pulled muscles from curved back and sitting wrong

maryonwheels46 · 08-23-2004, 12:52 AM

Help Please. I am a complete para with 30 degrees scolioses. For 4 1/2 years I have been in this chair and was never seated properly for my condition. I was put in a cloth back and a low profile roho. It will be two months before I might get my new chair with a verilite back and a quadtro roho cushion. In the mean time I have figured out alot of the pain in my back is from pulled muscles on the left side where they are being compromised.
I have no problem on the right side of my body. The hip is very close to the ribs. On the left side the hip is to far from the ribs and they feel like they are being torn apart.
One of the muscle is called the quadratus lumborum but to be honest it could be any of the ones attached to the hip and one feels like it is attached to the pelvic bone. I need to put the 1by4 under my cushion.
I went to my pain DR and he said I need a new chair.. Duh.. he said instead of taking baclofen four times a day up it to six times.And consider getting the baclofen and morfine pump. But to try the tens unit first. But what about now. I'm suffering. What can anyone suggest? Shootin myself and put me out of my misery. Just kidding.
A couple of questions for DR Wise.
1. The last ct I had the contrast was completely blocked at T9 and could not go up so how would this effect the meds in the pump?
2. What good is 40mgs more of baclofen?
3. What is the difference between baclofen and zanaflex/ I was really wanting to wean off the baclofen and work hard to reverse some of the atrofy in my legs. Is this possible?
4. Can't the Dr try some kind of shot in the muscles? This one is a dumb question.Is there some kind of muscle relaxer to take in the mean time?
Thank you very much.

SCI-Nurse · 08-23-2004, 10:55 AM

maryonwheels: I am sorry you are feeling so miserable. Both baclofen and zanaflex are antispasmodics. I am assuming that you are taking 20 mg of oral baclofen at a time because you mention your MD added 40 mg and it is now 6 times a day. This would make for a total of 120 mg/day. Correct? Baclofen has a half-life of 4-6 hours. You may want to try taking 30 mg every 6 hours instead. Sometimes taking it more often causes sedation. Just a thought.

Are you still taking Zanaflex? If so, how much? Zanaflex can often be more sedating than baclofen. Some of the other side effects are similar to baclofen but it has been found to be more toxic to the liver. It has to be slowly and gradually increased to no more than 36 mg total per day.

Both of these drugs can help in reducing your muscle tone. It sounds as if there are other postural issues going on. Was there ever any mention about correcting the scoliosis surgically?

Did they give a reason for the blockage at T9 with the CT? Will you be having an MRI or myelogram as a follow-up? What needs to be determined is if there is a blockage of CSF flow which is needed for proper functioning of the intrathecal baclofen/morphine pump and catheter. A good CSF flow is needed for absorption of the drug.

As far as a muscle shot, if the group of muscles can be isolated sometimes botox can help. It won't help if the tone involves several groups of muscles or large groups.

Maybe in the meantime, Dr Wise Young will see this question and respond.

You also might want to consider getting the trial test dose of intrathecal baclofen to see if it helps any. I would be curious though about what they think the blockage at T9 is. More tests may be warranted first. PLG

maryonwheels46 · 08-23-2004, 12:28 PM

PLG, I do not take Zanaflex. I just wondered if it would be better than Baclofen. My muscles have atrofied and thought about trying to build them up some if I could. I do take 20mgs baclofen every 6 hrs. and he does want me to take it every 4hrs but I don't want any sedation.
No one has mentioned correcting the scolioses. At my age I don't think I could go through such a drastic surgery. I had all the rods taken out of my back and a laminenectomy at T9 on Feb 5th and this at the curve has gotten worse.

I have had a myelogram and a MRI with contrast done before the surgery and that is when they found the blockage in the cord but the NS never heard about this cause the pain DR found this when he did a spinal block for pain. Orto sent me to him. No one ever addressed the blockage. I have alwase wondered about this. So, what steps should I take about the blockage and what would this cause? I should have a good flow of CSF. How is it flowing all the way through? Should I take it to a neuro Surg or who?
As far as the muscles go I am waiting for a new chair.
DR Wise, I sure need your expertise opinion.

