| Spinal Stenosis a Major Cause of Back Pain |
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Dear Dr. Donohue: Sixty-two must be the age when everything falls apart. I’m there. My latest body part to give way is my back. I have back pain a considerable amount of the time. It finally brought me to a doctor, who tells me I have spinal stenosis. I have been told to take Aleve for my pain, and I’m scheduled for physical therapy. I don’t have great hopes of a cure. What exactly is this? What else can be done for it? — T.R.
Answer: Spinal stenosis accounts for about one-third of all cases of low-back pain. It’s an elusive concept that calls for an anatomy lesson. The backbones (vertebrae, spinal column) have a tunnel running through them — the spinal canal. In that canal or tunnel is the spinal cord and spinal nerves. Spinal stenosis signifies that the spinal canal has narrowed and is pressing on the spinal cord or spinal nerves. That, in turn, produces back pain that can spread to the buttocks, the back of the thighs or the lower leg. The pain worsens on standing or waking, and goes away when the person sits. Aging is the most important factor in developing spinal stenosis. Back ligaments, which hold the backbones in place, thicken and calcify. Arthritic changes in the backbones sprout bone spurs that impinge on the canal. Back discs — the spongy shock absorbers between adjacent backbones — degenerate and crumble, and that narrows the canal and exerts pressure on the spine and spinal nerves. Nonsurgical treatment employs physical therapy to strengthen and stretch back muscles in an attempt to relieve pressure on the spine and its nerves. Anti-inflammatory medicines like your Aleve control pain. You might need stronger pain medicines. Epidural injections of cortisone ease inflammation and give the spinal canal and spinal nerves more room. “Epidural” means the injection is made into a space in the spinal canal above its covering membrane. Surgery is a solution when these measures fail. The pamphlet on back pain discusses the many conditions that lead to one of medicine’s biggest problems. It describes different conditions and their treatments. To obtain a copy, write to: Dr. Donohue — No. 303W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
Dear Dr. Donohue: Will you repeat the article on a runny nose when eating? My husband has it, and it’s embarrassing to him. — J.W.
Answer: Some explain why noses run upon eating by invoking sensitivity to temperature changes, i.e., hot or cold food. Or it could be that spices start the nose dripping. Chewing might trigger a reflex that makes the nose run. And, in all truth, the reason could be something that remains a mystery. Atrovent nasal spray, a prescription item, can sometimes stanch the drip. A drying antihistamine taken an hour before meals is another way to keep the nose dry. People shouldn’t resort to medicine before every meal. They should save it for occasions when a drippy nose is a source of embarrassment. This curiosity has a name, gustatory rhinorrhea. |
