Need Advice for lower back pain caused by muscle strain.

[+ augustus]

Dear All, can anyone advise pain relief for an 82-year-old woman who strained her lower back.  This happened to my aunt 2 days ago and I called EMS and she refuses to go to a hospital.  The EMT's said it is not a hip fracture.  She can move her legs but the pain is in her lower back and radiates to her buttock.   I have been giving her Tylenol 3 and an advil every 6 hours and applying ben gay.  It relieves her pain but not enough.  I have to take her to the bathroom and stuck at her home indefinitely since no one else wants to do it.  The EMT's said they would not take her if she refuses.  Does anyone know of a pain patch or something like that?    

[MscleLovr]

25 minutes ago, augustus said:

anyone know of a pain patch or something like that? 

I can’t advise on pain management (I have a permanent spinal problem but I take nothing for it) but I’d suggest you seek out a skilled chiropractor.
 

A chiropractor, preferably experienced with elderly patients, will be able to assess her and her range of movement. Some moderate manipulation may help her considerably. Alas for you, it may take more than the next couple of weeks for her to regain full and independent mobility. Have you considered getting a care worker in for some hours a couple of times a week?
 

 

[+ nycman]

You might want to try Lidocaine patches. I believe they are available over the counter. I’m also a big fan of ice packs. 20 min on. 20 min off. A great alternative is a cooler filled with ice that pumps cold water into a pad. It’s less time consuming than running to the freezer ever 20 min and you don’t have to move them every 20 min to apply it. Just apply the pads, turn the pump on/off every 20 min, and refill the unit with ice every couple of hours.

https://www.breg.com/products/cold-therapy/

Seeking out a palliative care doctor might also help. They often make house calls and are used to working with the limitations of elderly people who refuse hospital care. 

[+ Cash4Trash]

I've had luck with Therma heat wraps. A heating pad might offer some relief as well.  

[Rudynate]

gentle rehab exercises on a suspension trainer like a TRX are great for lower back discomfort

[Guest]

If the pain radiates to the buttocks, there's a tweaked nerve. There's no muscle that goes from the back to the buttocks. You don't mention how the injury occurred, but compression fractures (of the spine) are common in this age group. She'd have to been seen to be evaluated for that. If she refuses to get evaluated, the advice for lidocaine patches is fine. In addition, you can use diclofenac gel (3-4 times a day). 

Edited March 4, 2023 by Unicorn

[+ augustus]

9 hours ago, MscleLovr said:

Have you considered getting a care worker in for some hours a couple of times a week?

I did ask for one yesterday.  The social worker said there are none available.  She will try to pull one from someone else younger next week, She said many people in their 60's are ok but want an aide to do their housework. 

[+ augustus]

49 minutes ago, Unicorn said:

There's no muscle that goes from the back to the buttocks. You don't mention how the injury occurred, but compression fractures (of the spine) are common in this age group.

It's the base of her back to her right buttock.  She didn't fall and doesn't know how it happened.  Maybe the way she slept?

[Guest]

19 minutes ago, augustus said:

It's the base of her back to her right buttock.  She didn't fall and doesn't know how it happened.  Maybe the way she slept?

Spinal compressions can happen spontaneously, or even as a consequence of a sneeze. Arthritis and intervertebral disc degeneration also commonly irritate nerves. 

[+ augustus]

@nycman @Unicorn  I went out and brought the Lidocaine patches and it had no effect.  So late Saturday night I called an ambulance and insisted she go to the hospital.  It turns out she has a UTI !  That can cause severe pain in the lower back and lead to Sepsis rather quickly.  She is in the hospital now taking IV antibiotics.  

[Guest]

More than likely a misdiagnosis. Although not typical, urinary tract infections certainly can (fairly commonly) cause pain in the lower back. However, the pain will not radiate to the buttocks, since the urinary tract has no connection to the spinal cord, much less peripheral nerves. What is extraordinarily common, however, is for octogenarian women to have asymptomatic bacteriuria. Even if we assume the urine was collected correctly with a catheterized or true "clean-catch" specimen (very difficult for an octogenarian woman to do herself, especially if she's having bad back pain), there's almost a 50% chance a woman with no symptoms your mother's age will test positive for bacteria growing in her urine:

https://www.ncbi.nlm.nih.gov/books/NBK441848/

"...Asymptomatic bacteriuria is very common in clinical practice. While few infants and toddlers have asymptomatic bacteriuria, the incidence increases with age. The incidence is up to 15% or greater in women and men age 65 to 80 years and as high as 40% to 50% after age 80... Asymptomatic bacteriuria is more common among women than among men probably because of the shorter female urethra, which gives bacteria from the urethral meatus and the perineum a shorter distance to the bladder...".

