[Oldmanmatt]

Ok, background.

I cracked 3 vertebrae when I was ~14, getting thrown off mats, playing Judo.
Cue temp paralysis of left leg + tons of physio etc and a life time weak spot between L3/4.
In ‘96 @ 25 years, a surfing accident aggravated/re-awoke the sciatica and lead to a complete collapse a few months later (on a small yacht, in a storm, off the channel Islands). I ended up (via a long ambulance ride from St Peter Port) in Derriford hospital, where I was told the paralysis would be permanent.
It wasn’t, of course. I was introduced to a great physio, who specialised in Race Horses, and she in turn, introduced me to an Anaesthesiologist. Between them, and after an epidural, I was walking again after 4 weeks.
Four years and another three epidurals later, I had a self help routine down pat. Essentially, maintain an incredibly strong core and back.

I tried all sorts at the time, including most of the “alternative” routes. Nothing helped.

I have had some issues, occasionally, since then. But, careful management always suppressed it rapidly.

The only thing that I can absolutely state (having tried three different practitioners) is the Chiropractic makes it far, far worse and prolongs my recovery by weeks (I was introduced to the idea by an American friend, during a relapse, and eagerly trotted off to see the fella he used every week. One Star, do not recommend).

Anyway, I have not had an episode since before my daughter was born, so 14 years or so.

Until a couple of weeks ago. Having spent a few days prior, doing some very heavy DIY, but after a day off, I got up feeling a little DOMS, made my morning coffee, walked over put it on the coffee table. As I bent down to place the cup. It went.
I mean it really fucking went and I’m only now starting to cope with it, two weeks later.

Now, I’ve been doing all the usual exercises, trying to keep active, avoiding stress positions, juggling pain killers etc. I have not bothered with the GP, yet, because I don’t believe there is any new wonder treatment etc (at least Google hasn’t found any).

My problem, and I’m hoping someone here might have some experience, is sleeping.
By 8/9pm I cannot find any position that I can put up with, except bed.
 By 4am, I cannot remain in bed or find any position that isn’t agony, without an hour of roaming the house muttering and sighing, until it calms down.

Now, I keep being recommended Diazepam to deal with this, but I am reluctant to try it. I’ve not used it before and the people recommending it are doing so as second hand knowledge of friends/relatives who used it. I’m told it acts as a muscle relaxant, acts very quickly and relives the spasm caused by the sciatica.

Any idea if this is true? Is it worth bothering the quack for a prescription? Is it easy to stop again?

PS: Yes, I tried Acupuncture.
PPS: No, it didn’t work.

[tomtom]

That’s horrible OMM

I’m sure you’ve tried - but a range of different sleep positions?

 Maybe even in different beds?

Or accept that for now you’re only going to 2-4 hours rest before having to get up for a bit - reset for an hour or two - then back to sleep again? Until it eases up etc..

[Probes]

After doing my back, around T4-6, I had diazepam and can wholely recommend it! It took the edge off to get everything out of spasm and then start with recovery. My problem was a million miles from yours, I did take 9 months off climbing. All this was 10 years ago.
I have only 3 weeks ago done the bottom of my back, bulging disc, from shifting a silly amount of bricks about. I went straight to the physio that sorted me ten years ago. I have been able to sort my upper back on my own and thought I could the new problem, they gave me such a simple exercise that is given me great response already. So maybe there is something in getting it looked at again?!
I can only get comfortable at night lay on my front, no pillow. I feel your pain.

[Oldmanmatt]

Fetal position, righthand side, with a pillow between the knees.
Brilliant after about ten minutes, as the pain subsides and then the twitching stops, leaving only pins and needles in my left foot.
Of course, a couple of hours later, my right arm has gone dead and a comic “trying to turnover without the use of one arm or flexing my back in any way” routine ensues, until I achieve the same position on my lefthand side... which is not so effective for the sciatica, leading to the 4am thing...
Cheers though.
Did you have any addiction issues with the Diazepam?
I use Codeine , once a day, on bad days, but very reluctant to use such things (bad experience, many years ago).

