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Pain Management

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Heed the 'horse's tail'

Provided by: Sun Media
Written by: DR. GIFFORD JONES
Jan. 26, 2008

Why call 911 when it's the same old pain? After all, John X had suffered from occasional bouts of back pain for years and usually the discomfort subsided within a few days. However, two or three times, he had been totally disabled from severe bouts of sciatica, requiring bed rest for several weeks. With the use of painkillers and anti-inflammatory drugs the severe pain that radiated down his leg gradually went away.

One afternoon, after a sneeze, pain struck with a vengeance. This time, the usual medication failed to numb the agony, but John refused to seek help.

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Three days later, when he was unable to urinate or have a bowel movement, his family finally called 911 and he was admitted to emergency.

The diagnosis: Cauda equina syndrome, which required emergency surgery. Why? Because of injury to "the horse's tail."

Lower back pain affects millions of people every year and there are many causes. A simple sudden twist may stretch a ligament or injure a muscle. In many instances it's hard to pinpoint the cause, but fortunately, tincture of time cures most patients.

On occasion, there's no doubt about the diagnosis. Years ago, during a trip to Hawaii, a violent sneeze sent a lightning, knife-like pain down my leg. There was little doubt the diagnosis was sciatica due to a ruptured spinal disc.

The only place I could find to lie down was on the pew of an historic church.

As luck would have it, a few moments later a group of tourists entered and I knew what they were thinking: "Here's the local drunk lying in a pew at 10 in the morning!"

But I was in so much pain I didn't care what they thought.

Most people are aware of a ruptured spinal disc. But I'd bet that not one in 1,000 have heard of the mother of all back pains, the cauda equina syndrome, that injures the horse's tail. And unless treated promptly this injury can have terrifying consequences.

The horse's tail sounds like a cocktail mixture, but it has to do with the anatomy of the spinal nerves. The spinal cord ends at the upper portion of the lumbar (lower back) spine. But a collection of nerves at the end of the spinal cord continues further down the spine. This bundle of nerves resembles a horse's tail, and if a massive disc blowout occurs, prolonged pressure on these nerves can cause permanent paralysis of bowel and urinary function.

Several conditions can trigger this emergency. Sometimes an arthritic narrowing of the spinal canal will gradually compress the horse's tail. Other times it's an expanding tumour, spinal hemorrhage, birth abnormalities or a car accident. But the most common cause is sudden collapse of the spinal disc.

How can patients know whether they're suffering from severe back ache due to a disc protrusion, or from the cauda equina syndrome?

There are several red flags.

Be suspicious if you've suffered from previous bouts of back pain, but this one appears to be the worst. Be particularly apprehensive if the pain is associated with numbness in one or, more commonly, both legs, and an inability to move the legs.

Another red flag is "saddle anesthesia." It's the inability to feel anything in the body area that sits on a saddle. And, if you're can't urinate or have a bowel movement, the horse's tail has been badly injured.

One authority adds that a recent onset of sexual dysfunction is a red flag. But since many people suffer from this problem, the other flags are more reliable.

There are times in medicine when it's best to let nature do the healing. But when the horse's tail is injured, this is not one of those times.

This syndrome requires immediate surgery to remove the pressure on the horse's tail. The sooner the pressure is relieved the greater the chance that bowel and urinary function will be restored.

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