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Sciatica, Chronic Back Pain

Barbara spine patient smiling

As Barbara O’Mealia approaches 75-years-old, she’s realistic about her expectations for how her body should feel. Both her mother and grandmother suffered from severe arthritis late in their lives and, in turn, dealt with more than their fair share of pain. So she’s witnessed what age can do to a body.

But Barbara’s not going to simply hand herself over to it, either.

She’d gritted her way through chronic lower back pain before and she was determined to do it again when she began experiencing sciatica-like symptoms several months back. The pain originated in her left hip and radiated throughout her entire left leg straight down to her foot. But gradually the pain worsened, to the point that she needed to sit and wait for it to let up. She was also having trouble sleeping at night, because that’s when the pain was the worst.

“I was exhausted, but I was annoyed more than anything,” Barbara says. “I’m the kind, you keep going. My son would see me and say, ‘I don’t know how you do it.’ I’m not going to sit in a chair and wait to die.”

She saw Stephanie Yellin, DO, CAQSM, her family doctor and a Penn Medicine sports medicine specialist, who recommended that Barbara try physical therapy. When she reported back that it only seemed to amplify her symptoms, Dr. Yellin referred Barbara to Arthur Kitt, MD, MPH, a Penn Medicine pain management specialist.

A combination of treatments

After reviewing her x-rays, Dr. Kitt recommended a course of epidurals. At first, they provided some modest relief from the pain, but it proved to be short-lived. He then prescribed a non-opioid medication, called Gabapentin which he wanted Barbara to take in conjunction with the epidurals.

“We try not to base the treatment around just one single approach. It’s usually some combination of a procedure, medication, and physical therapy,” Dr. Kitt says. “I tried just the injections with Barbara at first because she was somewhat resistant to being on a medication and she’d already tried physical therapy.”

The alternative to the medication was likely surgery, which Barbara was even more leery of. So she tried the medication. The idea was to start with one pill a day and gradually work her way up to three. With the first pill, she got her first night of sound sleep in months. Three, however, made her feel too tired. So she went back to taking two, which she continues to do today.

Barbara had her first epidural while on the Gabapentin in November. She was back to feeling like her normal self for about a month afterward. Her second was in January. This time, three months later, she’s still pain-free.

“I’m very happy to be feeling this good again,” she says.

The exit strategy

Barbara spine patient standing by door“I’m really thrilled with how Barbara’s doing. She’s put in a lot of work on her end to get to this point,” Dr. Kitt says. “It’s kind of a waiting and watching thing now. I’m reminding her to keep doing her stretching, her core strengthening. It’s important to keep moving. And if she sticks to those new regimens, they’ll give her the best shot at staying pain-free.”

The plan with the Gabapentin from the beginning was to wean Barbara from it once Barbara was in a better state. 

“As long as she’s doing well, we’ll lower the dose bit by bit. And if she stays pain-free, we’ll just get her off of it,” Dr. Kitt says. “But it’s good to know that it’s something she tolerates and it’s something that helps her because in the future, if she was to have a flare-up, we’ll know we have a useful tool in our back pocket.”

There’s no way to predict if she will. But having recently returned from vacation, Barbara, for her part, has no plans of slowing down anytime soon.

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