SCI-Nurse · 08-23-2004, 12:36 PM

Well then, are you thinking about doing the intrathecal baclofen trial injection procedure to see it helps at all? You mention atrophy of your muscles. Do you still get significant spasticity in your legs? This additional tone will help combat this some. Do you have someone help you with ROM every day? This too will help. I will keep moving this up for Dr Young's opinion. PLG

alan · 08-23-2004, 05:53 PM

A somewhat related questiion, out of curiosity - with a morphine pump, does the drug flow with the CSF and bathe the entire cord and brain, or does the catheter have to be placed above the nerve root of the uppermost pained area and the drug drifts downward? I ask because when a doc mentioned a pump several years ago, he said it would have to be placed above my injury level to have any chance of working, not that he had much faith it would.

Alan

"Was it over when the Germans bombed Pearl Harbor?"

SCI-Nurse · 08-24-2004, 02:10 PM

Alan -- It has to do more with the CSF flow and uptake of the drug. It usually has a 4:1 gradient meaning the lower extremities will get more relief first. However, the drug is continually infusing and can be adjusted to meet your needs.

The surgeon usually inserts it into the L2-3 space and then can thread it up. Most tips are between T8-T10. Check out this web site from medtronics for more information.
Medtronic
You also may want to contact your local Medtronics representative for further questions at (800) 328-0810.
PLG

[This message was edited by SCI-Nurse on 08-27-04 at 08:03 PM.]

maryonwheels46 · 08-26-2004, 09:28 PM

I was told that the blockage was a vertabra lodged in the spine left from the original injury. That really don't sound right.
When I had the rods taken out the NS did the laminectomy to remove the blockage but no test was done to see if it worked.
Mary

SCI-Nurse · 08-27-2004, 08:34 AM

I am going to bump this up and maybe Dr Young can answer some of your questions. PLG

08-23-2004, 12:52 AM	#1
maryonwheels46 Senior Member Join Date: Mar 2003 Location: Texas Posts: 1,488	pulled muscles from curved back and sitting wrong Help Please. I am a complete para with 30 degrees scolioses. For 4 1/2 years I have been in this chair and was never seated properly for my condition. I was put in a cloth back and a low profile roho. It will be two months before I might get my new chair with a verilite back and a quadtro roho cushion. In the mean time I have figured out alot of the pain in my back is from pulled muscles on the left side where they are being compromised. I have no problem on the right side of my body. The hip is very close to the ribs. On the left side the hip is to far from the ribs and they feel like they are being torn apart. One of the muscle is called the quadratus lumborum but to be honest it could be any of the ones attached to the hip and one feels like it is attached to the pelvic bone. I need to put the 1by4 under my cushion. I went to my pain DR and he said I need a new chair.. Duh.. he said instead of taking baclofen four times a day up it to six times.And consider getting the baclofen and morfine pump. But to try the tens unit first. But what about now. I'm suffering. What can anyone suggest? Shootin myself and put me out of my misery. Just kidding. A couple of questions for DR Wise. 1. The last ct I had the contrast was completely blocked at T9 and could not go up so how would this effect the meds in the pump? 2. What good is 40mgs more of baclofen? 3. What is the difference between baclofen and zanaflex/ I was really wanting to wean off the baclofen and work hard to reverse some of the atrofy in my legs. Is this possible? 4. Can't the Dr try some kind of shot in the muscles? This one is a dumb question.Is there some kind of muscle relaxer to take in the mean time? Thank you very much.

