inflammation of the upper ligaments. Chronic inflammation can sometimes be difficult to detect on standard imaging but can significantly contribute to ongoing discomfort.
Given that you have already tried various treatments, including medications and physical therapy, here are some recommendations for further evaluation and management:
1. Consult a Pain Management Specialist: A pain management physician can offer a different perspective and may suggest interventions such as nerve blocks, epidural steroid injections, or other minimally invasive procedures that could provide relief.

2. Physical Therapy: While you have already engaged in physical therapy, it may be beneficial to revisit this option with a focus on specific modalities such as myofascial release, dry needling, or targeted strengthening exercises. A physical therapist with experience in chronic pain management can tailor a program to address your specific symptoms.

3. Alternative Therapies: Consider exploring complementary therapies such as acupuncture, chiropractic care, or massage therapy. Many patients find relief through these modalities, especially when conventional treatments have not been effective.

4. Lifestyle Modifications: Since you have been running for over two years, it may be worth evaluating your running form, footwear, and overall activity level. Incorporating low-impact exercises such as swimming or cycling may help reduce strain on your back while maintaining fitness.

5. Mind-Body Approaches: Chronic pain can often be exacerbated by stress and anxiety. Techniques such as mindfulness meditation, yoga, or cognitive-behavioral therapy (CBT) can help manage the psychological aspects of chronic pain and improve your overall well-being.

6. Further Imaging or Testing: If your symptoms persist, you might consider discussing with your physician the possibility of advanced imaging techniques or tests that could provide additional insights, such as a CT scan or a functional MRI, which can sometimes reveal issues not visible on standard MRI.

7. Re-evaluate Medications: If topical treatments and oral medications have not provided relief, it may be worth discussing alternative medications with your physician, including muscle relaxants, anti-inflammatory drugs, or even neuropathic pain medications like gabapentin or pregabalin.

In conclusion, chronic lower back pain can be multifactorial, and it often requires a multidisciplinary approach to management. It is essential to communicate openly with your healthcare providers about your ongoing symptoms and the impact they have on your daily life. By exploring various treatment options and possibly seeking a second opinion from specialists in pain management or rehabilitation, you may find a path toward relief and improved quality of life. Remember, persistence is key, and finding the right combination of therapies can take time.

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