Muscle Spasms - lower back

[Harrison27]

Hi, some may already know that I have 4 discs in my lower back bulging, one has an annular tear and I have been through all the usual treatments and been to the pain clinic. I am never sure if it is nerve pain or muscle pain - quite possibly both. I had been off work for 6 months. The past few weeks I have been trying to return to work, and was doing really well. I did have spells of horrid pain but just kept telling myself, they will pass. My job is fairly easy on my back as its a mixture of desk work and standing / moving around. It does involve a fair bit of driving, but I have always done that and I use lumbar supports etc.

Anyway the first few weeks were fine, yes a little more pain at night but I thought I was coping, then on Monday I went to our head office which is a little further away, felt fine whilst there, fine on the journey home and at night. The following day it felt like my back was going to lock again with the horrid spasms I get (the ones which make sure have to hit the floor and scream). I spent all of Tuesday feeling like my back was about to go, but kept moving (I was on a day working from home). Got up on the Wednesday and felt "normal" again, the. It started again last night - really painful muscles and being scared to move the wrong way, got up again today and was ok again.

I'm on 60mg of baclofen a day due to the spasms I get (I split it and take 10mg every 3 hours), but I wonder if it truly works?, but cannot think of an alternative to ask about?

I just wonder why this is happening now when it was not in the first couple of weeks. Is it just that I am using muscles that I was not before or could going back to work be making me worse again? Was at physio today and she said I will have good and bad days in the beginning and I just need to find a way to cope with the spasm, but how can you if they render you immobile. I also know that the reason the back does this is to protect itself from further injury, is it even possible to break this cycle?

Anyone got any tips / experiences on how to help with muscle spasms?

Thanks. Charles

[Bananas5]

Hello Charles

I can't answer the whys but tell you what david does. Acupuncture every 6 weeks stops the spasms starting.

If for any reason his appt is delayed a few days I use Ibuprofen gel on his back.

He does still get 'flair ups' when his whole body goes into spasms but they are infrequent these days.

Just remember you can't do what you used to do!

Hope this helps a little.

pat x

[Calceolaria]

Was going to Head Office somehow stressful ? Subconscious stimulus works in mysterious ways.

Heat is nice for muscle pain.

[Harrison27 in reply to Calceolaria]

Thanks Calceolaria. I'm not sure, as I was really excited about seeing people again but I suppose deep down I was apprehensive. It's just odd it can on the day after. Thanks for the reply. Charles

[Boozybird]

Hi Charles,

I think baclofen works but are you supposed to take it separately? You could try some NSAIDs too to keep the inflammation at bay while you get back into the swing? As far as I know, the annular tear leaks noxious crap out of the disc which irritates the nerves around the outside of the disc causing pain and spasm if they are really annoyed....Regular breaks from sitting perhaps even taking a mat into the office and lying down and rocking your knees to your chest during the day can interrupt the irritation. Is there any where you could do this? You can also buy those heat pads that you can strap around your lower back or waist depending on where the spasm is. I use them when I have to keep going all day long. The shoulder one fits best - they have velcro on them. And accupuncture may be good for you as Pat mentioned. It is a really horrible feeling when you know a spasm is nearby - you have my sympathy! best wishes

[Harrison27 in reply to Boozybird]

Hi Boozybird, thanks for your reply. I am going to try the thermacare back wraps again, the last time I put heat on my back (when it was at its worst 7 months ago), and heat made the spasm worse - mind you it may not have been anything to do with the heat.

I was getting acupuncture from the NHS but as I was doing quite well at the time (I was certainly not in a flare up), I never really noticed any difference, but that's not to say it won't help now but I would need to go private as the first available appt for me is next February.

My GP had never prescribed baclofen before so we felt that splitting it up might keep it at a level in my blood stream, but I am happy to take others advice - would it possibly work better taking 20mg 3 times a day, or even 15mg 4 times a day. I am happy to take advice and I can go back and discuss with my doctor.