[Probes]

I was on it for a week, and felt pretty out of sorts for a couple of days after, anxiousness..  so I can see how it can suck you in pretty quick. There was a definite 'crave' for those couple of days. It whacked me out whilst on it, I wouldn't have liked to do anything with risk... like drive. 

The side effects were easily outweighed at the time by the pain relief for me.

[cheque]

They gave me diazepam when I was in hospital in Spain to try and get me to sleep. It was one of the first drugs they gave me that I had to take as a pill rather than just getting it through the IV so it felt like a step forward.

I’d have one, fall asleep 30 minutes or so later then wake up about an hour after that and have anxiety attacks of varying severity for the rest of the night. I stopped taking them after a few nights ‘cos it was hell. I was on lots of other drugs though and in a terrible place mentally and physically. Wikipedia suggests that a few people have “paradoxical side effects” so maybe I’m one of them. I can still see how you’d get hooked on them, ‘cos they don’t last long.

I’ve nothing but sympathy for anyone who gets sciatica-type pain. It’s fucking dreadful.

[mrjonathanr]

Very sorry to read this OMM, sounds extremely difficult.

I had diazepam when I mashed a thoracic vertebra. It's a muscle relaxant, not analgesic AFAIK, but eases the muscle cramp which eases the pain, considerably. Makes reality a bit wobbly, floaty.

I took for about 3 days, did not have any issues with it. Give it a solid few weeks on it and I imagine you could have problems however. I knew someone who was on a moderate dose of a benzodiazepine permanently, too tricky to come off after long term use. I wouldn't worry about the odd one personally.

+ What Probes said about advice. In fact ++ I'd get to the doctor pronto, you need a medical assessment.

Wishing you a speedy recovery!

Oh, have you tried making mattress firmer, stick hardboard under it, maybe make it easier to sleep on a more supportive surface?

[petejh]

Something which I wish I didn't have a lot of experience of. Over 10 years of long periods of sciatica, epidurals (worst pain ever), and recurring bouts of what you're currently experiencing. Since finally having to have an emergency back surgery around 6 years ago, when one day the nerve become so damaged by compression I lost all use of my big toe, I've been a changed man (and can still use my big toe ). Still have the occasional twinge but it goes within 1-2 days. You have my sympathy, not that it'll make your back any better.
 
Basic issue as you know is getting the inflammation around the joint down to a manageable level and getting on with life. First you have to get the spasm to go away. My surgeon's advice for occasional flare-ups is to really hammer the anti-inflammatory for a couple of days - well over the maximum recommended daily dose (he states to go up to 3000mg max if your digestive system can handle it for two days), but only for 2 days maximum.  But it sounds like yours is longer term than that. Still might be worth a try if you haven't been taking any anti-inflammatories for the last week? If you have, then this approach likely won't work and will screw your stomach lining.

There isn't much new but there may be plenty you haven't tried. A good physio trained in spinal manipulations/mobilisations is probably well worth seeing for helping you to calm things down and ease the muscle spasm. Look for someone with the MACP qualification.
For longer term management as you know having strong and flexible muscles is key. You might want to try to find a physio who can teach you MAT - my experience has been very positive but it may all be placebo. These days I use it as a warm up prior to activity and it never fails to improve range of motion and that feeling of muscles being 'switched on'.
Also, consider swallowing your pride and seeing a strength coach - preferably cute, female and hot - to show you safe technique for strengthening your back/core and developing flexibility.. I remember watching a vid of you deadlifting and it's no surprise your back is currently knackered.

Can't help you with sleeping aids. I would have killed for some diazapan at some points in my back trouble but glad I never got any. You'll get better with or without it.

[Mr E S Capegoat]

Always worth working through this book if you haven’t already. Only a few quid and lots of good advice on sleeping, posture etc. Sometimes lying on your back with hips and knees bent up helps alleviate- supported on something.

