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Megan asked...

I have ongoing severe chronic back pain...

I have ongoing severe chronic back pain. An MRI has shown i have early disc degenerative disease and bulging discs for which ive had steroid injections in my joints and radiofrequency ablation. Although it has improved the pain, i am still in significant pain. I also found out my mri showed a tarlov cyst in my s2 but my doctor and pain specialist wont address this as a possible cause for the ongoing pain. The synptoms fit perfectly but they wont consider it. What can i do?

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The answer

Thank you for writing in to Ask the Expert.

Back pain can be extremely debilitating and we can understand your frustration at not being pain free and also your frustration that your GP and specialists do not seem to be addressing all your concerns.

Regarding the spinal degeneration and bulging discs yes, effective analgesia and anti-inflammatories can help along with the steroid injections and ablations, however there are limitations to how many times these medications can be given and, the amount of procedures that can be performed in a short time frame.

It may also be worth considering Exercising, Weight loss and TENS therapy to help strengthen your body generally as well as helping to reduce your pain levels.

Other ways that can help you manage your pain may be my practising some mindfulness and CBT techniques.

A Tarlov Cyst is where the nerve root sheath becomes dilated and a sac develops which then fills with cerebralspinal fluid.

The Tarlov Cyst as it enlarges or presses on other nerves can cause back pain, sciatica, pain on standing , walking and sometimes difficulty emptying the bladder and bowel.

It is difficult to treat the cyst as it is part of the nerve and therefore cannot be removed.

Sometimes the CSF fluid can be drained off and the cyst entrance sealed with ‘glue’ but this is only a temporary measure as the cyst tends to refill or reoccur in other areas too.

We would suggest speaking to your GP and Pain Management Specialist again for further ideas as to how your symptoms and pain can be managed but if this fails perhaps a referral to another specialist or Neurologist regarding management of the Tarlov Cyst and Pain would also be beneficial.

We enclose some details of information sites that you may find helpful:

Tarlov cyst

Back pain - NHS

Spine health -Sciatica

Mindfulness - NHS

Mindful - Our 5 steps to mindfulness

We hope this information is of use and wish you all the best

Answered by the Health at Hand nurses