Facet hypertrophy?

Hi,

::X-ray/MRI diagnostics further below::

I’m new here and am currently in the process of going through earlier threads. Please forgive me if I’m asking about something that has been answered fifty times already

My first herniated disc was back in late 2005. Over the years since, I’ve had issues on and off with the lower back. At least three additional herniations that I’m aware of.

From 2016 on, the pain has been nearly every day. Nothing seems to help—e.g., chiropractic adjustments, physical therapy, massage, Pilates and other core strengthening routines, copious NSAIDs/muscle relaxants, and so on. Waste of time and money so far.

In 2017 around the holidays, I was hit with sciatica so bad it felt like lightning was running up and down my leg. I couldn’t sleep, sit, or walk for more than a few minutes at a time. That entire Christmas holiday was spent trying to keep my leg in the one position where the pain was at least bearable.

Not trying be too dramatic here. No doubt many folks have had it much worse. I’m just trying to be complete in the story.

Another round of sciatica hit over the 2018 holidays, so I decided to go in for updated images and inquire about possible surgical interventions. Here are the diagnostic results:

***

#1. X-rays lumbar spine performed January 22, 2019 with mild scoliosis. There is no abnormal change in alignment with flexion or extension.

#2. MRI of the lumbar spine performed on January 22, 2019 demonstrates at L1-L2 a normal disc. At L2–L3 through normal distress. At L3-L4 through normal disc. Facet hypertrophy on the left is severe. At L4/L5 facet hypertrophy is moderate to severe lateral recess stenosis and moderate bilaterally. Degenerative disc disease mild. At L5-S1 right-sided disc protrusion small in size with lateral recess stenosis on the right severe and moderate. Degenerative disc disease mild.

***

The spine institute surgeon indicated that unless the pain becomes unbearable, I should continue with conservative care and add in some fish oil and a greens smoothie each day. Discharged with no follow-up.

At this point, I’m flustered. The pain is not “unbearable”, but certainly is significant and occurs nearly all day, every day. I’m happy to avoid surgery, but the persistent pain is starting to wear me down.

After searching for alternative approaches to low back pain and sciatica, I ran into Sarno’s books. At first, it was difficult to fully buy into the concepts. Dr. Schubiner’s “Unlearn Your Pain” helped clarify the areas I had trouble accepting. I’m a believer now.

That said, I’m wondering if there’s anything in the “facet hypertrophy is severe” diagnosis that may be delaying my progress in healing? I’ve been journaling and meditating for a couple of months, but so far the pain has not subsided at all.

My understanding is that facet degeneration is a form of arthritis, which only worsens over time. I’ve also read that treatment involves injections and possibly a procedure called rhizotomy, which essentially shuts down the nerves sending the pain signals.

Does anyone have this particular condition? If so, have you effectively treated it with the TMS approach? I certainly do believe in the ability of the mind to regulate pain. But I also wonder if some conditions like this are simply so irritating to the nerves that mind-body work alone may be insufficient.

Thanks in advance for your time and any information.

Happy Holidays!

 

You say that the pain got worse considerably 'over the holidays' - at least twice.... I would say that is where you should start looking for clues...! What is it about the holidays that triggered your pain? Is it that you 'have' to work or you are 'important' at work or desperately needed and there is no time for chronic pain...? Or from another angle - have you got perfectionist issues - do you feel guilty about taking a holiday or being away from work? Do you secretly dread holidays because of relations and relationships - or lack of them? Look at all the possible things that might bug you about holidays and how you feel about work/family etc... Maybe you will find a trigger that sets you off psychologically so that your body exhibits pain...more than at other times.
Depending on the arthritis some people get relief from snails..! sounds odd but my father-in-law has terrible back and hand pain from arthritis - he would not consider or entertain reading about tms.... (i did try!) but he is sure that minced up snails are doing the trick...! The other day I was reading about ancient remedies and minced up snails were mentioned - for arthritis!
Whatever you decide to do - keep looking for triggers for tms - they are sooooo common... good luck!