Thanks for the advice. Any thoughts on magnesium (I have heard that this can help spasm, or is this more for small spasms?). Thanks charles

[Boozybird in reply to Harrison27]

Charles, hopefully you will get through this. Talk to the doc about the baclofen dosing. I took it for years and it stopped the acute spasms but I can't remember the dose. I thought it was once a day but your rationale seems good for splitting it. I had the same problem as you seem to have. I had a discectomy in the end but this causes other problems but the spasms stopped! There is some evidence that annular tears can repair themselves but no one knows the best way to get this to happen yet. You may simply need to scale back a bit at work for a few more months. Zero to hero may be too much for a start back to work. I would def recommend a transforaminal epidural steroid injection right onto the nerve root as this may be all you need to stop the nerve being irritated thus stopping the spasms thus irritating the nerve. Vicious circle interrupted to allow healing. Try not to dwell on your fears of having to give up work. Focus on the problem of getting the torn disc happy again. You should defs lie down with your legs up for an hour when you get home. Breath calmly and allow the back to settle. Knees to chest gentle rocking stretches the back wall of the discs. Best wises

[Harrison27 in reply to Boozybird]

Hey Boozybird. Thanks for the really helpful and encouraging reply. I think the usual method of baclofen is to split your daily dose into 3 equal doses. They say 60mg is the maintenance dose, up to 100mg (after that I think they need to consider you for the baclofen pump). I loved your zero to hero comment! I suppose it may take me longer than I hope to get back to normal duties, as I suppose 7 months is a long time to be out of normal working life. It's funny you should mention the steroid injections, the private pain clinic doctor advised me to have them but to go through the NHS (he was also an NHS doctor in Aberdeen), the NHS pain consultant I saw in Dundee said they would not help and if I was wanting them I would have to go private! Odd considering they are health boards right next to each other geographically. They say they can't do a disectomy on me as I have 4 discs in my lumbar with issues and they can't remove that many or fuse 4 levels.

Anyway I keep doing the physio exercises, and I will be careful abut not trying too hard getting out and about for work (I'm lucky as I can work from home for some of my job).

My doc did suggest trying diazepam 5mg three times a day to see if that would help, but most pain doctors are against it's use. I'm not sure if others such as dantrolene or zanaflex might help. I suppose I just don't know if baclofen work for me (is that even possible?, but I have never had any of the side effects etc that some say they have with it such as stumbling etc, not me I seem to be immune to it).

I did wonder if perhaps a weekly visit to an osteopath might be a good idea?

Anyway thanks again for your answer, I really appreciate it. Charles

[Boozybird in reply to Harrison27]

Hi Charles, I'm not sure you need to go to diazepam coz baclofen is much the same but without the woozy head and it works particularly on the spine so I would carry on for the time being. I really think its the torn disc that's causing the problem as discs wear down and dehydrate but don't necessarily cause pain. So if you can go privately for the injections onto the irritable nerve then it may give you the boost you need to get going and put this phase behind you. I knew a young man who had similar story to you and it took him the best part of a year to get back to work full time. He phased himself back in so keep optimistic! I wouldn't bother with an osteopath - save the money and get the injection if you can. best wishes and chin up.

[Harrison27 in reply to Boozybird]

Thanks Boozybird. Your messages are really making me feel so much better and optimistic about a recovery. The private pain guy said the injections were 2k each plus consultants fees and I may need 3 or 4 of them before he would then consider nucleoplasty which is £4k ish. If I thought that a couple of injections would sort me out I would do it, but without remortgaging I do not have the £10k plus to go through the whole process (and he said there is no guarantee of success). I wish I had medical insurance! I wonder if they let trainees have a bash at the injections at much cheapness (like letting some college student with scissors let loose on your hair for a fiver!) I'm not sure if I can become a health tourist in Scotland and go to Aberdeen and have it all done on the NHS :-). Thanks agin Boozybird, did the person you knew have any procedures done? Charles x

[Boozybird in reply to Harrison27]

I met this doc at the back show and went to see him privately at his London clinic :painmedicinespecialist.co.uk/ I told him I didn't hv insurance and he said to get myself referred to his nhs clinic at Oswestry. My GP referred me and I had the injections with him there. He's really nice. The first injection worked best and helped stabilise The disc. Other injections not so much but I'm older and failed surgery so I would still recommend u try! The young man I knew did not hv surgery but lots and lots of intense physio - he was desperate and really miserable but came through in the end.

