ArcaMax

DEAR DR. ROACH: I am a 75-year-old male and have had pain in my buttocks down to my outside thigh muscles. My primary care doctor ordered an MRI of the lower back and referred me to an orthopedic doctor who specializes in back issues.

The doctor diagnosed my condition as lumbar spondylosis based on disc compression impacting the nerves. Initially, the doctor prescribed physical therapy, which didn't provide any benefit. The doctor didn't recommend surgery, which I would be reluctant to do anyway.

Subsequently, he referred me to a pain management doctor, where I understand that treatment is likely to be an epidural injection into the lower back near the spine. I am concerned about the risks and effectiveness of such a procedure and whether there are other options, such as medical marijuana or acupuncture. -- C.B.

ANSWER: "Spondylosis" refers to degenerative arthritis of the spine. This can lead to hard structures like bone, bone spurs and ligaments compressing the nerves that come off the spinal cord, or the spinal cord itself. This can lead to any combination of pain, weakness and numbness, although pain is usually the first symptom. Physical therapy is the mainstay of conservative management.

Since the problem is anatomical, one would expect the definitive solution to be surgical, but surgery has limitations and isn't more helpful than physical therapy in most people. There are exceptions in which case an urgent surgery is indicated, such as in a person with progressive weakness.

When surgery isn't indicated, then a pain management expert is the ideal consultant, in my opinion. They can consider medication (including anti-inflammatories and medications to reduce pain), injections and other treatments.

The data on acupuncture is conflicting, although some people clearly get relief. What isn't completely clear is whether it's better than "sham" acupuncture, where needles aren't inserted or placed in locations that are part of the traditional acupuncture treatment for low back pain.

Cannabis has been shown to provide a short-term improvement in pain compared to no treatment, but there are scant data on its long-term use or how it compares with other treatments.

A pain management expert can also discuss other possibilities, including facet joint injections, other types of injections, electrothermal and radiofrequency treatments, Botox, and spinal cord stimulators. Epidural injections are just one of the tools they have.

DEAR DR. ROACH: My girlfriend recently went to a local pharmacy where she regularly gets her vaccinations. She requested the high-dose flu vaccine for seniors. The paperwork shows that she was given the Fluad vaccine. My research indicates this wasn't the high-dose flu shot that is now available. Should she still get the higher-dose flu shot? -- L.I.

ANSWER: There are two types of flu vaccines made specifically for seniors over 65. High-dose flu vaccines like Flublok and Fluzone High-Dose contain more of the purified flu antigens than a standard-dose vaccine, which might have been what you were expecting.

The Fluad vaccine contains an adjuvant, which is a substance added to make the vaccine more effective in seniors who often have an immune system that isn't quite as robust as it used to be. Any of these are considered ideal for seniors. Your girlfriend doesn't need to get any more vaccines.

If these special vaccines for seniors aren't available, a regular flu vaccine is still a good idea. I wouldn't wait -- it's more important to get one now.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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