DEAR DR. DONOHUE: I spent 20 years in the Navy, and for many years I suffered from two herniated disks in my lower back. I was given drugs for pain relief. Since I retired, I have tried chiropractic care, steroid shots and various other remedies, all to no avail. Oxycodone and hydrocodone have been prescribed. Both have given some pain relief, but they cause tremendous insomnia. Hydrocodone gives me a hangover effect. I do not want surgery. Is there a drug that will relieve the pain, allow me to sleep and not give me a hangover? — W.H.

ANSWER: Let’s start with treatments other than pain relievers. Have you tried physical therapy? A trained therapist can put you through back exercises that might relax your muscles and end your pain.

Have you ever heard of the Alexander technique of postural exercises? The instructor teaches you how to hold yourself properly to ease back pain. This isn’t accomplished in one or two days; it takes time. You can find instructors trained in this method on the Internet.

Tylenol might ease your pain if you go on a regular regimen of it. How about the nonsteroidal anti-inflammatory drugs, like Aleve, Advil and Indocin? The lidocaine skin patch is another way to block pain, and most users do not suffer side effects.

Opioids like Ultram (tramadol), Nucynta (tapentadol) and codeine silence pain for many. Dose adjustments of these drugs allow use without grogginess, headaches or insomnia. Opioids carry a potential for addiction, but when used under a doctor’s care, the risk is worth a trial to obtain release from more than 20 years of pain. The fentanyl patch is another opioid. It’s worn on the skin for long duration of action.

Newer surgical techniques like microdiskectomy can remove herniated disks through small incisions and with quicker recovery. And the spinal stimulator is another option you might want to consider.

DEAR DR. DONOHUE: Will you talk about the spinal stimulator for back pain? I have had this problem for 13 years. Without pain medicines, the pain level is nine out of 10. — Anon

ANSWER: The spinal cord stimulator was approved by the Food and Drug Administration in 1989 for pain control of back problems. The device consists of a generator that delivers electric current to the spinal cord through soft, thin wires that have been introduced into the back. The current blocks pain signals from traveling to the brain.

After a trial week with an external generator, if the process works, another generator is implanted under the abdominal skin or the skin of the upper buttock. It’s much like a heart pacemaker. It doesn’t work for everyone, but the trial period ought to eliminate those people from consideration. The material you sent from your doctors is excellent. You have conscientious doctors. You’re in good hands.

TO READERS: Vaginal infections are a common burden for many women. The booklet on these infections explains them and their treatments. To obtain a copy, write: Dr. Donohue — No. 1203, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: What is your opinion on prolotherapy? I went to a seminar in hope that it would help my hip arthritis. The doctor said it is mostly for soft tissue damage, such as bursitis and tendonitis. — L.T.

ANSWER: The doctor is right. It’s not for arthritis.

Prolotherapy involves injections of a substance like dextrose (sugar) into ligaments and tendons to boost collagen production. Collagen is the body material that strengthens these tissues. Large studies have not been done to evaluate its effectiveness. I’d try it if other measures have failed.

The “prolo” of prolotherapy stands for “proliferative” — a maneuver or substance that enhances the rapid growth of collagen and support tissues like ligaments.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

Copy the Story Link