Resolved question:
Hello Doctor,
I am here for my mom, Durga Paul. SHe is 66 years old. We are from India, West Bengal State.
For the last 10-12 months she is suffering from pain in the Chest RIBS, Spinal cord, and below waist portion including legs. There is no joint pain.
Sharing some brief of her medical history.
She is diagnosed with hypothyroid and this is for last 15 years or so. Hyper tension. No pressure related issue or any blood sugar issue. In 2013 she is diagnosed with Perkinson disease. For that she is taking SIndopa medicine. And for thyroid, she is taking Ltoxin/Thyronorm.
Brain MRI & Spinal cord MRI done but nothing found wrong. Recently One test called NCV done and doctor said some nerves might got twisted or something like that which cause improper bllod flow through nerves. I have reports and doctor prescription with me and same I will attached herewith. Its something related to Neuropathy as per my understanding after went through some documents online :)
I would like to consult all these with a specialist Neurologist / or Neurology Sergent who can guide me what actually causing all these pain over her body and what is required to get cure of it.
If any medicine you can prescribe or what to do, would be great help. Let me know if anything more you want to know about her.
Thank You.
Submitted:
4 Days
Category:
Neurologist, Medical
Hello,
Thank you for posting your query at DoctorSpring.com
I have noted your mother's symptoms.
Yes, she has peripheral neuropathy, as per the reports of nerve conduction studies. This can cause pain and tingling in the legs.
This can be treated by medications such as pregabalin or gabapentin capsules.
In addition, she has mild disc disease with compression of nerves in the lower back, as per the doctor's prescription notes. She can undergo physiotherapy for the same.
Also, we need to exclude vitamin D deficiency and osteoporosis. This can be tested by doing a blood test for vitamin D level and bone densitometry/DEXA scan for osteoporosis.
I hope it helps.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Thank you very much. One query i have for that medication (pregabalin or gabapentin capsules) you suggested, what would be the dosage for this, and how long need to be taken ect. Also would like to know, do you thing there is any need for any operation. Is this completely curable. Kindly guide on this. Thank you again.
Here is the report for MRI Spine:
Clirrical History : Pain in chest wall lwith a gridle sensation.
Imaging Protccol : Multiplanar irnages of lurrbo-sacral spine on Tl. T2 and sTlR sequences were
obtained.
Findings :
Mild bulge of L4-5 disc is iloted mildly compressing the ventral thecal suface & impinging the
perineural fat at bilateral neuroforamen.
The effective AP canal diameier at various disc levels are as follows:
L1-2 = 18 ifirr L4-5 = 12 mm.
L2-3 = i6mrn. L5-S1 =i0nrm.
L3-4 = 17 m t.
Mild scoliosis of dorso-Lumbar curvature is noted wrth convexity towards right. The vertebral bodies
are normal in height and marrow signal intensity. Marginal osleophytes are notecl.
The ligamentum flava are not hypertrophied.
The cord ends at normal location The thecal sac, conus and the caucia equina nrerve roots show no
obvious; intrinsic abnormality
The perivertebral soft tissue structures are unremarkable
IMPR ESSION:
MRI of the Cegeneralive lumbo sacral spine shows nrild bulge of L4-5 ciisc inildly compressing the
ventral thecal surface & inrpinging the perineural fat at bilateral neuroforamen.
Screening images of dcrsal spine shows no obvious abnormallty. Haemangiomas are seen in D6 and
D9 vertebrae The cord appears normal.
Thank you for getting back.
Pregabalin is usually given at a dose of 75 mg twice daily after breakfast and dinner; and Gabapentin is usually started at a dose of 300 mg two times daily. The dose can be adjusted according to the patient's response.
It should be given for 4-6 weeks and after review, the decision can be taken to continue them further also.
I have reviewed the MRI report and it shows mild disc bulge.
Treatment as suggested earlier would suffice. Physiotherapy should include IFT/ultrasound for pain relief, and back extension exercises can be taught to strengthen the back muscles.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Hello doctor,
Good Day !!
Would like to update on my mom's present health, as you advised, she is taking pregabalin 75mg two times, along with she is taking Ltoxine (for hypothyroid), Sindopa plus (1/2 tablet daily for parkinson disease).
There is little bit improvement in pain on upper half of the body (as told you earlier, RIBS, Spine), but pain/strain is there in both legs after going to bed at night. Sometimes pain is more that she can't sleep, mainly on lower feet area, and the pain is from cup to feet.
Requesting your suggestion, if these medicines are to be continued and any other medicine need to be taken for legs pain. If need to make any chnages for Syndopa or any..
We are doing test on vitamin D deficiency and osteoporosis as suggested. Will update with report soon.
Kindly suggest. Thank you.
Thank you for getting back.
Pregabalin capsules should be continued for about one month to see a good relief. However, I am glad to note that mild improvement has started. I hope that physiotherapy is also going on along with medications.
Please update me about vitamin D and osteoporosis reports when available.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Hello Doctor,
I tried attaching the report DEXA & Vitamin D deficiency, but could not, so sending via mail to id info@doctorspring.com, kindly get it from there.
As I told in my last update, there was bit improvement, but again pain started after 3-4 days and it is continuing. Some time it is severe that she can’t control herself due to pain. We are bit scare of her condition, as why positive progress is not happening for the last 1 year, as we visited doctors from different specialization before coming here for consultation.
During severe pain, once one doctor prescribed a painkiller containing following composition:
(i) Tramadol Hydrochloride- 37.50 mg.
(ii) Paracetamol- 325 mg.
(iii) Excipients- q.s.
and is in used in time of excessive pain and having good relieve. Would like to know how far this is ok to take as per her condition. Also kindly suggest if this can be continued or not when pain is more, if not please suggest alternative medicine which can provide good result in time of excessive pain.. or else suggest otherwise.
Regarding physiotherapy, she was undergoing the same, first 3-4 days, there was improvement, but after that she couldn’t able absorbed the untrasound heat, hence it stopped now. But exercise is going on.
Kindly suggest how this can be cure … she is not feeling well at all, sometimes we are helpless in this condition what to do next for her recovery.
Thank you.
Tramadol/paracetamol combination is safe for pain relief, and this can be used as and when pain is present. It can be used upto 3 times prepay and can be used for as long as possible.
Physiotherapy exercises are fine for now.
I have noted the reports, which show low vitamin D and decreased bone density (osteopenia).
Following medications are needed:
1. TAB TAYO 60 K once a week for 12 weeks.
2. TAB SHELCAL 500 mg once daily after breakfast for three months.
Regular exercises such as walking for 20-30 minutes per day is also useful.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist