Has anyone gone through the epidural steroid injection series? The last time I saw my doctor, he said I needed fusion. This time I go, and he wants to try the ESI series first because he wants to wait as long as possible to do the surgery because of my age (29 next week).
The only thing I am scared of is the needle. I can handle pain after the shot. ie, when the numbness goes away from the injection. I wanted to know how they numb the skin. Is it mostly topical, or do they inject the local anesthetic into the sac first? I am the biggest baby when it comes to needles!! I am having it done in the L4-5 region.
If anyone can give me feedback, I would be grateful!
I had series done on my neck, C5 and C6 way back in '97. I don't remember a lot of it, but I can tell you one thing, I DO NOT like needles, and I did fine. I think, they go right into the sac to numb it but I can't be sure anymore. Good Luck!
Also, you said they would be doing this to the L4 and L5 region? What is exactly wrong with that area of your back. I just go diagnosed with L4 and L5 herniation and see my neurosugeon next week. I am only 28 too.
Thanks, Karie.
Hi Lori: I get them all the time for L4-5 and am in the process now of a series of 3. For arthritis and swollen tissues in the back and for major flares, these shots are wonderful. However, the side effects are that they weaken joints and ligaments if done too often. I do mine only once a year, or if a I have major flare up. These shots work for any inflammation. However, if you have a full blown herniated disk (the jelly center is leaking out), these shots won't help that! Also, know that arachnoitis can happen (gluing together of lumbar nerves) from the steroid called depo medrol, if the doctor gets that steroid in your dura sac (sac of water your nerves are in), which they are NOT supposed to puncture the dura sac. It is rare, but it does happen. Also, if you choose to do these shots, request sedation, if you have anxiety. They have you bend over a table with a pillow on it (to open up low back vertebre) and then they put demoral and vistoral into an I.V. (called short term sedation) and if you ask the doctor, he will even put you to sleep for a few minutes, while they do it. I've done shots with and without sedation; hospitals have the drugs and by golly, they can use them with this procedure! Many doctors don't use sedation; you must find one that will and also be sure your insurance will cover the sedation. Good luck to you, PatG
I have had these quite a lot. Too much in fact, or so I believe. I have had 9 in 12 months. I would like to know what they do to the joints, as I have read nothing about that.
Anyway as far as what they do, my doctor knocks me out completely with diprovan, it is a short term anesthetic. The process is like this: I check into outpatient surgery, they put me in a little room, ask me to remove everything except undies. Then they have me put on one of those cute little hospital gowns, I just love those, the breeze is so refreshing,haha. They then insert an IV, then they push my gurney into the fluoroscopy room where they do the procedure. I get all nicely positioned with a pillow under my hips, they wash me down with this really really cold stuff, then they put me to sleep. I wake up in recovery generally in agony and with a numb butt, they then give me some pain shots, I wait 20 minutes and my mommy drives me home. When the numbness wears off, it hurts some. So I ice it down. It usually takes 1 1/2 weeks for me to feel any relief at all, then, for me, it isn't a whole lot but better than nothing. I get a series of 3 in row, timed every two weeks. They work for approximately 1 1/2 months, then I go for another round.
My dx is a little different in that I have pseudoarthrosis L4/5 and severe facet arthritis. The shots help the facet pain.
Hope this gives a clue. One thing I will advise is: Do NOT have these unless they are done under fluoroscopy. If they do not use the fluoroscope they are shooting blind, too risky in my opinion. Hope I didn't give a little too much info.
Have a great one and remember, keep smiling.
Kathi
Thanks for the replies! You all have made me feel a little better now. I do know that they will be using fluoroscopy. The doctor told me already that they never do it without using that. I'm glad that I may be able to talk them into knocking me out for a few minutes. The pain afterwards doesn't scare me! lol
I have a herniation in L4-5. If this series of 3 shots doesn't work, then they are going to do the discogram as originally planned. I have done 6 months of rehab with no relief. I really don't want surgery for a while and hope like hell these shots give me relief for a while!
I am sure you really don't want to hear this but, ESI don't usually help a whole lot with a herniation. In fact, they usually only help with DDD or facet arthropathy. There are some people who it has helped, I sure hope you are one of them. If you don't get any relief at all with the first or second shot, then there is no sense paying for a third. At least that is what my pain doc tells me.
I don't blame you for not wanting surgery. I didn't either, and it should ALWAYS be done only as a very last resort. However, that having been said, if you are having pressure on nerves, then the sooner you have it done the better. The longer the nerve is compressed, the less likely it will decompress and the lower your odds of pain relief after surgery.
The disco is no picnic, I can tell you. But it is still the best test for finding the pain generator.
Good Luck, I sure hope those shots work for you,
Kathi
Ktarus,
Man, you and I have sooo much in common! AnI also have had many epidural injections, I got 12 over the space of a year. The new neurosurgeon I was seeing at the time was surprised I did not have renal and kidney failure, as any more than I think he said 3 in one year is too many. The steroids have a negative effect on the Liver and kidneys both. But at the time I was just grateful for whatever relief I could get.
HOwever, I did have some that backfired, and caused me more pain than I knew what to do with. One was the Facet Block. I got relief from the last one for the first nine hours, then pain hit like I had never felt before. I was up in tears all night, as I had noone who could drive me the forty miles to the pain clinic at 10pm. And I felt guilty asking them to do so! SO I laid on a triangle pillow, with my butt up in the air, in a semi-neutral position all night. I was still crying at 8 the next morning.
HOwever, not all of them were that bad, and many brought relief, but it was only temporary. They have suggested that i try them again, but with all the ones I had b4 I am not about to risk my body any more than I have to. Heck, many of the drugs we are on can do as much Liver and Kidney damage. Ktarus, are you aware that on the Patch we have about a 10-15 year lifespan?? I want off that soo badly!
Anyway, I would highly reccommend the injections, just do not overdo it!
Yes, you are very young for a fusion! I have a very good friend who has rods in her back, has had them since her 20s, and is now in her Forties, she is back in pain, and having some other neurological problems also. Try to stay away from fusion if you can. I am not one for recommending the IDET procedure, but as young as you are it may work for you. There is a spot in here on the IDET procedure, please check it out! I am looking at a fusion now, but I am in my 40s and hopefully it will last the rest of my life. It is a double on the L4/5 and L5/S1. But I have been through several surgeries already, and now the discs have failed. I have degenerative disk disease with bone spurs that grow wherever they please.
PLease do look into all your options, in your case the Injections for now may be your best bet. What is your pain level now?? I mean, perhaps you can get away with not having the fusion for a bit. I know that for awhile, b4 2 weeks ago when I finally crashed, I thought that I could wait another year for the fusion, but am now in so much pain it is the only solution.
Nuff said. I get diarrhea of the mouth! Good luck! Actually, I can honestly say that pain of the needles is minor compared to the pain u are probably in. I did not feel much discomfort as they anesthetise the area before they inject you. Also, some clinics will allow u to bring in your partner to hold your hand through it. They did it for me, I told them I was scared of needles and I was not going to do it without Jim being there. It made it so much easier. I even went for a few by myself once I got used to the procedures.
Love to you both,
Lisa
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Human beings, by changing the inner attitudes of their minds,
can change the outer aspects of their lives.
<p>[This message has been edited by moderator1 (edited 01-14-2003).]
Dear Iamahan,
I am sure you won't want to hear this but firstly find out what chemical they are going to use and then look up the package insert on the internet. Unfortunately I didn't do this. I have suffered terribly with back problems over the last 9 years and have since found out that Depo Medrol (Medrone in the UK) the epidural I had 9 years ago is NOT for use Intrathecally. The manufacturers say it causes Arachnoiditis, Meningitis, Paraplegia, Seizures etc. I now have Arachnoiditis which was caused by one steriod injection, which is highly toxic. You will be shocked at how many millions of people have this condition world wide if you look for it on the www. We have no rights to compensation as the courts protect the doctors as they are suppossed to have our best interests at heart.
Please have Informed Consent and look up the chemical.
<p>[This message has been edited by moderator1 (edited 01-14-2003).]
Just another side effect that does not help we spine people..WEIGHT GAIN...from the injections. More weight on the spine more pain from the spine..I am at the point no more injections. Discogram next,,,,,, <IMG SRC="http://www.healthboards.com/ubb/frown.gif">
I have been really lucky I guess. I have had no weight gain since my surgery and actually lost over 60 pounds. But it has done nothing to relieve my pain, haha. I have had at least 9-12 epidural shots in the last 12 months, and still no weight gain. It seems totally weird to me as I have always had a weight problem. So who knows, everything affects each person differently.
I can only say the epidurals really don't do an awful lot for me. I may get 1-1/2 months of some relief, then they wear off and I am worse than before the shot.
I know for a fact that some people have got the problem of arachnoiditis from them . I very bad spinal problem. Another is paralized from the sholders down. Please get the package incert before you have it done, and read it. See the sode affects for yourself. Hope the doctor will give you one! Best regards. kathryn2
I'm a little concerned about a few comments. I had what I recall were trigger point injections of depro medrol around 1994. They were a series of 4-5 injections that did nothing and cost a fortune so I stopped going in for them. (Totally ****** the doc off.) The same doc who was doing the injections asked me if I'd try Ultram...it had just hit the US market and I was his first patient to try it. Needless to say, I've never vomited so hard for eight hours as I did with just one dose of Ultram. Several years ago I was also put on Duract, which was a brand new anti-inflammatory. Well, come to find out it killed a handful of patients. My doc called me out of the blue one day after I'd been on Duract for 3-4 months and told me to discontinue it's use. I didn't find out why he had me stop using it until I did some Internet research. (He just told me I shouldn't take it long-term. Ha! They'd pulled it from the freaking market.) Anyhow, It doesn't sound to me like the depro was injected deeply enough to be a threat for arachnoiditis but what about sub-Q injections...anybody know anything about that? I had all this done BEFORE I had to have surgery. Does make you wonder how much of what we did to avoid surgery contributed to our need of surgery, huh? I do seriously believe the heavy use of cortical steroids that's used to treat colitis contributed a boatload to the eventual premature deterioration of my spine. It ticks me off to no end that cortical steroids are still the treatment of choice for colitis and IBS sufferers. How many of those patients are going to fall apart in 20 years? And what about all the children who are on massive steroids for asthma?
Lisa~ I was stunned to read your comment that the patch shortens your life span considerably! Nobody mentioned that little detail to me when I was on it! (I only stayed on it for three months because I was metabolizing it too quickly and I refused to go up to a much high dose.) I'm currently taking MS Contin with dilaudid for breakthrough. I had blood work done a few months ago for the first time in about 1 & 1/2 years (a big oversight on the part of my former pain doc...I had to freaking request she do it, she never would have thought to bother with it!!) and the liver enzymes came back fine. Anyone know anything concrete about the long term effects of MS Contin and/of dilaudid on the liver or kidneys? I figured they were probably rough on certain organs but none of the docs I'm currently seeing has told me anything solid.
Thanks,
Cheryl<p>[This message has been edited by BluMoon (edited 01-28-2002).]
Yes, I was told that since it takes both the kidneys and Liver, that it can have an extremely adverse effect on your organs that are needed to process it. This came from my pain doc, b4 he put me on it. I was willing to take the chance because it is also the same with MSCOntin and many of the others. They tear up your insides, slow down all your functions, what can you expect???
Any of these long term drugs are dangerous for our bodies because they have so much to work with to keep themselves going. Look at the side effects listed for each one. And the list gets longer when you are on them long term. I have heard that the patch is the least intrusive, and is one that your body can recover from.
I was on Ultram, and had excellent results for it. In the beginning, it was a wonder drug for me. So much so that i thought I was better after 4 days and returned to work, only to find out that it just "hides" the pain, I was off it ten days, as a truck driver I cannot work under narcotics, or anything, and i woke up in so much pain my fiance had to bring the truck to the house. But it was a great drug once I accepted the limitations. I would give my right arm to be only on that.
