### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I had a car wreck in 1992. Through the years Ive had a lot of neck and back pain. In 2008 I had a cervical fusion of C4-C7. I am in severe pain all the time. I had a MRI in 2010 and one a few weeks ago. I have been diagnosed with fibromyalgia as well, so Im not sure if the chronic, severe pain is from the neck problems, the fibromyalgia, or both. I had to quit work due to the pain makes me sick at times, severe headaches. legs & hands give out and tire very easily. I am a 41 year old female. This is very frustrating to me. I feel like if it keeps progressing, Im not going to be able to do much of anything. I can tell it just continues to get worse. This is the MRI results from 2010-There has been anterior fusion of c5, c6 & c7 with surgical screws & an anterior plate creating metal artifacts. Hypertrophic changes of the odontoid process & associated atlas are noted without narrowing of the adjacent subarachnoid space. There is no visible abnormality of the cervical spinal cord. At c4-5, osteoarthritic changes of the left facet joint are noted. There is a mild left-sided neural foraminal encroachment. There is bulging of the c4-5 disc without focal disc herniation or obliteration of the anterior subarachnoice space. No cord compression. At c6-7, posterior osteophyte formation without neural foraminal encroachment or disc herniation is noted . Ok now this is the results of the one I had a couple of months ago. There are postop changes consistent with an anterior fusion from c4-c7 with a compression plate transfixed of the vertebral bodies with screws at all three levels. There is a mild to moderate disc space narrowing at c4-5 and mild disc narrowing the AP diamter of the thecal sac to 10mm and very mildling effacing/flattening the cervical spinal cord. No significant spinal canal stenosis is seen at the surgical site. The neuroforamina are patent though there is mild right foraminal stenosis at c6-7 due to hypertrophic changes of uncovertebral joint. The visualized portions of the posterior fossa is unremarkable. So my question is has my problems progressed from 2010 to now, and are all these issues enough to cause this severe pain, numbness, & weakness in hands and legs. Or is it a combination of this plus the fibromyalgia. I try to go get a massage when I can afford it. The lady that does my massages said I have huge knots in my neck and shoulder muscles. She can never get them worked out completely. The massage does help at the time, and for a short time afterwards, but never last. I have tried injections and physical therapy. Nothing helps for any amount of time. Some days are so painful, I can hardly stand it. My neurosurgeon says another surgery is definetly in my future, but he wants to try and treat me with facet injections for as long as possible because I am so young. I already have trouble driving because I cant turn my head very much. I have limited mobility in my neck already, so I know that another surgery would probably make it impossible for me to continue to drive. I would appreciate another opinion. Thanks,

### output:

Hi, Thank you for posting your query. I have gone through your detailed descriptions, and it helped me a lot in understanding your problems. It is unfortunate that you have severe neuropathic pain and limitation of daily activities. Regarding your disease progression, there is little or no disease progression as per the MRI reports. I agree surgery is not required at present. In addition to the treatments that you are having at present, medications such as pregabalin or gabapentin would be useful. Please get back if you require any additional information. Best wishes, Chat Doctor. Ly/