Managing Chronic Pain After Spine Surgery: Seeking Solutions and Support

Pain near the vertebrae?

I underwent surgery for a herniated disc in 1988 at Taipei Medical University Hospital.
Since then, I have continued to experience pain and have been undergoing rehabilitation.
My doctor has been monitoring my condition, but over the past two weeks, the pain has intensified.
I am currently unable to work (I am a truck driver).
I have visited several nearby hospitals for examinations, but the doctors have only provided pain relief injections, oral pain medications, and physical therapy, without any improvement.
I experience aching and cramping pain from my pelvis down to my left thigh, calf, and foot, with a persistent tingling sensation, especially in my calf, which feels like intermittent cramps.
The muscle tension is severe, and I often wake up several times at night due to pain, making it difficult to sleep.
I would like to ask the doctor: (1) Is my condition suitable for a second surgery? (2) Can I request a CT scan or MRI to further determine the cause of my symptoms? (3) Additionally, could you recommend any hospitals in Hsinchu with specialists in this area?

Mr. Zhang, 40~49 year old female. Ask Date: 2005/11/08

Dr. Xu Zhenrong reply Rehabilitation

Hello Mr.
Zhang,
There are many potential causes for lumbar pain, including the recurrence of intervertebral disc herniation.
We cannot determine the exact cause of your pain based on your description.
The general approach in physical therapy includes heat therapy, traction, and electrical stimulation, along with spinal stabilization exercises.
The treatment course may take more than a month.

Given your job requires prolonged sitting, I recommend paying attention to your posture and avoiding staying in the same position for extended periods.
It would be beneficial to get up and move around every hour to reduce the likelihood of recurring back pain.

Regarding your condition, it may be necessary to consult an orthopedic physician for a detailed evaluation.
Whether a second surgery or a CT scan is needed should also be discussed with an orthopedic or neurosurgeon.
You can visit large hospitals such as Hsinchu Municipal Hospital (http://www.hch.gov.tw/) or Hsinchu Mackay Memorial Hospital (http://www.hc.mmh.org.tw/) for orthopedic consultation.

I would like to remind all patients that for any hospitalization (including non-surgical cases), you can ask your physician for a discharge summary note, which will include 1.
Chief complaint 2.
Treatment 3.
Surgery 4.
Test results (blood tests, X-rays, CT scans, etc.) 5.
Medications 6.
Others.
This can help other doctors better understand your situation.

Wishing you a speedy recovery.

Sincerely,
Hsu Chen-Jung
Taipei Hospital, Department of Health, Executive Yuan

Reply Date: 2005/11/08

More Info

Managing chronic pain after spine surgery can be a complex and challenging process. Your situation, characterized by persistent pain and discomfort following a herniated disc surgery, is not uncommon among patients who have undergone similar procedures. Here’s a comprehensive approach to addressing your concerns and seeking potential solutions.

1. Understanding Your Symptoms
The symptoms you describe—pain radiating from your pelvis down to your left thigh, calf, and foot, along with feelings of tightness and cramping—suggest that there may be ongoing nerve irritation or compression. This can occur for various reasons, including scar tissue formation (post-operative adhesions), recurrent disc herniation, or other spinal issues that may have developed over time.

2. Evaluating the Need for Further Surgery
Regarding your question about the necessity of a second surgery, it is essential to consider several factors:
- Severity of Symptoms: If your pain significantly affects your quality of life and daily functioning, further intervention may be warranted.

- Previous Surgical Outcomes: If the first surgery did not alleviate your symptoms or if new symptoms have developed, this could indicate a need for reevaluation.

- Consultation with Specialists: It is advisable to consult with a spine specialist or neurosurgeon who can assess your current condition and determine if surgery is appropriate. They may recommend imaging studies to visualize the spine and identify any underlying issues.

3. Imaging Studies
You mentioned the possibility of requesting a CT scan or MRI. These imaging modalities can provide valuable insights into the state of your spine, including:
- Disc Integrity: Assessing whether there is any recurrent herniation or degeneration of adjacent discs.

- Nerve Compression: Identifying any structures that may be compressing spinal nerves, leading to your symptoms.

- Scar Tissue: Evaluating for the presence of scar tissue that may be contributing to nerve irritation.

It is reasonable to request these studies, especially if your symptoms have worsened. Discuss this with your healthcare provider, as they can help facilitate the necessary referrals.

4. Non-Surgical Management Options
While you explore the possibility of further surgery, consider the following non-surgical management strategies:
- Physical Therapy: A tailored physical therapy program can help strengthen the muscles supporting your spine, improve flexibility, and reduce pain. Therapists can also employ modalities such as ultrasound or electrical stimulation to alleviate discomfort.

- Pain Management Specialists: Consulting with a pain management specialist can provide additional options, such as nerve blocks, epidural steroid injections, or other interventional procedures aimed at reducing pain and inflammation.

- Medication Review: If you are relying on pain medications, it may be beneficial to review these with your doctor. Sometimes, a combination of medications or alternative therapies (like gabapentin for nerve pain) can provide better relief.

- Lifestyle Modifications: Incorporating low-impact exercises, maintaining a healthy weight, and practicing good posture can also contribute to pain management.

5. Finding the Right Specialist
For your request regarding recommendations for specialists in the Hsinchu area, I suggest looking for hospitals or clinics that have a dedicated spine center or orthopedic department. You can also seek referrals from your primary care physician or inquire at local hospitals about their spine specialists. Online reviews and patient testimonials can also guide you in finding a reputable provider.

Conclusion
Chronic pain after spine surgery can be debilitating, but with a comprehensive approach that includes thorough evaluation, appropriate imaging, and a combination of therapeutic interventions, you can work towards finding relief. It is crucial to advocate for your health by seeking the necessary evaluations and treatments that align with your specific needs. Remember, you are not alone in this journey, and there are resources and professionals available to support you.

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