Treat Your Own Back https://www.amazon.co.uk/dp/0959804927/ref=cm_sw_r_cp_api_i_o11VDb2X3XXC6

Pain relief wise : the usuals, anti inflammatory meds codeine and paracetamol work well together. You can get a prescription for tramadol but can be a bit heavy duty. Also heat packs can help sooth for a bit and ease spasm. To early days for manipulation / mobs unless it centralises the symptoms. Given your age it’s likely a worn disc / facet that will settle in 1-6 months  but that’s speculation. Diazepam can be useful for spasm but is a poor sleep aid and obvs can lead to dependency and paradoxical symptoms or withdrawal. I’d be last resort on that. Take it steady and good luck with it. Patience is key. 😊💗 ✌️

[Oldmanmatt]

Cheers guys!


Pete, I normally deadlift 2x BW x3 reps, one session, every week, believe it or not.
Like most of you, I’m actually exceptionally strong and fit, compared to the average man of my age and work as a PT and coach etc.
But...
I have a pretty good idea of what triggered this. I have a real problem with painting. In the four days before, I’d dismantled three bedroom’s worth of furniture and built new for the same. Dragged out the smouldering remains of an exploded double oven and installed a new one. Shifted a large fridge/freezer from oneend of the house to the other. All without incident. But the day I spent painting the exterior, up and down scaffolding and wielding a roller, left me more sore than anything else. I genuinely feel something about painting kills me.
I spend half my life up a ladder, stripping and setting at the wall, or building bits of wall, or working on electrics etc etc, but painting does me in.

[Will Hunt]

You need to go to the doctor as soon as possible.

The pain that you're experiencing now might not be caused by the same issues that you had years ago; it could be down to something totally different. Backs should not be fucked about with. Get yourself seen by a GP.

A colleague of mine experienced serious back pain after rummaging round in the cupboard under the stairs. She saw the GP who told her to come back in two weeks if it hadn't improved. She went back a fortnight later and was referred for a scan. The radiologist told her she would get her results back within ten days. Before she'd even left the hospital she was telephoned and ordered to report immediately to neurosurgery at St James', where a consultant told her not to allow herself to be discharged until she'd been operated on.

By and by, she received surgery to sort out the slipped disc. The condition was cauda equina. As I understand it, the soft interior part (the disc) of one of her vertebrae had slipped inwards and was pressing on the nerves of her spinal cord. She was lucky in that she wasn't paralysed and didn't lose any bladder/sexual function within days of it happening. She was also lucky that she doesn't seem to have any crippling chronic pain to deal with and, after a period of some months off, has been able to return to work. When they operated on her it wasn't a case of, "we'll just do this nice quick procedure and you'll be back to normal in no time"; it was, "we're going to do our level best and hopefully things won't be too bad in the future". She wasn't sent home from the hospital with any sissy drugs like tramadol or codeine or fentanyl. They sent her home with a bottle of morphine and orders of how often she was allowed to put a drop on her tongue.

Stop fucking around with self-medication and get yourself seen as soon as possible.

[nick63]

Completely agree with Will. Don't go to a physio or chiro for spinal manipulation. You need to get to your GP and get a X-ray or better still an MRI. Discs don't slip (!) but they do herniate or bulge which do cause the symptoms you describe. Surgery is not always required as given time and exercise it is now known they heal.

If you get any symptoms of loss of sensation around your genitals or anus, bilateral loss of strength in your lower limbs, and/or pins and needles in lower limbs this could indicate a caudal equina which needs to be acted on as a matter of urgency.

[Yoof]

Also agree with getting looked at by a GP to check nothing super serious is wrong. According to the consultant I saw, having microdiscectomies can be the start of a *slippy* slope that leads to more herniations; your body will dissolve/heal the bulging/herniated tissue eventually, so apparently just managing the pain and letting the discs heal properly is good longer-term.