[Harrison27 in reply to Boozybird]

Hey, that really interesting, I wonder if they could do that for me, I can ask my GP to refer me to the pain consultant I saw privately at his NHS practice in Aberdeen, I'm not sure of the ins and outs of that in Scotland as we do not have choose and book or any services like that. I was doing some pretty intense physio, sometimes going 3 times a week, but I guess I have used up my appointments as they have signed me off and now they want me to go to back fitness classes, but I'm not sure when they will start, I'm very disciplined and do my physio exercises every 2-3 hours daily. How long did the effects of the first injection last? How are you doing now?

[Boozybird in reply to Harrison27]

Unfortunately there was a long wait for nhs Oswestry but he does private patients which is quicker. I had the first one about 18 months ago and my back is still stable which is a blessing coz it means I don't really have any acute episodes. Obvs I don't push my luck! Stability is a big thing! Not core stability but just knowing youll be ok from one day to the next. I have pain all the time but like I say, I had surgery and I'm old so different from your situation. If u can afford it you might consider getting the injection to see what effect it has and if beneficial join an nhs queue for repeats if nec. They might try and push gabapentin drug etc on you but they did nothing for me. Modifying the nerve/disc with steroids was by far the most effective treatment I've tried. Best wishes

[Harrison27 in reply to Boozybird]

Hey Boozybird (well you don't come across as old)!! Thanks for the reply. I never thought about that, I could afford one or 2 injections (but because of my paranoia about not being fully fit to work, I want to keep some money set aside in case I go on to half pay or anything (not that I'm hoping that will happen at all!!!). I am at a loss as to why my NHS area say no to the injections but Aberdeen do it, I could email the private pain consultant ( as it was him that suggested having the injections done via the NHS in the first place, he does the private consulting at the weekend but during the week he works for NHS in Aberdeen - I wonder if my doctor could refer me straight to him?, despite it being out of our area.

As for the gabapentin, I was on that but the consultant has just moved me onto pregabalin instead, I am taking so many different tablets, it hard to know which work and which don't, but the pain consultant said we are not at the stage where we should be dropping any medication, that will come later when I am better.

Thanks once more for replying, you really are helping me and I really appreciate it. Charles

[Boozybird in reply to Harrison27]

Yes, perhaps a good idea to keep taking the pregab as this is all about restoring the health of the relationship between nerve and disc. Definitely chase up all possibilies for the injection. You might just need one and you will certainly know whether there has been a benefit after one. Perhaps consider paying for one to get the show on the road and if it works well then get yourself referred by fair means or foul!

[Boozybird in reply to Boozybird]

Ps. To be clear, these injections are NOT facet joint injections but transforaminal steroid injections directly onto the nerve root as it exits onto the torn disc. This is where the noxious crap leaking out of the tear (like a hessian sack!) will be annoying (creating inflammation) the nerve. Thus a cycle of disruption is perpetuated.

[Calceolaria]

I have been taking a small amount of magnesium sulphate or Epsom Salts as it is known also, in my morning cuppa, enough to cover an old sixpence. I have a footsoak with a handful in too. I'm not in spasm at the moment, just trying stuff. Others on the site are regular magnesium fans and they might be using another form to the one I'm trying.

[Harrison27 in reply to Calceolaria]

Oh right, I never knew that you could take the Epsom salts in a drink, I will need to check the bag I have as I'm guessing some may not be suitable for ingestion. Any other tips for dealing with spasm would be very much appreciated, or even thing you have tried which have not helped as I can appreciate you could end up spending so much money on "remedies" which do not work. Thanks. Charles

[sharelle]

It sounds like when I was working, I was doing a similar job to you, driving lots, head office away and working from home on days. The driving used to aggravate the spasms so I pretty much walked around with a TENS machine on which helped. I also used water bottles (but I see heat not good for you) or I simply lay on the floor in the middle of a meeting! They were used to me! Good luck

[Harrison27 in reply to sharelle]

