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Help for Spinal Stenosis Pain

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.

I walk three miles every day in a grocery store using a small grocery cart. So the question I have is, What you would advise me to do? 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 am trying various 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, prolotherapy has been shown to be modestly effective when combined with spinal manipulation in some studies.

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 with 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: Will you tell me what scarring alopecia is, and is there a cure for this scalp problem? The dermatologist I recently have seen has me on clobetasol once a day and ketoconazole shampoo. I know that a side effect of clobetasol is to affect the adrenal glands if a patient takes it for a long time period. Would it be better if I accept this condition and stop the medication that is applied to my scalp once a day and just continue to use the shampoo? —M.M.

Answer: “Alopecia” is the medical term for hair loss. Many conditions can cause hair loss, but they can be broken down into those that cause scarring and those that don’t. There are at least a dozen specific diagnoses that cause hair loss and scarring. It usually requires a skin biopsy to see what the exact diagnosis is. Unfortunately, most causes don’t have a cure.

Most of these conditions are treated with steroid creams, often as the first treatment. Clobetasol is a high-potency steroid. A small amount of clobetasol is absorbed into the body (only about 3 percent is absorbed through the scalp), but it does not commonly affect the function of the adrenal glands. Still, it is advisable to use a lower-potency steroid, or a higher-potency one less frequently, if the condition is improving, to minimize the risk.

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.