Resolved question:
My mother, born in 1930, has a sharp/shooting pain in her right leg. It starts from just above the knee, curls arounf the inner thigh towards the groin, traverses the right nate, reaches the spine in lower quarter of her back, and then radiates out in a horizontal circle from that point. Occasionaly it encircles her abdomen.
Please tell me 1) what is wrong, 2) what type of doctor she should visit, 3) what other studies might be needed, and 4) what the treament should be.
Adoctor told me yesterday that the problem might be "compresion radicular." It might have something to do with her medula, and we might need an x-ray of her medula.
She has not fallen. It is difficult for her to walk due to the pain she feels in her right inner thigh when she put weight on the right leg. This has been a problem for a bout a week. She was seen by a doctor who prescribed anti-inflamatory medication. The pain persists. However, doctors are advised to be wary of her being prescribed pain medication, as she has numerous times been treated for addiction to prescription meds.
Please get back to me ASAP, as she reports being in pain.
Submitted:
4 Days
Category:
Internal Medicine Specialist
Hello,
Thank you for asking your query at DoctorSpring.
I appreciate your accurate description of the symptoms. The symptom pattern is suggestive of a compressive radiculopathy at the lumbar level - In simpler terms a pinched nerve root in the lower spine. Since nerve too travels and exist through the spine, any deformity / trauma / injury can cause pressure over the nerves and cause radiating pain and symptoms. (For example a minor fracture, a disc prolapse etc can cause this).
She should visit a Orthopaedic Surgeon or Spine Surgeon or an Internist - as the cause of the pinched nerve could be multiple. Any of the above Doctors will suggest cross referral if needed.
An Xray followed by MRI of the spine may be needed. A routine blood test is also recommended. A complete physical examination and Neurological examination is must - This will give a initial diagnosis . Specific blood tests might be needed based on the MRI findings.
Treatment depends on the cause (final diagnosis). As of now rest and pain medication is very important. Avoid strain and excess movement. NSAIDs can help. The addictive potential is less for NSAIDs, so you can give it under medical supervision. Make sure she is taking it with food along with an anti ulcer medication.
Hope this helps
Please feel free to ask followup questions / clarifications.
Thank you
We had the MRI and it does show a narrowing at, I believe, the 4th lumbar. But we subsequently had a test of the passage of nerve signals from her feet to her brain, which showed no significant attenuation.
She has gone to more than 8 weeks of therapy. The inner thigh pain vanished with stretching. And the size of the painful area on her right thigh has diminished by 80%. However there remains a small area which is very hard to the touch and painful. The therapist and doctor here in Mexico call it a "contractura," a chronic contraction.
They have treated it with heat, electro shock, ultra sound, and most recently with a large electro magnet. These treatments have helped, but every day this small, painful area returns. Ibuprofen seems to eliminate the pain for a while.
Another doctor said she might have compression at thorasic vertibaes 12 and 11, where the nerve iminates laterally from the medula.
What can we do?
Hello,
I have to say your mother has satisfactory progression considering her age. For now you need to continue Ibuprofen on a daily basis and keep up with the physical therapy (which ever was most comfortable). The varying pain and related symptoms should resolve once the nerves are soother down.Do physical therapy and back strengthening exercise. A medication like Gabapentin can be considered in consult with your Doctor. These medications like Gapanetin is for neuropathic pain and are effective in many cases.
You can expect a slow but steady resolution of symptoms.
Hope this helps
Thank you
Doctor,
Thank you for your reply. Can you speak to the interaction between Gabapentin and Warfarin (Coumadin), a blood thinner? She is also taking Lanoxin for a diagnosis of atrial fibrilation. Jeff Prather, MA
Hello,
There is no major interaction between Gabapentin and Warfarin. But Gabapentin may decrease the INR which is a blood clotting test used to monitor Warfarin therapy.
Hence if INR is reduced , Warfarin dose will be required to be increased. It is required to test INR 5- 7 days after taking both the drugs together. Lanoxin has no interaction with the Gabapentin or Warfarin.
I hope this has helped.
Thankyou