Hi Sharelle. I was thinking about a TENS machine, but not sure if they are all similar or whether you get specific ones for back spasm. I think because the last time I had 5 full days of constant spasms (taking 50mg a day of diazepam and still the spasms were coming, it was just awful), I have it in my head that heat made it worse but maybe it was just the case that the spasms were so bad that it was nothing to do with heat making them worse, I should really try heat again. Goodness knows what's happened to me as I used to manage fine with maybe a couple of times in the years where I would be rendered immobile but this episode has been ongoing since November 2012. I am clearly better than I was but still no where near what I was like prior to November (there are no significant changes in my MRI from the one done in March to the one done 7 years ago). I have heard that sometimes people can go through really prolonged flare ups then it eventually settles (I really hope so) as I'm only 37 and I really could not face a life where I cannot work. I done another site visit yesterday (round trip of 150 miles), I was ok today although my torso was really tilted again this morning, I was in more pain than usual but not as much as I was on Tuesday, so maybe it is my muscles "growling" as I have not used them so much.

Can I ask Sharelle, did you have to give up work at a young age because of your problem?

Sorry for the short novel there!! Thanks for replying. Charles

[Hidden]

Unfortunately with a complicated injury such as yours, pain will originate in muscles, nerves and triggers. The brain can't cope with the overload of info (muscles working harder because you are more active, sets off the nerves which sets of the triggers which sets off the spasms). Can happen in any order. The body is acting normally by sending these pain messages. What we have to do is over ride the program and trick the body into a new normal level of activity.

The secret is to pace yourself. Find a level of activity for everything you have to do in a day (all activities combined) it may be 10 mins sitting, 20 mins walking etc). Then work on increasing this by 5 - 10 mins for each activity until you reach something that is managable. It will take months (took me 5 yrs to work up to sitting for 50 mins I started on a 20 min rotation of sitting, standing, walking, lying down) . Its a very slow and demoralising process but worth it in the long run. You are tricking your body into accepting more activity.

What we are asking our bodies to do is the eqivilent of running a marathon. Nobody goes out and runs a full marathon without training first. We back pain sufferers have to train our bodies to accept more activity.

Doing this my back spasms stopped after 3 months. I got them at night every 2 - 3 days.

The other thing to try is organise your work and activity into a routine. Pain loves routine. Again a tedious task but you will feel the benefits quite quickly. You can get occy health in to assess your workstation, how you do your job etc. When I worked in an office, I had a higher level table top (waist height) so I could do non computer tasks while standing. I had a stand for my computer screen and a chair at the correct height so I was comfortable. I swopped a task with another member of staff which meant I could walk around half way though my morning.

With driving, I now plan my week carefully. I can only drive a half hour at a time or I pay for it the next day. I plan my route to avoid hill starts, traffic lights, anywhere where I have to stop, start and change gear often. I was fortunate to have an ex police driving instructor and he taught me to read the road and this has proved so useful now. I know what speed I'm going at by the angle of my foot. I never paralell park as this involves too much spine rotation. I'd rather park a bit away and walk extra (I have to walk after driving anyway). I don't have a blue badge. I try to get an end of a row so I can open my door fully to swing my legs out and stand up. On the occasions when I can't and I find another driver has parked too close to my door on my return, I'm not shy of asking some one to get it out of the space for me. So when I know I'm going to be driving I reduce my activities the day before and the day after and increase my exercises. This goes a long way to reduce the increased pain.

Living life to a careful time table is very tedious. No room for spontenaety but the plus side is that the pain is reduced. I have just returned from working away for 3 weeks (no normal routine, no normal furniture) my back is killing me today and will do so for about a week. I don't mind, it means I can use my week to catch up with physio dr appts (try to avoid them) and gently tease my body back to normal with more exercise and rest periods.

I have come to realise that I have pain (similar injury to you but with pelvic complications) if I don't do things as well as when I do do things. So now I'm biting the bullet and trying things. I know what the pay off is and I know how to recover from it and I'm happy to take the time to do it. My body is very strong from all the exercises I do and a previous life of ballet, cycling and walking. Its only weakness is my lower spine and I do what I can to protect it.

I am sure that you could get an appt at the disabilty driving centre and they will show you how to sit, set your seat etc for more comfortable driving. If not many driving schools have instrutors specialised in this. You could book one for a session to go over it.

Working within the limits of your pain goes a long way in the long term.