I have a very special girlfriend who right now, as I speak, is grappling to accept that it is coming down to more pain relievers for her. I remember being there, wwondering what i could take and get away with, and what i could do without, so I would not become dependent. Unfortunately I now have to accept where I am at, because I know that if I go off all these meds, I will not even be close to a human being.
Many do not realise that the side effects do go away, like with the patch. Every time they up the dosage, I spend a week as a zombie. I hate it. But I know that after the initial week, I will not be that way. Normally I warn the fam, tell them I will be down for a few and they work with it. Except for my dad who just plain considers me a drug addict. He has never had anything but appendicitis for his entire life, really has no idea what chronic pain is all about, and therefore can not even begin to empathise.
AS far as the injections go, well, being steroid based, it is only common sense to know that the kidneys cannot continually process steroids. Like I said, I had well over 12 in one year, I kept hoping they would find one that worked. The closest was the facet block and the SI block. The rest were a waste of time, but I had to find relief somewhere. It was not until I hit the second Neurosurgeons office and he told me I was lucky not to have renal failure that I quit them.
We have to constantly watch all our drugs. I never would have known that Baclofen only should be prescribed up to 80mgs per day if I had not researched it on Medline. Not only was I on 90 mgs for 2 weeks, it had failed to work and left me with severe anxiety and insomnia. THis is a drug that is supposed to make you tired. LOL! When I read all the differring reactions we have, it is a wonder we all just do not get together and write a book! I am sorely tempted! Perhaps I will write down some thoughts on the laptop while I am recovering from my surgery????????
These boards are an awesome place to base it on too. So many of us, reacting differently to all these drugs, what a hodgepodge!
Time to go, enuff of my 2 cents!
Lisa
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Human beings, by changing the inner attitudes of their minds,
can change the outer aspects of their lives.
Thanks for the info. I'm back to the clinic next week so I'll be sure to pin my doc down and make sure we yack about the subject for a bit. I want it straight from the horses mouth, so to speak.
I hear you about your GF. It took me a LONG time to get over having to try certain drugs. Even tho I fully understand the differences between being physically addicted and being a drug addict who is psychologically, physically and mentally addicted to the drug AND the addicted lifestyle it's still a tough first step to take. Part of me felt like I was caving when I decided to go the med route. Luckily none of the pain meds I've been on have had lasting, disturbing, lifestyle-altering side effects. (You'd think it would be kinda hard to adversely affect a life that's not really being lived, right?) Most of the spacyness goes away after a week, ditto the nausea, tiredness or other annoying stuff. I still notice a weird *speed* boost when I take dilaudid that lasts about 45 minutes to an hour but so what... it's not like I'm gonna go dancing or start rearranging my living room furniture or anything like that.
I'm used to the ticks, jitters, forgetfulness and sudden anxiety that rears it's ugly head when the drugs aren't working up to snuff anymore. I think the anxiety thing is the worst feeling of them all. I've never experienced anything like that before and being someone who likes to be in control of my feelings it's kinda scary. My docs have allowed me to keep a low dose of zanax on hand in case I start to experience this annoying side effect. It's like the addict's version of American Express...I never leave home without it!
Yanno, writing a book or starting a journal just might be the ticket. I've often thought about writing something about the freaking hoops a legit pain patient has to jump through just to get minor relief for their pain. Good idea! I used to see a neurologist for my pain treatment and it seems like every month she'd give me her standard lecture about how hard the government was cracking down on her because of the types of drugs she prescribes for her patients. I'd just stare at her blankly without saying a word. I mean...cripes, here I am with my entire life a shambles, struggling with constant frigging pain 24/7, I've lost everything that's meaningful or important to me and I'm trying desperately to hang onto what little shred of human dignity I still have left while at the same time I'm forced to beg for the relief I DO get and she wants me to feel sympathy for HER because the government breathes down her neck for treating chronic pain patients? Um, sorry but I just can't seem to muster any empathy for people like that.