 

Hi,

Good point on the timing of the worst symptoms. I thought of this also when reading “Healing Back Pain” sometime back. There’s a section where he describes the “Weekend-Vacation Syndrome”:

“When we generate anxiety depends mostly on the details of our personality structure. Not uncommonly, people will report that they almost always have an attack of pain when they are on vacation, or if they already have pain that it gets worse on weekends.”​

This is certainly true in my case. I had a tendency to keep things under check during the work week. The pain would be there, but I always focused the attention on getting things done. My vacation was always in the month of December, when I could take a block of time off to relax and spend with family.

But over the past few years, I was in constant pain over the holidays. So it is very likely to be as Sarno mentioned, where one basically “stores it up” and then the pain comes raging out once we have a moment to decompress.

In June this year, I took a voluntary severance from my job of 18 years. The plan is to take a year off and try to heal from all this stress and back pain. From 2012 until 2016, I was working between 60-80 hours each week (nights and weekends on-call) while trying to manage the rest of my life. This would have been fine in my 30s, but I’m 48 now and it’s not so fun anymore. Especially on salary where there’s no additional financial benefit.

I’m certainly a perfectionist—e.g., straight A student, hard worker, and obsessed over excelling at everything I do. It’s clear to me that this has become a very big problem, but I’m having trouble unlearning the anxiety associated with failure.

Anyway, you gave me some things to think about, for sure. Thanks very much! I’m not a big fan of snails, but might give them a try nevertheless I’m always looking for options that don’t involve pharmaceuticals and surgery.

Have a great day!

 

GregA,

Since you are new to the forum, you probably haven't seen the contributions by Steven Ozanich, the author of The Great Pain Deception. I've bookmarked this thread and have referred to it often - during my recovery process and also when a symptom imperative pops up. I hope you find it as insightful as I have.

http://www.tmswiki.org/forum/threads/seeking-the-grail.529/ (Steven Ozanich - Seeking the Grail)

 

One of Dr. Schubiner's books contains a chart from The American Journal of Neuroradiology showing the percentage of people at various ages with facet degeneration who are nonetheless asymptomatic. The ages and percentages with facet degeneration are as follows: age 20-4%, age 30-9%, age 40-18%, age 50-32%, age 60-50%, age 70-79%, age 80-83%. These are people with MRIs showing facet degeneration who have NO PAIN.

Here is a link to a prominent pain neuroscientist's view of MRIs and back pain:

http://theconversation.com/no-brain-no-pain-it-is-in-the-mind-so-test-results-can-make-it-worse-40989 (No brain, no pain: it is in the mind, so test results can make it worse)

 

And not just pain - my husband - (who is pretty healthy but has nonetheless done the SEP and found it very beneficial to understand himself ) used to always damage himself on the eve of a holiday.... He drilled a hole in his thumb, he even chopped off the top of a finger (well - it was a holiday with his parents...!) - now he sees that he has a sort of 'guilt' about being on hollday and not being productive - he now addresses that - and no longer hurts himself 'accidentally' before the holidays!!

 

Thanks so much! I’ll read this today. I Also downloaded Ozanich’s book for reading over the holidays.

I have a lot of work to do here, as it seems clear that a good deal of my emotions are still buried. I’ve been really good at pushing things away in order to stay focused on goals over the years. Hopefully, this sabbatical will allow me to finally heal and get my life back.

 

Duggit,

Thanks for the pointer on that. I was unable to find a chart in the particular Schubiner book on my desk, but on page 11 of “Unlearn Your Pain”, noted the following:

“When you take a large number of people with no back pain at all, you find the following on MRIs: 50% of healthy 30-year-olds have degenerative disc disease and 40% have bulging discs; 80% of healthy 50-year-olds have degenerative disc disease and 60% have bulging discs; and the numbers go up from there (Brinjikji, 2015)”​

So I checked his reference at the AJNR and found:

http://www.ajnr.org/content/36/4/811 (Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations)

Where Schubiner did not specifically reference facet degeneration—the arthritic process—the paper does:

“Findings such as disk degeneration, facet hypertrophy, and disk protrusion are often interpreted as causes of back pain, triggering both medical and surgical interventions, which are sometimes unsuccessful in alleviating the patient's symptoms.​

“Prior studies have demonstrated that imaging findings of spinal degeneration associated with back pain are also present in a large proportion of asymptomatic individuals.​

“Our study suggests that imaging findings of degenerative changes such as disk degeneration, disk signal loss, disk height loss, disk protrusion, and facet arthropathy are generally part of the normal aging process rather than pathologic processes requiring intervention.”​

And they provide a table of findings (attached).

