DEAR DR. ROACH: For several months, I’ve been suffering with severe lower-back pain while standing. It radiates down, into my buttocks. Several weeks of physical therapy was not helpful, and I can’t take many medications because I have atrial fibrillation. An MRI showed arthritis in my spine but also several schwannomas on the nerve sheaths. What information do you have on schwannomas of the spine? — D.B.
ANSWER: The Schwann cell, in the peripheral nervous system, produces myelin sheaths, a protective coating around the nerve that is necessary for electrical impulses to travel.
Tumors of these cells are called schwannomas. Often, they are found in the nerve connected to the ear, affecting the sense of balance. They also arise in the nerves leaving the spine. They can occur in anyone, but when there are multiple tumors, the physician should consider schwannomatosis, a condition related to neurofibromatosis. These tumors are generally benign, although there is a rare malignant variety, called a malignant nerve sheath tumor. Due to their location, they can cause pressure on the nerve, which leads to symptoms of pain and sometimes weakness.
It sounds as if you have at least two possible reasons for your symptoms, and only an expert reading of your MRI may be able to tell whether the pain is being caused by the schwannomas or because the arthritis is putting pressure on the nerve. (Radiation of pain into the buttock is strong evidence that the pain is due to nerve compression.) While physical therapy almost always is the best initial treatment for most back pain, this is one case where seeing a surgeon soon is important. The MRI is not definitive for schwannoma, so a biopsy may be needed to confirm the diagnosis. Many experts would recommend surgery for confirmation as well as to relieve the pressure on the nerve in order to stop the pain. Radiation therapy sometimes is used to treat pain in people who cannot have surgery.
DEAR DR. ROACH: I have an adult child who suffers from moderate to severe depression. When she becomes sick, such as from the flu, bronchitis or a viral infection, she is hesitant to go to a doctor, and when she does, she claims the prescribed medications, including codeine cough medicine, provide no relief. She thinks the depression has compromised her immune system. Is there a correlation between depression and the immune system? — T.M.
ANSWER: There is conflicting information on depression and the immune system, but I would say the preponderance of data suggests that there is an interaction between the two. However, it’s not clear which is the cause and which is the effect.
Many authorities feel that deficiencies in the immune system, which can be caused by many conditions, might predispose people to depression, as opposed to your daughter’s theory that the depression has adversely affected her immune system. However, she may well be right that there is an effect. Certainly, some treatments that help the immune system — such as good diet, moderate exercise and proper sleep — can be helpful in depression as well. I do not mean to suggest that these by themselves are curative in severe depression, which is a serious, even life-threatening, illness.
Many of the treatments we have for the flu, bronchitis and other viral infections are barely better than placebo. Your daughter may be seeing the lack of effect more clearly than people who are expecting to see dramatic benefit.
The mind and the body are closely connected: The relationship between the immune system and depression shows us that we cannot expect optimum results unless we recognize this connection and treat it accordingly.