Vertebral hemangioma
My boyfriend has been experiencing sudden lower back pain at night, which affects his sleep.
Sometimes the pain starts in the afternoon or evening, and it has been a problem for many years.
A few years ago, the pain was so severe that he couldn't walk and had to crawl out of his workplace.
Last year, he also felt a slight pain in his left foot, which led him to consult a neurosurgeon and undergo an MRI.
The doctor informed him that there are hemangiomas between two vertebrae in the lumbar region, which could be causing the pain, as the report showed no other factors compressing the nerves.
However, the doctor mentioned that hemangiomas are generally benign and not a cause for concern, as they appear small and do not require treatment.
Despite this, he still experiences lower back pain, although the foot pain has resolved.
The back pain significantly impacts his work and sleep.
Is there any way to alleviate this pain (besides medication)? Which specialist should he consult for further evaluation? Is treatment really unnecessary?
Hsu, 20~29 year old female. Ask Date: 2023/01/03
Dr. Chen Yongxue reply Orthopedics
Hello, if your symptoms significantly interfere with your daily life, it is advisable to seek further treatment.
However, it is important to confirm whether the pain is caused by vascular issues (which is not common).
Please visit the outpatient clinic for further physical examination.
Thank you.
Reply Date: 2023/01/03
More Info
Managing pain from spinal hemangiomas can be quite challenging, especially when the discomfort significantly impacts daily activities and sleep. Spinal hemangiomas are benign vascular tumors that are typically asymptomatic and often discovered incidentally during imaging studies, such as MRI. However, in some cases, they can cause pain due to their location and the potential for expansion, which may irritate surrounding structures.
Understanding Spinal Hemangiomas
Spinal hemangiomas are the most common benign tumors of the spine, and they are usually found in the thoracic and lumbar regions. They are composed of blood vessels and can vary in size. While most hemangiomas do not require treatment, they can cause pain if they become large enough to affect nearby nerves or if they lead to vertebral body instability.
Pain Management Strategies
1. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can design a personalized exercise program to strengthen the muscles surrounding the spine, improve flexibility, and enhance posture. This can help alleviate some of the pain associated with spinal hemangiomas.
2. Pain Management Techniques: Various non-pharmacological pain management techniques can be employed, such as:
- Heat and Cold Therapy: Applying heat can help relax tense muscles and improve blood flow, while cold therapy can reduce inflammation and numb sharp pain.
- Massage Therapy: Therapeutic massage can relieve muscle tension and improve circulation, which may help alleviate pain.
- Acupuncture: Some patients find relief through acupuncture, which involves inserting thin needles into specific points on the body to relieve pain.
3. Mind-Body Techniques: Practices such as yoga, tai chi, and mindfulness meditation can help manage pain by promoting relaxation and reducing stress, which can exacerbate pain perception.
4. Chiropractic Care: Some individuals benefit from chiropractic adjustments, which can help improve spinal alignment and reduce discomfort. However, it is essential to consult with your healthcare provider before pursuing this option, especially with a history of spinal issues.
5. Interventional Procedures: If conservative measures do not provide relief, you might consider discussing interventional pain management options with a pain specialist. These can include:
- Epidural Steroid Injections: These injections can help reduce inflammation and provide temporary pain relief.
- Nerve Blocks: Targeted nerve blocks can help alleviate pain by interrupting the pain signals sent to the brain.
When to Seek Further Evaluation
If your pain persists or worsens despite these interventions, it may be necessary to seek further evaluation. You might consider consulting with:
- Pain Management Specialists: They can provide a comprehensive approach to managing chronic pain and may offer advanced treatment options.
- Neurosurgeons: If there is a concern about the hemangiomas causing significant structural issues or if there is a change in your symptoms, a neurosurgeon can provide further evaluation and discuss potential surgical options if necessary.
Conclusion
While spinal hemangiomas are generally benign and often do not require treatment, persistent pain should not be ignored. A multidisciplinary approach involving physical therapy, pain management techniques, and possibly interventional procedures can help manage symptoms effectively. It is crucial to maintain open communication with your healthcare providers to explore all available options and tailor a treatment plan that best suits your needs. If you have any concerns about the progression of your symptoms or the need for further intervention, do not hesitate to seek a second opinion or further evaluation.
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