So it does appear that facet degeneration is included in the “gray hairs of the spine” concept asserted by Sarno. This is good information to have.

Clearly, I have some additional discovery to do regarding my emotions and their impact on pain.

 

This is a complicated set of mind-body interactions. The more I think about things over the past five years—i.e., “accidents” and other pain events/flare-ups—the more they seem related to some subconscious drive.

For example, in 2017 when sciatica first appeared on the scene for me, I was really wanting to avoid spending time with some of my relatives over the holidays. They’re always talking politics and they frequently become hyper-combative over issues that to me seem rather trivial. Their sense of powerlessness and blind rage drives them to deeper animosity towards anyone who disagrees with them. I wanted so badly to avoid this type of hostile environment at a time of year that should be joyous.

So it is very possible that I subconsciously sabotaged my own holiday experience by manifesting an attack of sciatica. Rather than spending my time arguing and coming away distressed, my mind likely decided for me that physical pain was preferable to potentially ending (or at least seriously damaging) my relationships.

This gives me a lot to think about.

 

You got it! and the autonomic body does the sabotage for us - it seems to sense our stress and /or distress - so giving us a dose of pain or a moment of inattention leading to damage... they say there's no such thing as an accident... perhaps they are right!!

 

Of all the myriad of TMS symptoms that I've had, I have to say that sciatica was the most painful and scary for me. The first time it struck, I didn't know about TMS. The doctor prescribed oral steroids and it went away within a few days. However, the next year it came back with a vengeance and lasted for over three months. By this time, I knew about TMS and was already working the SEP. I've related the story below before on this Wiki, but it's worth mentioning again.

In December 2016, my brother was seriously ill and was not expected to live. He lived over a 1000 miles away from me. Since I was in too much pain to fly, we decided to drive to see him in the hospital. My husband made a bed for me in the back seat. As soon as I got into the car, the sciatica started. Suddenly, I felt rage boiling up inside of me. I was furious .....at the pain, that my brother was dying, and that my health was in shambles. Inside of my head, I screamed for the sciatica to "beat it!!!" I may have cursed, I don't remember. But within a few seconds it went away and never came back.

Because I've been hard on myself throughout my life, I don't normally treat my TMS symptoms this way. I prefer to take a kinder and more gentle approach. However, I think there are times when we are fed up enough that we have to let our brain know who's the boss!

As a side note, my brother was told by a cardiologist that his only resort was a heart transplant. My brother began to rapidly decline, flat lined several times, and was making his funeral plans. The next day, a different cardiologist came into the room. He told my brother that he had quite a few patients who had recovered completely from this illness and he saw no reason that he wouldn't recover too ( a severe virus had attacked his heart). Within days, my brother began to improve. Three years later, he rides his motorcycle, travels, and has a great life. This wonderful doctor gave my brother the best prescription and Christmas present ever...HOPE. And, my brother's brain was receptive enough to believe him.

 

Hi,

I’m glad to hear things worked out well for your brother. My father has been dealing with heart issues also and it can be very discouraging. Sometimes we really need that feeling of hope coming from a physician we trust.

I agree that sciatica has definitely been the most irritating TMS issue so far. My longest episode was perhaps three weeks or so over the 2017 holiday season, but it was a monster in terms of pain. These days it doesn’t hurt, but I do get frequent muscle twitches in my calf and toes. More annoying than painful, really.

On the difference in approaches between gentle vs aggressive, I’ve also found that yelling at my pain does tend to shut it down—at least temporarily in my case. It comes back later, but I’ve noticed that it responds to the angry approach.

This gives me hope that the pain is in fact more psychogenic than it is the result of real tissue damage. I still suspect there’s some actual physical irritation to the local nerves, but that my brain is exaggerating the intensity for its own reasons—i.e., distraction.

 

When I was healing from TMS I would bellow at the pain - out loud if necessary - but sometimes a hundred times in a day,,, it would go - then flare up again, then go, then return... But i kept on keeping on - and now I am cured! (something good coming from me being SO stubborn!)