Needless to say, she's not my doc anymore..she can boo-hoo about her woes to somebody else.
Blu moon,
Don't blame you a bit! Any DOc that is more concerned for themselves than the patients is definitely NOT my kind of doc!
I just got off the phone with my car saleslady who had a friend with a fusion. Seems hers is failing, it has been 7 months now and the pain is worse! After hearing about the failures I have to wonder, is it worth it to even try?? I know what i have now, I deal with it, do I want worse for myself and my family?????
THe thing that pushes at me though is my desire to get off the drugs, at the least the major doses. I can live with having to deal with the small ones, but the large ones are what are worrying me. Everywhere I look lately I am seeing FAILED FUSIONS! Maybe God is telling me something???
Lisa
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Human beings, by changing the inner attitudes of their minds,
can change the outer aspects of their lives.
I finally found out what steroid they are using. They are using solu-medrol. Does anyone know anything about that one? I think my fear of this shot comming up in 2 days is getting better. Most people say it isn't that bad, just general soreness the days after.
I need to run and take care of some athletes! Thanks for the replies everyone!
Now, Lisa, every fusion is not a failed fusion. You're just seeing them everywhere because you notice them. It's like when you were pregnant and all you saw were pregnant women. Remember, the general success rate for fusion is 90%, which leaves only 10% failure rate. Pretty small. I've had a fusion and while I can't say if it has fused successfully (too soon), I can say that I feel much better. I have no reason to believe that it won't fuse. Failed fusions are caused by pretty specific reasons (unfortunately, smoking is one of them). Make sure that you know all of the stuff you shouldn't do. I also went with a very conservative surgeon who has me in a TLSO until July. It made sense to me that the more immobile I remain, the more likely I'll fuse. What does your surgeon plan for the post op recovery? See if it makes sense to you. Remember, odds are in your favor (even with the smoking). Maggie <IMG SRC="http://www.healthboards.com/ubb/bouncing.gif">
I have been having some pretty bad days lately, so haven't been on in a while.
Lori, I would definitely give the steroid shot a try. As I said, some folks find they work for them, some don't. I have an aunt who herniated a disc, got a series of three and is able to do things again. You will never know unless you try. The epidural steroid injections are entirely different from trigger point injections. Trigger points injections are rarely successful, ESI can be.
Lisa, I know how difficult it is to keep hearing about "failed fusion syndrome" everywhere you go. I am lucky enough to know quite a few people whose fusions have been a success. My problem is that I envy them, haha. But they have all been done the old way with pedicle and screws and I wish I had gone that route. But what is done is done, I can't cry over spilt milk, just try to keep on keepin on. I haven't gotten ICQ yet because of these last few days, I have been basically bedridden from the pain. But I am still going to and will let you know when. This message is kinda short and maybe terse cause I can't sit too long right now.
Oh yea, I talked to my pain doc the other day about the patch lessening your life span. He had never heard of that, and in fact stated that it really has not been used long enough for that kind of data to be available. Let me know where you heard/read that, I would like to investigate it more. Hope that lessens your fear of it some.
Maggie, if you do more research you will find that the success rate in spinal fusion surgery is 50%!! Not the 80-90 the doctors want you to believe. They are not necessarily caused by specific reasons at all, most of the time the doctors can't find a reason for the failure. It isn't that I want to scare anyone, but the facts are the facts. I too, was in a TLSO for 6 months, I didn't smoke, I did all they wanted me to do. I just didn't fuse. It happens. That is why surgery should always be the absolute last resort.
Now, you combine that with the fact that a successful fusion to the patient means no pain (ie, being the way they were before surgery, not). To the surgeon it means that the instrumentation was well placed, the spine is aligned, there are no nerve impingements, no infections, healing went well. Pain does not really fall into their scheme of a successful fusion, ask your surgeon. If he is honest he will tell you that, hopefully, there will be at least a 30% decrease in pain levels following healing. But that his goal is to reduce any nerve impingments, neurological deficits,instability, etc.
