Recently, I went for an MRI scan and was told I have a slipped disc pressing on a nerve, which is causing pain down my left leg. I was prescribed 300mg gabapentin, to be taken three times a day for a week, which had to increase to 600mg a day for the second week.
I am still in pain and worried that this is the wrong approach. Surely the slipped disc is the problem, and something should be done to alleviate that?
In answering your question, let me first explain something about what has happened to you and how your condition is likely to progress.
A slipped or herniated disc occurs when one of the rubbery discs that lie between the bony vertebrae in the back and act as shock absorbers ruptures.
Pay more for the NHS?
A new survey has found that three in five people now support tax increases to boost funding for the NHS.
It would be naive to pretend that the health service’s problems can be solved simply by throwing more cash at it: money alone won’t solve the problem of excess bureaucracy, or instantly raise the numbers of doctors and nurses, for example (it takes years to train both).
But extra money is a good place to start if it means the NHS can afford the latest cancer drug treatments and not have to ration cataract operations.
If voters are prepared to pay more for the NHS, then politicians must listen and start the conversation.
Each disc comprises a tough outer fibrous ring enclosing a softer centre. If the disc degenerates with age, or trauma, then the soft interior can bulge out through a breach in the outer ring and press on one or more nerves in the spinal cord – the bundle of nerves that extends from the brain down to the level of your lowest ribs.
If a nerve is impinged upon, there may be referred pain, which is pain felt not at the site of the damaged disc, but instead in the region that the nerve supplies, such as the legs or buttocks.
The pain you have is called sciatica, as it is the sciatic nerve, which exits the lower part of the spine, one branch to the left leg, the other to the right, that is impinged upon in this case.
The object of treatment is to reduce pain but, as you point out, it does not address the underlying cause.
Sadly, the anatomy is not so simple that we can push the herniated disc back into place. Instead, symptoms typically improve in time when the disc material shrinks back and the prolapsed disc heals – this can take days or months.
Painkillers ranging from paracetamol to non-steroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment.
It also helps to restrict, as much as is practical, any activity that might worsen the pain – this differs from individual to individual.
Some patients find that sitting or reclining provides relief from symptoms; others find the pain is worse even when resting in bed.
Losing weight if you are overweight is beneficial, as it reduces the pressure on the lower back.
Gabapentin is helpful in some patients with nerve-derived pain, and the current thinking is that this buys you some relief while you wait for the disc to heal.
The object of treatment is to reduce pain but, as you point out, it does not address the underlying cause
I assume that the decision to prescribe gabapentin was because you did not obtain relief from simple painkillers or NSAIDs.
If your symptoms do not resolve as the weeks and months pass, or if the pain becomes more severe or there is weakness in the leg, then surgery may be considered.
This involves partial or complete removal of the herniated disc, and is carried out under general anaesthetic by a spinal surgeon or a neurosurgeon.
If your symptoms don’t improve, I would ask your GP for a referral to a spinal surgeon.
But rest assured that while your current treatment may sound conservative, it is highly likely to be effective.
Around 18 months ago, I started to sweat when doing anything: shopping, gardening, even climbing stairs. My periods have also been irregular.
My GP said it was likely that I am menopausal (I am 49) and my sweats were probably bad as I was fat. I am 21 st and 5 ft 8 in.
Another GP suggested thinking about hormone replacement therapy (HRT) but, because of my weight, said this could be a problem. I am now exploring the herbal route: I’m on black cohosh, which so far is having no effect.
As more than 90 per cent of women become menopausal between the ages of 45 and 55, I suspect that this is the most likely cause of your sweating.
During the perimenopause, the run-up to the menopause (which occurs a year after the last period), levels of oestrogen fall and this causes the temperature regulation area of the hypothalamus, a region of the brain just above the pituitary gland at the base of the brain, to behave abnormally.
Under normal circumstances, the hypothalamus will initiate mechanisms to cool the body when its temperature increases by more than 0.4c. Blood flow to the skin then increases, causing flushing and a rise in sweat production.
Why I’m worried about ‘plastic’ food
Sainsbury’s is to introduce packaging for chicken that enables those too squeamish to touch meat to tip it straight into the pan.
This is in response to feedback from focus groups that found younger customers in particular are fearful not just of touching meat, but of the germs it may hold. Yet would these same people shrink from picking up and eating a burger? I suspect not.
I fear for the eating habits of a generation who are so scared of eating anything that does not look like a sterile, packaged meal.