Dear Dr. Roach: I have suffered sciatic pain on my left side for over a year, and an MRI revealed spinal stenosis and arthritis. My doctor, who specializes in physiatry, has recommended an epidural injection with ultrasound. While I trust him, I have been doing some research, and am reluctant to go that route for various reasons. Some of the resources I have checked say the benefits are not conclusive. I asked about acupuncture, and he said it would be an option. I already have tried physical therapy and more-conservative measures. What would you recommend?
M.M.
Epidural injections (the epidural space is located just around the spinal cord) usually are performed with some type of visualization, such as X-ray or ultrasound, and they involve injecting a local anesthetic (which wears off in a few hours) and a steroid (which can last for weeks). They are widely used. However, a 2014 study showed that although there was a small benefit of adding steroid to the local anesthetic at three weeks, after six weeks from the injection, that difference was no longer significant. Adverse effects were seen in 22 per cent of the steroid and anesthetic group versus 16 per cent in the anesthetic-only group. Although this difference was not statistically significant, even a 15 per cent risk of adverse effects is pretty high (fortunately, serious adverse effects were rare).
There are no high-quality studies evaluating acupuncture as there are for epidural injections, but several small studies have shown improvement in pain scores. Acupuncture is probably safer than epidural injection, but no medical procedure is risk-free. There are many well-documented cases of collapsed lung from acupuncture, although the absolute risk is very small.
Physical therapy, including exercises done in the water and bicycling, are the mainstay of conservative treatment. I have consistently argued for caution before considering a surgical treatment for spinal stenosis, but some carefully selected people will benefit from surgery.
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Dear Dr. Roach: My husband had an MRI about 10 years ago before back surgery, and we were informed that he has only one functioning kidney. The other is atrophied and useless. We were not told that he needed to take any precautions, but now I wonder if we should have asked more questions. Are there any medications or foods he should avoid? He is 54 and otherwise healthy.
S.H.
I鈥檓 not sure why your husband鈥檚 kidney is atrophied. The most likely cause is congenital dysplasia, meaning your husband likely had this at birth. People with one functioning kidney generally have no problems and need no special diet or medication restrictions. For someone in your husband鈥檚 situation, I would recommend a healthy diet, avoiding dehydration and keeping away from high doses of medicines that can affect the kidney, such as ibuprofen and Tylenol. In very large doses over years, they can cause kidney disease. Occasional doses are fine.
