Pain

The pain you're describing is a possible disk herniation at the L3/L4 disk area. You can further determine it if the pain goes past the hip, across your thigh and stops at the inside of your knee. In such cases, if it's been more than a week, at the very least you need to get a facet injection or an epidural to relieve the inflammation, but also either an MRI or CT to determine the extent of the problem and the underlying cause.

Regardless though, the pain indicated is usually disk related - it just depends on where the pain originates and how far it goes. Sciatic nerve pain (from herniation of the L5/S1 or L4/5 disks) tends to radiate laterally to the hips, but also down the back of the legs. The L3/4 disk nerve though, is unmistakeable - it originates along the side of the spine just below the middle of the back, goes down the spine, across the waist and across the hip, then across the thigh until it stops at the inside of the knee.

Use the Interactive Spinal Chart at the link below to help determine which disk is giving you problems.

If the pain is irritating this nerve path, you need to see a Neurosurgeon (not necessarily for surgery - they're just the most qualified to diagnose and help you since they deal with it every day) ASAP.

1. Stay off your feet and get as much rest as possible.

2. Take an anti-inflammatory to reduce the swelling and muscle spasms

3. Don't sit if you can avoid it (sitting is the worst position for your back other than standing)

4. When you're lying down, lie on your side in a fetal position, with a cushion/pillow between your knees and one behind your lower back, and one in front of you to hug. The one between the knees keeps pressure off the lumbar area; behind the back keeps you from rolling over onto your back, which is a bad position also; and the one to hug keeps you from rolling onto your stomach, which also puts pressure on the lower spine. If you have to sleep on your back, make sure your legs are raised to the point where your lower back is flat on the bed. Your legs should be in a "Z", like a sitting position only lying on your back. Sofa cushions are usually big enough to put under your legs.

Alternatively, you can lie on your back with your legs on the sofa, with the back of your legs against the front of the sofa. I've spent many hours like that when lying in bed wasn't helping. Sometimes a hard, flat surface is required to get all pressure off the spine.

Aside from the nerve pain, you'll also be hit with severe muscle spasms from the trauma that's caused. This tightens up the entire area, making the pain even worse. Normally a doctor will prescribe a good muscle relaxer like Flexeril, but Valium (or Valerian Root, if you like herbal alternatives) works also - anything to relax your body.

If the pain continues past 3-5 days, then the damage is probably bad enough to require an epidural or facet injection (local or target steroid injection) to reduce the disk swelling. The problem though is that they take time to schedule, as it's considered a minor surgical procedure; as such, by the time your appointment comes up the pain is usually gone anyway. Anything scheduled more than 3-5 days is worthless, unless you're at a point you can't walk, but in such cases they'll usually get you in ASAP anyway. If they can't get you in, ask your doctor for a course of Prednisone, or a steroid dosepak - they work just as good in a pinch (no pun intended). Prior to my last spinal operation, I had to use Prednisone for about 8 weeks to keep the inflammation down just so the opiates could work.

Pain Meds - at some point, if you don't have any (or you've already used up what you have) you'll be screaming for some kind of painkiller. If they've determined you've got a disk problem, you'll usually get at least a couple of weeks or a month worth, but if it persists, you'll need something to counter the impression you're just looking for more drugs, which unfortunately is something all people with real pain must deal with. You should start a Pain Diary right now - you can download one at the Partners Against Pain link below.

One thing to always remember - if you go in to see a doctor, or go to a hospital, and you have real pain, don't immediately start asking for painkillers or you'll likely be tagged a 'drug seeker' and won't be taken seriously, even if you have a real problem. It sucks, but until things change it's the way things are in the medical world right now. I've been a formal Pain Management patient for my spinal problems for 11 years now and I've seen the worst the profession has. I've also been tagged a DS by a doctor who was subbing for my regular doctor, and when I had a real emergent problem (my cervical disks at C5/6/7 were flattened). That bitch nearly caused me to have my left arm permanently paralyzed, and I didn't even know she had done that until I finally saw another doctor and nurse who knew my history very well. It was so bad I literally had to drop everything to have surgery done.

If you're referred to a Neurosurgeon (don't go to an Orthopedist, they know squat about nerves) you'll probably be asked to fill out a Pain Assessment form anyway, which is part of a pain diary. By starting to document your pain now, you'll be in a better position later if you need pain meds, as real pain is difficult to fake, as is a pain diary. Pain is subjective; what may be excruciating for you might be nothing to me, so a diary also helps the doctor see how the pain is affecting you relative to your documented symptoms in the diary, and what you've done to care for yourself.

OTC Meds - there are 3 OTC meds that I use when I don't feel the need to take any Percocet (I use 10/325's, about 150 per month, and they're not my primary pain med):

1. Bayer Back and Body Aspirin - works fast.

2. Tylenol E/S Rapid Release Gel-Caps - because I use so much Percocet (I've used the same amount for about 13 years now) and Percocet is a combination of Tylenol and Oxycodone (where 10 is the Oxy and 325 is the Tylenol amount) I don't use Tylenol unless I feel that adding to what I'm already taking will help. These work the fastest.

3. Aleve - Aleve is Naproxen in non-prescription form. Prescription dose is 500mg, and you have to use it for a couple of days to get any benefit. It's the one NSAID that doesn't have any problems like the others, aside from things like constipation. Always take it with food and a lot of liquid. If you're not prescribed prescription Naproxen, or if you need it and don't have any, Aleve is a great substitute. Just remember to take enough for prescription dosage.

Heat

Heat therapy has always worked for me. Some use ice, but cold makes me worse. There are a couple of things you can use:

1. Salonpas Patches - I've used these for years. 20 years ago you could only find them in an Asian market, just like Tiger Balm, but you can get them at Wal-Mart or on the 'net now. Great for targeted nerve pain.

2. Thermophore Heat Pad - If you've ever been to a Chiropractor, you've probably used one; most of them started using them a few years ago, though I've been using them for almost 20 years. It's an instant moist heat pad - the flannel covering draws moisture from the air and the body. You can get it with a timer switch or one you have to hold down. You can find them at some pharmacies (usually ones near medical offices or hospitals) or you an order one from the Thermophore site at the link below. The "Standard" (14"x27") is the best size.

Staying off of your feet can't be stressed enough. Like most of us, you'll probably need to go to a doctor to get a note for your employer who still has a kindergarten mentality when it comes to sick leave. The more you stay on your feet or sit, the longer it will take to heal.

When you say "suicidal people" you probably mean people who are at risk of killing themselves. This risk might be low or moderate or high and it can change from day to day, week to week, month to month. The 'risk' level can only be ascertained by a rigorous assessment for suicide procedure by a competent, qualified person. Only after a person is found dead and it is believed that they died by suicide can you begin to analyse any information (from medical practitioners and other professionals, friends, relatives, neighbours and anyone who knew the person well) that might help you to understand the state of mind of the person at the time that they decided to take their own life.

Also some people who kill themselves do so 'out of the blue' that is without anyone suspecting that their state of mind is such that they are 'at risk of suicide'. One study concluded that up to 45% of suicides may be in this category.

So it is not possible to answer your question with a number. Anyone that you believe to be "suicidal" should be encouraged to seek help from a qualified health care practitioner as soon as possible.