Currently off work after a particularly bad episode of this. Diazepam definitely helped with the spasming when it was bad, although it did knock me out at the higher doses (as did the morphine and other drugs...). Reccommend it if the spasming is really bad.

Very interested to hear what other people's core workouts/stretching excercises look like when they're relatively well if anyone is willing to share.

[Muesli]

OMM,


I have a similar back story to you (although less extreme) .


I had a flare up with muscle spasms that left me unable to move last year. I was prescribed diazepam and codeine and like you was initially wary of it but it worked a treat and it relaxed the spasms  such that i could move relatively freely 48 hours later and was back to gentle exercise the next week.


I did not notice any adverse effects other than constipation ( i guess from the codeine) shutting down normal intestinal movements.


As a muscle relaxant the diazepam was very effective and i did not notice any changes in my mood or perception.

[cheque]

She wasn't sent home from the hospital with any sissy drugs like tramadol or codeine or fentanyl. They sent her home with a bottle of morphine

It’s immaterial to this discussion but you’ve put fentanyl in the wrong category.

[sheavi]

Some useful advice given above so far and some not very useful advice.  If you have any concern re: red flags then obviously go and see your GP, (or a good physio) who will take a thorough history and physical examination before deciding on an appropriate course of action. However, loss of bladder/bowel function, saddle anaesthesia etc is for immediate A&E.

https://fpnotebook.com/Ortho/Sx/LwBckPnRdFlg.htm

Anyway from the information you've given I would suggest a short course of diazepam, a prescription of amitriptyline and NSAIDS - see your GP for these.

Medication info
https://cks.nice.org.uk/sciatica-lumbar-radiculopathy#!scenario

Best wishes

[nick63]

Yes I agree Sheavi. I was not underplaying the dangers of cauda equina. It is a medical emergency and having treated at least 3 people who were sent home from A+E with nothing more than analgesia I fully appreciate the consequences. But symptoms can vary and may not be as marked as the classic 'red flags'. Further taking medication, especially strong analgesia may mask symptoms and prolong much needed urgent treatment.

[Oldmanmatt]

Ok.

Pride swallowed.

I ended up in MIU earlier and it’s been established that my symptoms are pretty classic sciatica and the numbness etc not into the red flag territory. They were pretty thorough.
More frequent and stronger analgesics.
I hadn’t mentioned the timing issue. That is, it gets progressively worse as the day progresses, so apparently classic inflammation, whereas Caudal Equina is more persistent/constant.
Getting a GP appointment here is total lottery. By the time I finally got through on the phone (to request a triage call), I was told I wouldn’t even get one of those before tomorrow after 12.
Couldn’t wait any longer, so picked the MIU with the shortest wait according to the NHS site.
And there in lies another tale, which I’ll recount on the election thread...

[Oldmanmatt]

Well...
Opioids didn’t cut it.

I struggled on a week or so after the MIU, but Codeine gives too brief a window of relief. I was switched on to a Pregabalin, ibuprofen and paracetamol stew, with Omeprazole seasoning.

Nice.

Permanently slightly drunk.
Bonus.


The Neuropathics leave an odd tingling (not quite pins and needles) where the pain was and I’ve managed to sleep through four nights now. Able to function quite well too.
Enough to be able to start exercising again and work etc.

Enough to be able to over do it, at which point the pain breaks through and I have to have a little lie down.
(That’s my excuse, I like it, I’m sticking with it, you can’t prove it’s not true).

Edit:

Actually, the Pregabalin makes me easily confused, a little clumsy and far too jolly/talkative.

[webbo]

Pregabablin gets used in mental health for anxiety.
I think there might be some issues with side effects but I can’t remember what they were.

[Oldmanmatt]

Pregabablin gets used in mental health for anxiety.
I think there might be some issues with side effects but I can’t remember what they were.

That’s actually one of them...

I think?

What were we talking about?

[cheque]

Good to hear Matt, the sleeping bit not the side effects obviously.