DR MARTIN SCURR: The nerve-wracking surgery that could cure back pain… and the best way to treat a stuffy nose

For several years I have suffered from lower back pain. In the past year I have had MRI and CT scans, x-rays, colonoscopy and ultrasound scans which have only found some degeneration of the spine. The pain seems to get better when I stand up, but it’s there all the time and affects me badly.

Nadine Taylor, Southport.

Dr. Scurr replies: It sounds like you’ve had an extensive set of tests yet, despite that you don’t have an exact diagnosis.

I’m wondering if the problem is facet arthritis because from the type of testing you’ve had it seems like other common causes of lower back pain at your age (you say you’re 73) such as a collapsed vertebra on due to osteoporosis or a herniated disc, have been excluded.

The facet joints come in pairs – one at the top and one at the bottom on each side of the vertebrae – and stabilize the spine.

Osteoarthritis – or degeneration – of the facet joints is common, and the vast majority of adults over 60 will have it to some degree.

However, the degree of discomfort and pain will vary. Some people with facet joint degeneration experience few symptoms, perhaps with just a little stiffness; others are crippled by chronic pain. (In old-fashioned terms, the pain might have been described as low back.)

Treatment is typically with non-steroidal anti-inflammatory drugs, physical therapy, and sometimes other complementary approaches such as acupuncture or tai chi.

If these don’t help, another option is a surgical procedure known as rhizolysis, which uses radiofrequency ablation to destroy the nerves leading to the joints.

The specialist first injects a local anesthetic into the affected joint. If this resolves the pain immediately, it confirms that the problem is facet arthritis – and then radiofrequency ablation is performed, bringing pain relief that can last for years.

I would recommend asking your GP or physio specifically if the scans showed facet arthritis. In that case, you should be referred to a spine surgeon.

I wake up most mornings with a stuffy nose and I sneeze a lot. It goes away by noon – but I’ve gotten into the habit of taking an antihistamine and a cold and flu pill every morning to stop it. Is this safe in the long term?

Gina Knight, East London.

Dr. Scurr replies: The fact that it seems to take an antihistamine to control your symptoms leads me to conclude that your symptoms are due to allergic rhinitis – inflammation of the nasal passages.

Antihistamines are a type of drug known as anticholinergics, which inhibit the action of certain brain chemicals and include tricyclic antidepressants and drugs used to treat Parkinson’s disease.

There is evidence linking some of these drugs to dementia if taken long term, although I can assure you that regular antihistamine use is not implicated. But I wonder what is causing your nasal allergies at night; it could be feathers in your pillows or duvets and/or house dust.

It is not unusual to develop an allergy in adulthood triggered by, for example, a viral infection or menopause; some kind of change in your immunology that ‘turns on’ an allergen. I suggest that you carefully vacuum on and under your mattress and under the bed and that you regularly dust all surfaces (the advice is to do this twice a month).

You can also try using an anti-allergy nasal spray at night instead of an oral antihistamine if you want to avoid a long-term anticholinergic. The most effective are corticosteroid sprays such as beclomethasone.

As with all medicines, such sprays can have their own side effects, mainly excessive drying of the nose and nosebleeds (stop using the spray if you experience any of these).

I would alternate between using this at night and in the morning. After a few months, you will be able to compare its effectiveness with the antihistamines.