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L4/L5 overall mild central canal stenosis

AnonymousUserAAnonymousUser Posts: 49,321
edited 06/11/2012 - 8:34 AM in Spinal Stenosis
Hello all,

I am at my wit's end with the conflicting advice that I receive from four different doctors. My back pain started on my 31st birthday and has been getting worse since then. I just turned 32 recently.

From my chart last year:
L4/L5 mild annular bulge and or mild facet arthritic changes.
Overall mild central canal stenosis

L5/S1 mild disk bulge
Mild facet arthritic changes

I have low back pain that is dull but also thoracic pain that only started after months of the lumbar pain. It does feel better at complete rest like laying down or relaxed in chair. If I ride in a car for an hour, the pain will not stop even if I am taking maximum ibuprofen or other NSAID. This is even in addition to narcotics at the levels prescribed.

I seem to have trigger points in the muscles around the thoracic area. Overall, there is a muscle tightness on one side but both sides have been inflamed. A Dexpak nearly stopped all pain with hydrocodone.

In the last month, my upper buttocks have been cramping a lot when I walk around. It just feels like muscle pain, but is bad often for days at a time with no major exercise, just work done.

So, now I have tolerance to pain medication and while my job, family and other activities could use more pain management, a local pharmacist has decided that running short six pills is a major sign.

Every doctor I have seen still prescribes hydrocodone to help the pain but it lost it's effectiveness months ago I believe. It does work, albeit not as good.

One says that he believes me and that without seeing the charts it still sounds like I am in pain.

Another, a DO, pushes and moves my legs around then prescribes more pain medication without explaining the manipulation.

The third, an internal medicine MD says that just the stenosis could cause the pain. Currently my primary, but could not even convince pharmacist the early refill recently was needed. Of course only after a pain diary do I realize pain in other areas too but forget to tell him about that new symptom. We do have an MRI planned if I can get Medicare to help.

A fourth sums it all up to stress and dismisses any stenosis.

Anyone with similar problems out there? I am more interested in knowing if I am just a normal 32 year old with normal spinal stenosis. I feel somehow that if others have the same radiology report and pain, I am not a diverter or abuser.


  • Welcome to Spine-Health. I have to say that, unless I'm missing something, you've been going to the wrong kind of docs. I would suggest, like many here, that you schedule an appointment with a fellowship-trained spinal doctor or, preferrably, surgeon.

    I also have problems with my L4/5 - both facet and disc issues. It's pretty much the same that you're going through. I totally understand the lower back pain, but I also have sciatica and no thoracic pain. The result of my problem is that it's difficult to lay down, sit or (especially) stand for any length of time without some pretty bad pain.

    I also take hydrocodone and it's been helping my for over a year. Do you take any muscle relaxants? Those are very generously prescribed for spine patients because muscle spasms are so common. That might help your upper buttocks pain.

    As for your last paragraph, no, you're not a normal 32-year-old with spinal stenosis - you're a spiney like all of us here - we pride ourselves on be abnormal, we help each other tremendously, and we all understand what you're going through.

    I'm really hoping you get that MRI because that's so important in moving forward with your problem. But please, consider going to a fellowship-trained spine surgeon to discuss the results and your course of treatment.

    Take care and feel free to PM me any time. I feel for you and would like to see you find the right doctor and treatment.
  • If I had seen your post first, I would have written what Cath said to you. You can waste a lot of time dealing with a family doctor, internist, etc. Many have just enough knowledge to believe they know what is causing your pain. Even with a MRI, if you are not seeing a spinal specialist, you could be receiving faulty advice and treatment.

    One of the most important keys to successful back treatment is obtaining the right diagnosis.

    Spinal stenosis is not normal for a 32-year old...and it will not go away as you age. You will need expert care to deal with your problems.
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  • I do feel better now to know that others with far more serious problems see a commonality. So far, when I have problems in a "male area", I get sent to a urologist. If I had a tremor, they sent me to a neurologist. I never realized that maybe I should insist or find my own spine doctor. Not one DO or MD out of at least five that I has even mentioned it.

    I hope this doesn't feel like a rant, but I feel so much better that it seems ok to just go on.

    Now, at least one MD has told me that the radiology report was nothing to worry about. I see some textbooks say that only 50 year old radiological exams show stenosis in 30% or so of that age group. Mine, is at least (from what I can tell) 2-5mm more narrow than the other canals immediately adjacent.

