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2987 Views 9 Replies 6 Participants Last post by  potiphar
I had a deep bone scan done over 2 years ago to look for reasons that I have chronic back pain. Didn't get any clarity on my pain but Kaiser came up with an Osteoperosis diagnosis. That filtered through their system for a year and then I got contacted by a specialist and began fossimax. So, now its over a year later and I'd like to see if the fossimax is working but Kaiser doesn't want to do any more tests. What I was told was that if the Fossimax was working why do an X ray (radiation) and if it wasn't then I was screwed? Anybody got an idea on a way to check any of this? I did do a Longs Drug store bone check which is not good medical info but it did show bone loss but not how much. So?? K
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Whoever Kaiser is, he has a point. The only good reason for doing an investigation is to manage treatment (which is why X-rays for chronic back pain are an utter waste of time, as the results show no correlation with pain. They also give you a belt of radiation 100X that of a chest X-ray. The Royal Society of Radiologists in UK estimate on dosage grounds that 17 people a year die here because of back X-rays. But I digress).

Imaging of all kinds for back pain is grossly over-used and over-interpreted - for example research even shows that 65% of pain-free people have abnormal MRIs, so they're only useful when carefully targeted and wisely interpreted).

So if it were me I'd be happy to keep my osteoporosis under control by pumping in the Fosamax, exercising, and laying off too much alcohol or steroid sandwiches. Why worry about what you can't change?

What about your mechanical back pain though? What few people (even professionals, unfortunately) realise is that back pain has two components: nociceptive pain from acute injury, and neuropathic pain, from poor adaptation of the pain pathways in the nervous system. You can look at it as hardware and software problems. The pain you get is just an error message, and is not much more specific than the ones you get in Windows.

Since most chronic pain is predominantly the latter (neuropathic), it's not surprising that investigations either show nothing or old damage that doesn't matter much now. So conventional pain killers are poor, and if someone's foolish enough to get surgery done on the old damage, it often doesn't work.

Treatment that does work (variably but effectively!) is all actually aiming to reset the nervous system. Stretch exercise programmes are a mainstay, and can be augmented by drugs (like amitriptyline, gabapentin etc), TENS, acupuncture, and more high-tech stuff like epidurals or facet joint injections. I don't find manipulation has much long-term benefit for chronic pain - people end up needing it every week forever, which is not really cost-effective in my book.

Sorry to chunder on, back I treat back pain more than I play saxophone, and just wish it was generally done better.
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Assessment of evidence always helps to balance things out:

2400 reported cases of jaw necrosis whilst on biphosphonates
80-90% were in cancer patients on high dose iv bisphosphonates
39 million prescriptions a year - only 3 million on iv drugs

So, 240-480 cases (max total) of jaw necrosis on oral biphosphonates, in n million patients, with no direct causal relationship proven.

But 35% of wrist fractures occur in women
30-50% of women will experience wrist fracture in a lifetime (much higher for those with osteoporosis)
Sax players need wrists too.

Do sums, and THEN decide on whether to take biphosphonates or not.
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