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08-23-2004, 10:55 AM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,326	maryonwheels: I am sorry you are feeling so miserable. Both baclofen and zanaflex are antispasmodics. I am assuming that you are taking 20 mg of oral baclofen at a time because you mention your MD added 40 mg and it is now 6 times a day. This would make for a total of 120 mg/day. Correct? Baclofen has a half-life of 4-6 hours. You may want to try taking 30 mg every 6 hours instead. Sometimes taking it more often causes sedation. Just a thought. Are you still taking Zanaflex? If so, how much? Zanaflex can often be more sedating than baclofen. Some of the other side effects are similar to baclofen but it has been found to be more toxic to the liver. It has to be slowly and gradually increased to no more than 36 mg total per day. Both of these drugs can help in reducing your muscle tone. It sounds as if there are other postural issues going on. Was there ever any mention about correcting the scoliosis surgically? Did they give a reason for the blockage at T9 with the CT? Will you be having an MRI or myelogram as a follow-up? What needs to be determined is if there is a blockage of CSF flow which is needed for proper functioning of the intrathecal baclofen/morphine pump and catheter. A good CSF flow is needed for absorption of the drug. As far as a muscle shot, if the group of muscles can be isolated sometimes botox can help. It won't help if the tone involves several groups of muscles or large groups. Maybe in the meantime, Dr Wise Young will see this question and respond. You also might want to consider getting the trial test dose of intrathecal baclofen to see if it helps any. I would be curious though about what they think the blockage at T9 is. More tests may be warranted first. PLG

08-23-2004, 12:28 PM	#3
maryonwheels46 Senior Member Join Date: Mar 2003 Location: Texas Posts: 1,488	PLG, I do not take Zanaflex. I just wondered if it would be better than Baclofen. My muscles have atrofied and thought about trying to build them up some if I could. I do take 20mgs baclofen every 6 hrs. and he does want me to take it every 4hrs but I don't want any sedation. No one has mentioned correcting the scolioses. At my age I don't think I could go through such a drastic surgery. I had all the rods taken out of my back and a laminenectomy at T9 on Feb 5th and this at the curve has gotten worse. I have had a myelogram and a MRI with contrast done before the surgery and that is when they found the blockage in the cord but the NS never heard about this cause the pain DR found this when he did a spinal block for pain. Orto sent me to him. No one ever addressed the blockage. I have alwase wondered about this. So, what steps should I take about the blockage and what would this cause? I should have a good flow of CSF. How is it flowing all the way through? Should I take it to a neuro Surg or who? As far as the muscles go I am waiting for a new chair. DR Wise, I sure need your expertise opinion.

08-23-2004, 12:36 PM	#4
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,326	Well then, are you thinking about doing the intrathecal baclofen trial injection procedure to see it helps at all? You mention atrophy of your muscles. Do you still get significant spasticity in your legs? This additional tone will help combat this some. Do you have someone help you with ROM every day? This too will help. I will keep moving this up for Dr Young's opinion. PLG

08-23-2004, 05:53 PM	#5
alan Senior Member Join Date: Jul 2001 Location: Baltimore, MD Posts: 6,169	A somewhat related questiion, out of curiosity - with a morphine pump, does the drug flow with the CSF and bathe the entire cord and brain, or does the catheter have to be placed above the nerve root of the uppermost pained area and the drug drifts downward? I ask because when a doc mentioned a pump several years ago, he said it would have to be placed above my injury level to have any chance of working, not that he had much faith it would. Alan "Was it over when the Germans bombed Pearl Harbor?"

08-24-2004, 02:10 PM	#6
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,326	Alan -- It has to do more with the CSF flow and uptake of the drug. It usually has a 4:1 gradient meaning the lower extremities will get more relief first. However, the drug is continually infusing and can be adjusted to meet your needs. The surgeon usually inserts it into the L2-3 space and then can thread it up. Most tips are between T8-T10. Check out this web site from medtronics for more information. Medtronic You also may want to contact your local Medtronics representative for further questions at (800) 328-0810. PLG [This message was edited by SCI-Nurse on 08-27-04 at 08:03 PM.]

08-26-2004, 09:28 PM	#7
maryonwheels46 Senior Member Join Date: Mar 2003 Location: Texas Posts: 1,488	I was told that the blockage was a vertabra lodged in the spine left from the original injury. That really don't sound right. When I had the rods taken out the NS did the laminectomy to remove the blockage but no test was done to see if it worked. Mary

08-27-2004, 08:34 AM	#8
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,326	I am going to bump this up and maybe Dr Young can answer some of your questions. PLG