Back surgery, pain management fails
Dear Dr. Roach: At 64, I was in very good health except for moderate hypertension, which was treated with lisinopril. I then had an incident lifting a heavy load, which injured my back. Long story short, three years of pain drove me to have an L4-L5 vertebrae back fusion. I am now 67, and in hindsight, surgery was a bad decision.
Since my surgery, every injection I have received from three pain-management doctors has been ineffective. These included painkillers to target nerves for radiofrequency nerve ablation; steroids at several spots above and below the fusion; and a recent epidural at L6 that was supposed to travel up my spine. The doctors said that relief would come within the hour or several days. These injections have never brought any relief. But they do, however, aggravate my pain for the next several days. I jokingly asked my current doctor if he is injecting me with saline solution.
Is my system impervious to the desired effect of these injections? My only limited relief is with hydrocodone tablets, which have other side-effects (opioid-induced constipation). It’s sometimes as aggravating as the back pain. R.S.
I don’t know why some people respond well to injections and others do not. Most experts do not keep attempting injections if the first one (or maybe few) are ineffective. However, some people have a good response, so it usually is worth a try. There isn’t outstanding evidence of benefit in trials (that is probably because there are quite a few people like you, who have gotten no benefit at all).
Your story is another reminder not to make the decision for back surgery lightly. Dear Dr. Roach: My husband has precancerous cells in his prostate. Is there a danger to me performing oral sex? What other types of diseases can be transmitted through this activity? A male movie star stated that he contracted throat cancer from performing oral sex on women. I’m very concerned for my own health and safety.
Anon. I think you are concerned about human papillomavirus. Some strains of this virus can cause several types of cancers, especially cervical cancer in women and some cancers of the mouth and pharynx in both women and men. The Centers for Disease Control and Prevention estimates that there are about 9,000 cases of HPV-associated throat cancers, roughly 80 percent of which happen in men. It is thought that oral sex is the usual way that the virus is acquired.
Prostate cancers are not HPVassociated, so there is no increased risk to you due to your husband’s prostate cancer. It is unlikely, though still possible, for you to contract or have HPV, even if neither you nor your husband have had symptoms, such as genital warts, and if you have never had an abnormal Pap smear (associated with HPV infection).
The HPV vaccine is an anticancer vaccine. There is incontrovertible evidence now that it protects against cervical cancer, and most experts believe that the vaccine will protect against HPVrelated throat cancers as well. The vaccine is indicated for all children and young adults up to age 26, and may be appropriate in certain circumstances for people even older. 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 ToYour GoodHealth@med.cornell.edu