    You would think someone who is on almost a second family basis with the President of the BOM here would be able to get better health care. He was the one who sent to the doctor I do like and then when he had to "leave suddenly", when no other doctor would take me due to only "three 1mg xanax and 3x 5mg hydro apap", he found a decent DO who took over my care until my primary came back.

    I do not know how anyone lives with this. The pain and discomfort is bad enough, since I am at the point where the prescribed medication is not enough. Not being able to play with my kids is worse, even though I am not that great at kids play. I wish that I could pick my almost three year old daughter up and do circles but I cannot. My son begs to be thrown around, but he at 45 pounds is just too big and my daughter at 30 is too.

    One of the worst things about this is not knowing who to turn to. Even one of my best friends, who is an ICU doc has no real good advice... he is a lung doctor and trained to keep people alive while bodies heal. I worry that one doctor might want to just get me hooked on higher pain meds and then I worry that another will go away again.

    So even if I do find spinal doc, I have another problem: my county has people who just love to get high on pain meds. I have to travel to another bordering state because the pharmacies in my state are so paranoid they will not even fill dose escalations if needed until after the original script goes out. In our county, if you are six pills short due to breakout pain and your doctor writes another... tough. My old pharmacy, which I was going to for 15 years has a pharmacist who banned me for six pills I took early while Dexpak was kicking in and the doctor refilled.

    Did the doc lash me? No. Did he tell me not to do it again? Not really, just to call him. What did he tell me to do? Try to reduce another day's dosage if you have to use more.

    Walmart has told me, as another pharmacy did, that they will call the Doctor to verify the script is real. Other than that, if I am not getting five scripts a month, none of their pharmacists had a problem with it. Yes, I actually went back and asked all shifts about it.

    Thanks a lot if you read this and even more thanks if you have something to add. You all probably know how good it feels to get this out in the open.

    "The new diversion expert in town with his massive six pills."
    I hope this makes someone laugh, I feel like a dug addict when someone hangs me for six pills. I did in fact include that I wanted the pharmacist's reasoning behind me being a diverter or abuser.
  • Feel free to express your feelings. That's why the board exists! May I ask in what country you live? You don't need to answer if it makes you uncomfortable...or..whatever.

    Have you had a MRI? It sounds like you need to get some baseline data for comparison to any future problems that might arise.

    I think you'll need to find a new way to interact with your small children! Lifting them is pretty much out of the question with any type of spine problems. They should be able to understand that "Daddy's back is not well and he cannot pick you up"...or "rough house" for that matter. I recall someone on the board saying she hurt her back badly playing a game she called "monster" with her kids. Depending on what is causing your spinal problems, you may have to learn to make some adjustments in order to protect your back. Sad, but better than the alternative.

    Please come often and post your comments, questions or just to vent. You might want to look into the chat room. You will find many sympathetic, understanding folks in there who understand what you are going through.

    Take good care.

  • Gsbennett31GGsbennett31 Posts: 1
    edited 10/19/2015 - 7:57 PM
    my doctor won't call me back. just referred me to surgeon on 27th of october. i had the mris for suspicion of ms due to 24/7 pain, numbness, tingling in legs & hands. sometimes not being able to move.

    perhaps, you can help.

    had 4 mris & two give me concern.

    lumbar mri:

    l4-5 mild cabal canal stenosis
    bilateral pedicle edema is present at l4 and l5 and bilateral pars defects are suspected at these levels

    mri dorsal

    bones: fracture suspicious osseous lesion

    t6 -t7 mild central disk bulge with mild depression on the anterior cord and adjacent cord signal abnormality. the cord signal abnormality is thought to be secondary to the disk bold and degenerative rather than multiple sclerosis

    all i've heard is to meet with a surgeon.

    thanks for your assistance!!


    no on one the spine-health patient forums is medically qualified to provide any advice or
    or recommendations on any diagnostic test. however, the following key words can always be applied.
    • mild treated with conservative measures such as physical therapy and mild medications. many times these situations can be cleared up and the condition can be resolved.moderate some more treatments may be needed, ie spinal injections, ultra sound and stronger medications. always a possibility of more aggressive treatment if the conservative measures don't helpsevere need for stronger medications. the requirement for surgery may be necessary
    welcome to spine-health

    liz, spine-health moderator
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