I have been suffering from lower back pain for several years. Last year I had MRIs and CT scans, x-rays, a colonoscopy, and ultrasounds, which only found some spinal degeneration. The pain seems to get better when I get up, but it is there all the time and it affects me a lot.
Nadine Taylor, Southport.
Dr. Scurr responds: It seems that a series of extensive investigations have still been carried out on him, despite that, he does not have an exact diagnosis.
I’m wondering if the problem is facet joint arthritis, because from the type of testing you’ve had, it seems there are other common causes of low back pain at your age (you say you’re 73), such as a collapsed vertebra due to osteoporosis. or a herniated disc, have been ruled out.
Facet joints come in pairs, one at the top and one at the bottom on each side of the vertebrae, and stabilize the spine.
One option for back pain is a surgical procedure known as rhizolysis, which uses radiofrequency ablation to destroy the nerves leading to the joints.
Osteoarthritis (or degeneration) of the facet joints is common and the vast majority of adults over the age of 60 will suffer from it to some extent.
However, the degree of discomfort and pain will vary. Some people with facet joint impairment experience few symptoms, perhaps just a little stiffness; others are paralyzed by chronic pain. (In ancient terms, the pain might have been described as lumbago.)
Treatment usually consists of nonsteroidal anti-inflammatory drugs, physical therapy, and sometimes other complementary approaches such as acupuncture or tai chi.
If this doesn’t help, another option is a surgical procedure known as rhizolysis, which uses radiofrequency ablation to destroy the nerves leading to the joints.
First, the specialist injects local anesthetic into the affected joint. If this immediately resolves the pain, it confirms that the problem is facet joint arthritis and then radiofrequency ablation is performed, providing pain relief that can last for years.
I would recommend specifically asking your GP or physiotherapist if the scans showed facet joint arthritis. If so, you should be referred to a spine surgeon.
I wake up most mornings with a stuffy nose and sneeze a lot. It goes away around noon, but I’ve gotten into the habit of taking an antihistamine and a cold and flu pill every morning to stop it. Is this safe in the long term?
Gina Knight, East London.
Dr. Scurr responds: The fact that taking an antihistamine seems to control your symptoms leads me to conclude that your symptoms are due to allergic rhinitis (inflammation of the nasal passages).
Antihistamines are a type of drug known as anticholinergics, which inhibit the action of certain brain chemicals and include tricyclic antidepressants and drugs used to treat Parkinson’s.
There is evidence linking some of these medications to dementia if taken long term, although I can assure you that regular use of antihistamines is not implicated. But I wonder what is causing your nocturnal nasal allergy; It could be feathers on pillows or duvets and/or household dust.
It is not uncommon to develop an allergy in adulthood caused, for example, by a viral infection or menopause; some type of change in your immunology that “turns on” an allergy gene. I suggest carefully vacuuming over and under the mattress and under the bed, and dusting all surfaces regularly (the advice is to do this twice a month).
You can also try using an anti-allergy nasal spray at night instead of an oral antihistamine, if you want to avoid an anticholinergic long-term. The most effective are sprays with corticosteroids such as beclomethasone.
As with any medication, these sprays can have their own side effects, primarily excessive nasal dryness and nosebleeds (stop using the spray if you experience any of these).
I would switch to using this at night and in the morning. After a couple of months, you will be able to compare its effectiveness with that of antihistamines.