It is unfortunate but too many people have unrealistic expectations of what the outcome of the surgery will be. I know I did. I blame a lot of that on what the surgeons tell us before surgery, and what we choose to hear when he is telling us what he expects the outcome to be.
In some ways I will admit I regret having my fusion, but that is only on the bad days like these. In actual fact I am better than I was before the surgery, just not as good as I think I should be. I still can't work, the pain rules my life most of the time, but now the pain patch works better, it didn't work at all before.
I don't want to start any arguments about any of this information. In fact, if anyone doesn't believe me they can check on Discovery Health under the program they had on spinal fusions. They specifically stated something about "with fusion surgery have only a 50% success rate, blah blah blah". I just hate to see people go into this with unrealistic expectations, as I said, I did and it was very hard to come to terms with.
Ok, I am probably going to regret posting this. But I am going to anyway as we all need to be very realistic about this. Not give hope, never that. Just don't expect the moon, then when you get just the stars you'll feel better about it.
I am trying to be up, honest and compassionate,(even if it doesn't seem like it),it is just difficult today. So if anyone takes this message wrong, I humbly apologize and will take my beating lying down.
Well, my injection is tomorrow! I am in miserable amounts of pain today. They told me I couldn't take any NSAID's 24 hours prior. I am dying! I can't walk without a limp today due to the groin and hip pain I get from time to time. On top of that, I have a killer headache today! I can take pain killers, but then I would be knocked out and I have to work a soccer game tonight. I am an athletic trainer for those of you who don't know. I hope nobody gets hurt tonight.
I really hope I get some relief from this injection. I want to avoid surgery for as long as humanly possible!
Kathi,
Don't regret posting...you saved me from having to say the exact same thing. I've alluded to several of the points you made in your post in some of my past posts. In fact, one of my first posts was about realistic expectations. Don't for one minute think a fused spine is a pain-free spine or a non-fused one either, for that matter. Fusion is not indicated for pain relief it's sole purpose is to produce spinal stability. If instability were the only cause of pain for patients with fusion then all patients with well placed instrumentation (like myself) would be pain-free. Such is NOT the case. (I was going to ask Maggie to quantify her statistics for successful fusion as I've been told it's much closer to 50-50 % too.)
I think EVERY back surgery is a huge gamble. Cases that should have been cut and dry come out the other side a total mess and that's even when very good, reputable surgeons and proven procedures are used. Bottom line, it's like playing Russian Roulette and the more you play (operate) the greater your chances of hitting the loaded chamber. Backs don't do well with repeat exposure to the stresses of surgery. Heck with all their nerves, bone and blood supply spines are delicate enough as it is. Have anyone ever watched an authentic, fusion surgery video? Prior to my fusion I was allowed to watch two training videos that my surgeon normally doesn't allow patients to watch. (They're intended for the surgeons.) I've had ten other major operations for problems other than spinal and I can say without a doubt that fusion is about as invasive as surgery can get!
Lisa, please just think long and hard. I'd hate to see you go through this procedure only to decide later that SI fusion was what you need instead. I went into fusion because I was at the end of my rope and I was told it was my only option if I wanted to be able to stand, move or walk. The final outcome? My back is a mess. I can stand unassisted about five minutes at a time and I'll be on pain meds and antibiotics for the rest of my life. Could I have postponed surgery forever? I don't know anymore...it seems like such a long time ago and I think time makes me forget how desperate I was prior to surgery. It's easy to look back and say I'd tried absolutely everything and I couldn't hold on any longer but sitting where I am today that seems impossible because I know my pain now is far greater and more relentless and encompassing than it ever was then. I will say I believed 100% going into surgery that I was making the right decision. I believed I'd come through surgery with flying colors and I'd be on my way to a better life in a matter of months. That did NOT happen and you can't imagine the shock when I finally realized three months later that I was in a totally different world than the one I'd pictured back before surgery.
Although we all think there could be nothing worse than where we're at this very moment that's not true. It CAN be a lot worse...you'll just have to trust me on that one.
