Originally Posted by allanbruce
I know some of these injections hurt because I could hardly walk after a round of facet joint injections a while back but as I have said that if you are already tense and sore this sometimes is not the best time for the needles as they seem to make my pain worse before it settles down, even with the lidacane.
Could someone explain about all the different types of injections as I don't know what a trigger point is let alone a cadean. And epidural is that into the dura around the spinal cord? May need to start a new thread though, as I keep getting slapped on the wrist for doing something wrong. I am here for the subject of painful needles and the only way I can tell anyone about the subject is to talk about my experiences. That is what I have been taught, but hey I don't run the place. Allan
Sure no need to feel I'm going to criticize you for lack of medical knowledge. Treatment types are broad and varied so your question is a very good question.
First of all are the non-analgesia shots that are typically steroids like cortisone that are done to reduce inflammation in the joints. These shots go into the synovial space between the joints.
Now to understand trigger point injections you need to understand what trigger points are. This thread describes them in detail and differentiates them from tender points. http://www.healthboards.com/boards/showthread.php?t=289163
. One of the diagnostic criteria for Fybromyalgia is the presence of tender points. On the other hand if you have trigger points odds then its an indicator of soft muscle damage and often points to Myofascial Pain Syndrome, basically the fascia is the connective tissue between the muscle and dermis that forms a sheath around the muscle and helps anchor it in place. When the fascia gets damaged the muscles have to suspend themselves so they are in a constant state of tension.
The gist of it is trigger points are sensitive to the touch like tender points, but trigger points radiate pain outwards when pressed upon tender points don't. So a trigger point is a sensitive area of the dermatomes that radiate pain when pressed upon. Dermatomes are regions of the skin that all feed into the same basal branch, which is the nerve branch coming off the spine and feed out from formens (canal like holes in the disk that allow the nerves to branch out into the body) in each spinal disc. The reason I am bringing up dermatomes now is they will have major significance when we discuss Basal Branch Nerve Blocks and Radio Frequency Ablation.
So the trigger points are very specific points that like I stated earlier you can miss by millimeters if you don't help guide the doctors needle to the precise location and depth. Again, its a very small and specific point that can be 1-3 millimeters in diameter. If the doctor misses the trigger point then injection serves no purpose and you end up going though a painful procedure without any benefits. If the doctor hits the trigger point its probably one of the most painful experiences a person would voluntarily undergo, but after a couple of days of tenderness it provides relief for 4-8 weeks. The anaglesic is generally some form of lidocaine.
An epidural simply means beneath the skin. Its most common association would be with epidural blocks, commonly used in delivering babies that basically involves an injection into the spine that numbs the entire lower body but also impairs motor as well as sensory nerves.
That's the reason doctors have switched to Basal Branch Nerve Blocks. So they can focus on sensory branches and try to avoid motor nerve branches. Unfortunately some nerves are dual function and bundle the sensory & motor functions along together. So using a dermatome map doctors know which Basal Nerve Branch to aim for based on where the pain is. The patient still needs to assist in guiding them because every though they do the procedure with live video X ray they can still hit a motor branch accidentally.
Radio frequency Ablations are similar to Basal Branch Nerve Blocks but they use a needle that is electrified. After injecting the anesthesia they find a harmonic radio frequency to the pain signal then `slowly increase the amperage to burn out the nerve till its numb. RFAs generally last about a year in relief