[evandtwins]

I have had existing idiopathic PN since January 1994, but markedly worse since July 2012. Greater burning, increase in fasciculation, and intense heel and foot pain.

I threw out my lower back very badly on Christmas morning and had a lumbar MRI last month that showed the following:

L3/4: 5 mm right paracentral disc protrusion. No definite direct nerve root impingement is seen.

L4/5: Small broad-based posterior disk bulge with superimposed 3 mm central disc protrusion. There is minor narrowing of the subarticular recesses bilaterally.

Two questions for anyone willing to lend an opinion and gain the instant good karma that results:

1) Is is possible that these back issues could be making an existing PN worse?

2) A alternate theory might be an immune-mediated neuropathy to explain the dramatic flareup after 18 years of stable symptoms. Would a prednisone trial be warranted to test that theory? If the prednisone reduced symptoms, should I press for an IVIG trial?

Any opinions that you could render would be extremely appreciated so that I can ask the right questions with my medical providers moving forward.

Great thanks,

JB

[Stacy2012]

Have you had your thyroid checked? My heel and foot pain went away after I got on thyroid meds.

Just something to throw out there.

[jenng]

I can speak to this as I have this very thing! Known PN, ideopathic since 2004 or so. Then the end of 2012 a dramatic increase of symptoms in my left foot. My lumbar MRI showed some defects in L5-S1 especially with a conjoined nerve root on the left. After about 8 months of PT, injections and the like, I ended up doing a single level fusion.

Was it worth it? Maybe. I have less burning type pain. Numbness, transient tingling and some lateral muscle weakness are still there. It is hard knowing what symptoms would have been there anyway and what were from a pinched nerve. Heck, I didn't have any consesus from different neurologists on if it was a radiculopathy. That's the hard thing when you have underlying PN.

I guess make sure you get several opinions if you choose to have surgery, and know chances are it may not fix your issues.

As for an autoimmune cause, they assume that is my underlying reason based on family history, but I have no strong bloodwork to back this up. I suppose if you have a doctor willing to do a steroid trial, & you are willing, go for it. IVIG will be hard to come by through insurance unless you have a firm autoimmune diagnosis.

[evandtwins]

I have had my TSH checked several times, always normal.

I am hoping to have a cortisone injection to see if reducing the lumbar inflammation might cause the PN symptoms to calm down a bit, which would suggest that the lumbar spine issues are makin the pre-existing PN worse.

[Stacy2012]

TSH is useless. It is the T3free and T4 free that matters. Most doctors are still using outdated info unless they are up to date on thyroid issues. Optimal results is a T3free in the upper range of normal and T4free in the middle range of nomral. And it MUST have FREE behind it not just t3 and t4

If you do not know what these two are and only know TSH you really should be tested.

[jenng]

Epidural injections didn't work in my case. My neurosurgeon said sometimes they don't, and again more difficult to know with underlying PN. But they usually do want you to try imjections or PT before more invasive surgery.

[Jomar]

Perhaps some expert PT, expert chiro, might help ??

You might ask about the spine issues on our spinal forum for more input?

[glenntaj]

--but look up "double crush hypothesis" and/or "double crush phenomenon" in this forum, particularly in my posts.

This refers to an existing nerve compromise, for whatever reason, being made worse by compression being added to that nerve tract, and the result is often "greater than the sum of the parts" symptomologically.