DEAR DR. ROACH: I enjoyed your informative article on spinal stenosis. I also have acute and chronic pain in my lower back. I am 75 years of age and have had vertebroplasty on seven vertebrae. I realize that my back will not be normal again. I am currently working with a doctor who uses osteopathic manipulation. He is suggesting prolotherapy in conjunction with the manipulation. I have tried the prolotherapy previously without any relief of pain.
What is your assessment of prolotherapy therapy, or would you advise me to go to a pain clinic? The pain level in the lower back usually is about 6 or higher on pain scale of 1 to 10.
I walk 3 miles every day in a grocery store using a small grocery cart. I am trying other exercises, even working on a balance ball. But it just does not seem to improve. I would greatly appreciate any advice you could give me. — D.R.
ANSWER: Prolotherapy is the injection of an irritant solution into a space, designed to stimulate healing and reduce pain. However, if it hasn’t worked for you in the past, it is unlikely to work for you again. On the other hand, some studies have shown prolotherapy to be modestly effective when combined with spinal manipulation.
A pain clinic has several modalities available, including steroid injections and pain medications. Unfortunately, steroid injections have been shown to be ineffective in back pain that is due to spinal stenosis lasting beyond six weeks.
It sounds like you are doing what you can with exercise. I think continuing with the manipulation and prolotherapy as a trial of six weeks or so is reasonable, and at that point you can continue if it begins helping. If not, you can try a pain specialist, as there are effective non-narcotic medications that may be of help, in combination with your continued exercise.
However, I think that an experienced physical therapist may be able to guide your exercises more effectively.
. DEAR DR. ROACH: My husband drinks tonic water with quinine every day because he was told that it will help alleviate his leg cramps. He drinks as much as 1 1/2 quarts a day. Is that much safe? If not, what is a safe amount? — D.V. ANSWER: Many people have found that quinine relieves leg cramps. However, the Food and Drug Administration banned sales of quinine for leg cramps due to unproven effectiveness and the possibility of side
effects. Quinine in large doses can cause abnormal heart rhythms, blood problems and even organ failure.
However, the amount of quinine in tonic water is quite small, compared with quinine tablets. One common brand has 17mg in a liter, so your husband is getting about 25mg. The quinine tablets formerly prescribed for leg cramps were 200mg. Toxic effects are unlikely at the dose in quinine water. Some people are allergic to quinine, in which case even the small dose in tonic water could potentially cause problems.
Your husband can keep on as he’s been doing if he finds that it helps.