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Old 06-17-2008, 06:43 PM   #1
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Has anyone ever had Facet Nerve Injections - need advice re Pain Management Please

Thank you to those following my posts - I could really use some feedback. I posted yesterday (I was overwhelmed) that the new PM doctor (anesthesiologist) recommends two facet nerve injections. He said that he would burn the nerves and I would be pain free for 6 months. He sad nerves do grow back but that "they don't teach you that in med school". Do nerves grow back?

I then visited the holistic osteo tonight. She doesn't want to label me but said I'm out of alignment and she'll work towards getting me aligned which is the more conservative route. She performed another myfacsial release and also put some electrodes (like acupuncture) in the sciatic nerve/muscle to "collapse it" to give me a few days of relief. I feel lower back pain of about a 6, but I feel pretty good overall.

I recapped to the Osteo my PM visit of yesterday regarding the facet joint injections. She said that perhaps I should think about non-invasive procedures (stick with her) and she'll let me know if a month or so if it's working or not.

I then came home and my GP finally left a message. I've asked my GP to "call the shots" and coordinate this for me. He received the report from the PM doctor I visited yesterday and thinks I should try it. He said he has seen success with facet injections in 75% of his patients. I have not yet had a chance to update him re my osteo/myofascial pain visits but will tomorrow.

After talking to my husband (and to the osteo), we think it is probably best to:
1. stay with the manipulate therapy until school starts again in September.

2. if I don't feel any improvement by September to move forward with the facet injections in September. The PM doctor said I'ld be on my feet within 24 hours.

The PM doctor did say if the injections didn't work, he would recommend a fusion of L4/L5 and S1 (I think I have that right). But that is "remote". Additionally, this PM doctor is out of my network so I'll have to find one in my network because even though all the hospital bills would be in network, the PM doctors are not in network. Do you think an Othropedic doctor can do facet injections? My out of pocket cap is $4K and we don't have $4K though I'm unsure what this will al cost in any event.
Thank you. I realize this is a lot of questions and I would appreciate any feedback. I also plan to look up the doctor that Cmpgrrl recommended but I can't spell it. And, I'm researching on line as well but I figured the best advice will come here.
Many thanks
T




.

Can anyone share their views or experiene? Thank you - I'ld be really grateful - I'm also trying to reseach on line as well.

 
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Old 06-17-2008, 07:41 PM   #2
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

Hey Tara,

I've had about 12 facet blocks now and each time you have one, they work for less time. The nerve does grow back but that's if they burn it off - it takes usually 12 months or so. This is not a painful procedure - provided it's done in a hospital setting with some medazalam or something to calm you down, and lots of local anaesthetic in first. You do have to lie still for 15 minutes or so per block. You shouldn't need any additional pain relief but I've ended up in emergency afterward because of it upsetting other areas of my spine. Do I recommend them? Well, that's a hard one. If I'm 100% honest I have to say No, I did them to please my PM and because they did provide perhaps 10% relief. I have stopped having them now because they cause scar tissue over time - something my PM didn't tell me! You will be up and about the next day, I'd almost guarantee this and you may get excellent relief - I now people that do. Most of my pain is nerve pain, so blocks are really for treating any joint pain that crops up - again, I wont' be having any more.

This is one where you'll really have to follow your heart - and is this something that you'll have to go through in order for you pm to keep treating you? Can you get the blocks done at a lesser cost by someone else? I don't know how much they cost over there but as a day patient in Australia it's around $1250 - $3250 depending on how many he does, if they are just diagnostic (local anaesthetic and cortisone) or if they are denervations (where they burn the nerve back so it doesn't regrow for 12 months or so). Normal blocks are cheaper, denervations more expensive. Blocks are supposed to last 3 - 6 months with just the local and cortisone but to be honest they don't last that long in my experience.

Good luck, Tara, you'll make the right decision for you. Blocks are expensive but not painful, don't worry about that. The problem with the is that they are not a 'fix' and they honestly make you worse to start with and, in my experience, work about 10% as well as they should. The awful thing was that my old PM used to make me feel like I had to keep having them and that I had to say how great they were. I hope I haven't put you off, as I said, I do know of people who think they're the bees knees. Good luck, mate.

