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When Pain Lingers For Months After Compression Fracture

Dear Dr. Roach: I fell about three months ago and sustained a compression fracture of my T11 vertebra. What can I do? The pain is about the same as it was then. There’s numbness on the outside of my right foot. I have no tolerance for the idea of a needle in my back. — B.H.

Answer: “T11” denotes the 11th thoracic vertebra — there are 12 thoracic (in the thorax, or middle back) vertebrae and five lumbar (lower back), so the 11th is in the mid-to-lower back. Think of the vertebral body as a hatbox. A compression fracture is what happens if you crush a hatbox: It loses height, and the space between it and the next vertebra is reduced. This can put pressure on the nerve between them as it exits the spinal column. Pain can come from the fracture itself, but also because the nerve is damaged. That damage is why the outside of the foot is numb.

Most often, compression fractures heal over a few weeks, but I am concerned that you are continuing to have the same amount of pain and numbness. Although a back brace can be helpful, I am not sure it will help you enough. If medication isn’t helping (and you haven’t told me if you’re taking any), then it’s time to consider more-aggressive treatments.

Kyphoplasty and vertebroplasty involve that needle in your back you have no tolerance for, and attempt to restore the height of the vertebral body with a balloon and cement. However, recent studies have shown that people who had these procedures didn’t do any better than those who underwent a simulated procedure (with no balloon and no cement). So although they may help some people, I can’t recommend them.

Spinal fusion surgery is another option, but it should be considered only if symptoms are very difficult to live with.

The last concern I had is why you had a fracture to begin with. A simple fall doesn’t usually cause a compression fracture. If you haven’t already, you should have a DEXA scan to look for osteoporosis and a vitamin D level check. This might help prevent further fractures.

Dear Dr. Roach: I’m a 24-year-old college student and a nonsmoker. My girlfriend is always burning incense in her apartment. When I go there, I get sick to my stomach and have headaches. Is exposure to burning incense as dangerous as secondhand cigarette smoke? — P.M.

Answer: Incense smoke contains toxic substances, including carbon monoxide and a variety of cancer-causing chemicals. At least one study found increased risk of squamous cell cancer of the upper respiratory tract, a kind of cancer risk that’s also increased in smokers. I would expect the health hazard to be worse with more frequent incense burning and poor ventilation. And clearly, it is affecting you, since you are having some symptoms there.

It’s just as reasonable to ask someone to stop burning incense as it is to ask someone to stop smoking when you are in the same room with them.

Dear Dr. Roach: Is alcoholism a disease or an illness? What constitutes a disease? — D.D.

Answer: My dictionary defines “disease” as “a particular quality, habit or disposition regarded as adversely affecting a person or group of people.” With that definition, alcoholism is certainly a disease. In practice and research, we use the terms “alcohol abuse” and “alcohol dependence,” as these terms have more precise meaning than “alcoholism.” But, like any disease, alcohol abuse and dependence have good treatments, including specialists in addiction treatment.

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 write to P.O. Box 536475, Orlando, FL 32853-6475.