Chronic Lower Back Pain: Seeking Solutions After Multiple Treatments

Lower back pain?

Two and a half years ago, I injured my left lower back and hip while lifting something heavy.
I sought treatment from both traditional Chinese medicine with acupuncture and Western medicine with electrical therapy, heat packs, and stretching, but none were effective.
Eventually, I went to a large hospital's rehabilitation department, where the doctor used ultrasound to examine my hip and found extensive damage, as well as injury to the quadratus lumborum muscle.
Dr.
Su from the rehabilitation department explained that it was a fascia injury and recommended PRP (Platelet-Rich Plasma) therapy.
One session involved high-concentration glucose combined with autologous platelets.
After receiving the glucose injection, I noticed significant improvement in the quadratus lumborum area, but there was little effect on my hip (the same was true for the PRP injection).
Before the PRP treatment, I had been stretching my gluteal muscles, which initially felt better, but the more I stretched, the more pain I experienced in the back of my thigh.
Later, the doctor arranged for an MRI of my left hip joint, which revealed that my femoral head was thicker than average, had poor mobility, and was compressing the hip labrum, suggesting that surgery might be necessary for improvement.
I consulted several orthopedic surgeons, all of whom stated that my hip joint appeared normal with no abnormalities.
They then arranged an MRI of my lumbar spine, which confirmed a herniated disc at L5-S1.
At that time, the orthopedic surgeon performed a manual anesthetic injection into my lower back, but there was no improvement in my symptoms.
I could perform superman exercises without any pain, and I did not experience any symptoms related to the herniated disc.
This orthopedic surgeon also believed it was a fascia injury but mentioned that some doctors recommended surgery, which he did not advise, as he felt it would not resolve the issue.
He indicated that Western medical treatments could only provide limited assistance.
I subsequently explored various treatment options, including traditional martial arts clinics, private physical therapy centers, and traditional Chinese medicine, but there was no improvement, and my condition continued to worsen (not due to the treatment process).
Some doctors believed it was caused by the herniated disc, but I found that lying on the ground or performing exercises with my hands supporting my lower back only increased my pain.
I then returned to Chi Mei Hospital's rehabilitation department to see Dr.
Huang, who explained that I would ultimately need to undergo PRP therapy again.
He believed that the previous treatment was insufficient and suggested using ultrasound guidance for injections into the ischium, hip joint, sacroiliac joint, and lumbar region.
After anesthetizing the area and identifying pain points, the conclusion was that the sacroiliac joint was primarily responsible for the pain, with slight involvement of the lower back, and no impact from the ischium or hip joint.
However, based on my previous experience, I declined the PRP treatment.
Later, I consulted a neurosurgeon who believed the issue stemmed from the herniated disc.
He suggested that only in the operating room, while taking X-rays and administering anesthesia, could they accurately target the nerve root, as manual and ultrasound-guided injections were not precise enough.
However, I thought about the implications of undergoing the procedure, knowing it would likely lead to a recommendation for surgery, so I did not pursue further examinations.
This summarizes my medical journey in seeking help from doctors, hoping for different insights.
This pain has persisted for over two years and is worsening, with examinations and treatments proving ineffective.
I kindly request any assistance or guidance you can provide.
Thank you.

Rong, 30~39 year old female. Ask Date: 2022/10/20

Dr. You Dianqi reply Orthopedics

Hello! It is recommended that you seek a reassessment from another hospital of a higher medical center level or consult with an orthopedic or neurosurgery specialist for a comprehensive evaluation.
Thank you.

Reply Date: 2022/10/20

More Info

Chronic lower back pain can be a debilitating condition, especially when it persists despite various treatment modalities. Your experience of having sustained an injury two and a half years ago, followed by a series of treatments that have not yielded satisfactory results, is indeed frustrating. It appears that you have undergone a comprehensive evaluation, including acupuncture, physical therapy, PRP (Platelet-Rich Plasma) injections, and imaging studies such as MRI, which have all contributed to a complex clinical picture.

From your description, it seems that the initial injury involved significant trauma to the left side of your lower back and hip, leading to myofascial pain and possibly a lumbar strain. The MRI findings of an L5-S1 disc herniation suggest that there may be nerve root involvement, which could explain some of the persistent pain and discomfort you are experiencing. However, the fact that certain movements do not exacerbate your pain raises questions about the source of your symptoms.

Given the multifactorial nature of chronic pain, it is essential to consider both mechanical and non-mechanical factors. The fact that you have had some improvement with PRP injections in the quadratus lumborum area indicates that there may be a myofascial component to your pain. However, the lack of improvement in the gluteal region suggests that the underlying issue may not solely be muscular or fascial.

Here are some potential avenues for further exploration and management:
1. Multidisciplinary Approach: Given the complexity of your case, a multidisciplinary approach involving pain management specialists, physical therapists, and orthopedic surgeons may be beneficial. Each specialist can provide insights from their respective fields, which may lead to a more comprehensive treatment plan.

2. Further Imaging: If you have not already done so, consider obtaining a detailed MRI of the lumbar spine and pelvis to assess for any additional structural abnormalities that may not have been previously identified. This could include evaluating the sacroiliac joints, which can often be a source of pain that mimics lumbar disc issues.

3. Pain Management Techniques: If conservative treatments have not been effective, you might explore interventional pain management options such as epidural steroid injections or nerve blocks. These can provide temporary relief and help identify the specific source of pain.

4. Physical Therapy: A tailored physical therapy program focusing on core stabilization, flexibility, and strength training may help alleviate pain. It is crucial to work with a therapist who understands your specific condition and can modify exercises based on your pain response.

5. Alternative Therapies: Consider exploring alternative therapies such as acupuncture, chiropractic care, or osteopathic manipulation. While these may not work for everyone, some patients find relief through these modalities.

6. Psychological Support: Chronic pain can lead to psychological distress, including anxiety and depression. Cognitive-behavioral therapy (CBT) or mindfulness-based stress reduction may help you cope with the emotional aspects of chronic pain.

7. Surgical Consultation: If conservative measures fail and your quality of life is significantly impacted, a surgical consultation may be warranted. Discuss the potential benefits and risks of surgery with a spine surgeon who specializes in disc herniation and related conditions.

In conclusion, chronic lower back pain is a complex condition that often requires a multifaceted approach to treatment. It is essential to continue advocating for your health and exploring different avenues for relief. Collaborating with a team of healthcare professionals who can provide a comprehensive evaluation and tailored treatment plan will be crucial in your journey toward recovery. Remember, while the road may be long, there is hope for improvement and a return to a more functional and pain-free life.

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