 
Old 06-17-2008, 07:57 PM   #3
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

Phew, thanks Juliet. I was afraid I wouldn't hear from anyone due to being banned - I am upset that I upset someone.

Thank you for being honest. I have been reading and I do see that they can fail and did read about scar tissue and, quite frankly, that doctor got the report over mighty quickl - less than 24 hours. I am seriously feeling pressured (my own pressure). I wouldn't stay with these Pain Specialists because I can't afford them so I'll have to get a recommendation from my GP or find someone on line and then interview them.

None of this is affecting my 3 percocets from my 70 yo doctor but they aren't cutting the pain anyway so what do I have to lose, I also ask myself. Well, 1 in 4 is not a great % but 7 months or so would be nice to have no pain.

I have to talk to my GP in depth. I'll ask him to take over the Pain Meds (whatever kind I need though I've taken Celebrex before and it didn't help anymore than Advil OTC does.

Wow, 12 of them! Here I am worried about 2. I don't want to appease any of te doctors, I really just want help. I may ask my GP to refer me out again until I make up my mind if he won't take over my Pain Meds. I don't want to look like I'm avoiding help either but it's all changed from one dx to another and like everyone else the pain is well painful.

You're very kind to me and I appreciate your feedback. Wishing you a good day tomorrow ,
Thank you again.
T

 
Old 06-17-2008, 08:14 PM   #4
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

No worries, Tara, I think getting another opinion is a great idea. 12 was not a great idea and I don't believe that my pm had my best interests at heart when he did these - sounds awful but that's the way it is. My new PM is great and he doesn't believe the side effects are worth it in my case.

Hey, question for you, what have you got to lose? One try and see how it goes. Get a new pm for cost reasons and see how you go. One is not going to do any damage and they don't hurt. My pain is nerve pain, different to yours, I think - from the sounds of it, you might get some real relief. In which case, give it a go...then you'll know. It's a very low risk procedure too - especially in your lumbar.

Please stop being sad, you didn't offend anyone - unless someone complained, and if they did, well, you're in pain and you're going through hell right now, you made a mistake, apologised - it's time for everyone to move on. Saying the wrong thing once, does not a bad person make. You'll get lots of replies Tara, you're a lovely person.

 
Old 06-18-2008, 06:03 AM   #5
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

Tara, I am lost, dont know what you could have said but hey who is perfect? Dont worry about it my gosh at times we all say things & at times its not what is said but how one perceives it. So relax & dont worry. Sammy

 
Old 06-18-2008, 09:26 AM   #6
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

I will respond to your post but I want you to know this is not easy for me because of what has happend to me with a nerve injection. I don't want to scare you, sound negative in anyway, or discourage you so please realize that this is not my intent. I simply want to make you aware that with
any procedure or surgery a complication can happen; its just a risk of doing the procedure.

I have had several injections and blocks. I would have relief for maybe a day or two but not enough to say WOW, these things are great. My doctor has used the nerve blocks for mainly diagnostic purposes to help them him verify his suspicions. Many doctors use them for this. I know another board user, Shawley, you might do a search on his user name, has had FANTASTICsuccess with these injections and has had a month or more of relief so they do work for some people. I guess it depends on the complexity of your case and the skill of the injector in finding the correct placement.

Unfortunately my last injection I had was not a pleasant experience. When the injection was injected, I came up off the table and my surgeon was telling me lay down, don't move, yada, yada. I had pain down my legs like a hot lighting bolt of fire. It was terrible. Well my pain did not settle down and in fact it was the turning point in my pain mgmt. This made me go on meds 24/7 and I have yet to come back off of them. I will never forget Sept 7, 2007 - I have been told that they believe my nerve mylein sheath (sp?) may have been hit or the nerve itself was hit during the injection.

Does this mean this will happen to you? Absolutely not!! My injection was one of those complications that can happen. I have been told that my spinal anatomy is not the norm so maybe this had something to do with it. I will never know.