While she's in the hospital, I would suggest advocating for imaging of the lower back. If a compression fracture is found, that does not prove the fracture is recent, much less the cause of the pain. A bone scan would be needed to determine that the compression fracture is new. Of course, if her pain goes away in 48 hours, then nothing to worry about. But I'd still recommend getting some imaging, at the minimum plain X-rays, as soon as possible. 

(If the urine was not clean-catch, the chance of bacteria growing out of the urine is closer to 90%. You could ask your mother how her urine was collected.) 

[+ nycman]

10 minutes ago, Unicorn said:

More than likely a misdiagnosis.

I had the same thought. Almost all old ladies have "dirty" urine. 
It’s rarely a UTI, but it’s often called that. It’s more likely just a billable 
excuse to admit them, not a "real" diagnosis. Of course, if she gets 
100% better after a day or two of IV antibiotics, well then UTI it is!
Just don’t get your hopes up too high yet. And of course, don’t forget 
that your listening to two online wackos who have neither seen your 
mother’s chart nor examined her.

@augustus regardless, I’m glad you were able to get her into the 
hospital and I hope they are able to help. I’m sure this has been an
unbelievable burden.  

[Guest]

2 hours ago, nycman said:

...listening to two online wackos...

Well, wacko or not, the UTI diagnosis is fairly unlikely. Also unlikely is a pathological fracture caused by a cancer, but that would be an important condition to exclude in a woman the age of the OP's mother. This cannot be done with a urinalysis. It's super-simple to do at least a lumbosacral spine series while she's already in the hospital, at virtually no risk or discomfort to the patient. Rather than wacko physicians, be concerned with physicians with tunnel vision who can only think of one diagnosis and stop considering reasonable alternatives when they get a test that seems to confirm their first idea. 

Of course, if an ER physician only thinks of UTI's in old women, then does UA's on all of them and says "Aha! I was right!" when most of the UA's in these women come out positive, it reinforces the tunnel vision. Of course, there's no follow-up for the ER doctor. Most of the time it's just a disc or arthritis pinching a nerve, so little harm done in putting the patient on Abx (some, but not too much harm--at least not enough to result in a major lawsuit). Of course, one of these days, if that ER doctor keeps doing that, he's going to miss a cancer, in an age group usually not screened for cancer, then he might piss off a patient or family member. 

[+ augustus]

2 hours ago, nycman said:

And of course, don’t forget 
that your listening to two online wackos who have neither seen your 
mother’s chart nor examined her.

lmao....most of us here are wacked out to some degree.  

 

2 hours ago, nycman said:

Of course, if she gets 
100% better after a day or two of IV antibiotics, well then UTI it is!

She has gotten better.  Today was the 2nd day of ceftriaxone by IV and she said the pain is almost gone.  We will see.

[+ augustus]

4 hours ago, Unicorn said:

While she's in the hospital, I would suggest advocating for imaging of the lower back.

They did imaging on her back.  The only thing they found, as the doctor told me, was "an old sub-acute fracture" in her spine.  But her pain is practically gone now.  And my aunt was very confused on Saturday and now she says she is just tired.  She was almost delirious before I called the ambulance.  She was asking where she was (in her own house).  I hope it was just the UTI.  The only thing they gave her for the pain earlier was Advil.  

[+ augustus]

2 hours ago, nycman said:

I’m glad you were able to get her into the 
hospital and I hope they are able to help. I’m sure this has been an
unbelievable burden.  

I had another Aunt I was helping out before she passed away in 2020.  Helping the very elderly is the hardest thing I've ever dealt with.  It's no joke.  Even one's own children don't want to get involved (unless there's an estate involved).  It really is horrible.

Edited March 7, 2023 by augustus

[Guest]

The confusion raises the suspicion for infection more than the low back pain (or the bacteria in the UA). If she's not being treated for osteoporosis, that might be a good idea. Surprisingly, even women way beyond menopause can benefit, even in short order. If the pain is almost all gone, that definitely supports the diagnosis of infection. I hope she has a durable power of attorney for healthcare (presumably you'd be named as the primary decision maker), in case of future delirium or inability to make decisions for other reasons.