Personally, I will not have anymore injections unless they say if you won't have one we won't write you a pain script but that is based upon this last injection.

However with this said, I strongly recommend that everyone try at least one or two because you don't know you might be like a Shawley and have great results and to get rid of some pain for even a month is worth it in my book.

Good luck and I pray that I have scared you off. I just felt I needed to state what happened to me. I would want someone to do the same for me.

 
Old 06-18-2008, 12:11 PM   #7
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

Hey T, I can't comment on the facet block injections, because I've never had one. But I can tell you the type of specialty my doc is..... He is a physiatrist. They are sometimes listed in phone books and provider directories under PM&R or Physical Medicine and Rehabilitation. If you look up the word physiatrist, you should get a few good definitions.

Remember, an anesthesiologist is also usually a good specialty for a PM doc. Their job is to manage people's pain, pre and post operatively, and many don't realize that some of them go into PM as a specialty.

In my opinion, this PM you just saw, doesn't sound like a good fit for you. Not every doc is the right doc for every person. You absolutely have a right to find the best care that you can and I have always felt that our "gut" instinct was given to us for a reason. I would even travel a bit if I had to.

I'm sorry you are feeling so bad right now. Please know, I pray for you every day. I really hate to see my friends here suffering. It just should not happen to such good people. Hang in there as best as you can and let me know if there is anything I can do, OK? I'm no expert, but I promise I will do my best to help, if I can. Hugs, CMP/MM

 
Old 06-18-2008, 03:30 PM   #8
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

Thanks Sammy! No worries anymore on what I said. I hope you're feeling good today.

Thanks again Juliet. I am getting a second opinion.

Thanks for being so honest Pepper - I really want to know good/bad experiences. I will look for Shawley's posts - thank you for the heads up on that. I cannot believe you too have been put through the wringer with the injection.

Thanks Cmpgrrl - I agree, we did not fit each other. You will all be interested to know that the report he faxed to my GP is "for diagnostic testing" but that is not what he told me. He told me denervation (sp), burning the nerve, it would take two injections. So I called my GP today and I said "got your message; I'm a little concerned about everything moving so quickly so I'll make an appt to come in to talk (as I don't want to talk to my doctors over the phone anymore). I went on to say that this doctor/practice is out of my network and he said "oh". I said "can you recommend someone in this area whom you trust" and he said in my county, which is quite large, he would recommend only one Orthopedic Surgeon and of course he is also not in my network but I need to call and confirm this because sometimes the doctors will take whatever my insurance pays out. I'ld get that in writing though.

I woke up at 2:30 am and have been up since - very bad lower back pain and spasms. My GP called in Flexeril, 3 a day for 7 days. I think he is concerned that with the percocet and valium I have on hand that it's too much medicine but I'm almost immune to the percocet and am tolerant to valium as well. I really need to get into Pain Management. Cmpgrrl I did reseach physiatrists but I don't have one in my network - I'm willing to go out of network though. I do have PM&R's in my network so I'll start dialing. I need a new referral from my GP and I don't want him to think I'm "drug seeking" so I'll explain to him that 3 percs are just not cutting it. I'm also going to bring my husband along (Sammy had a good experience with that!). Given everything that happened this year, I need his support. I have also confirmed that the 2 hospitals in the County have PM facilities so I may try them. I wish I knew someone in my area who has used PM in this area. Finally, I'll ask the osteo. She agrees that pain meds are necessary for me until I figure out what else to do or perhaps she can somehow fix me. I doubt it though because arthritis is in sciatic area and there is no cure per my research. I wish I were asympthomatic (no symptoms).

Thanks everyone! I really appreciate the time you have taken to reply and share your experiences. Pepper that sounds so painful - you didn't scare me at all. The reseach/abstracts I've read so far aren't promising. That said, I may try it in September but I may go to a big City with a well-known doctor if I can secure an appointment.

And on it goes!
T

 
Old 06-18-2008, 04:16 PM   #9
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

T,

I am so glad I did not scare you. Sometimes it is hard to know whether to post or not. You want to be positive and honest but at the same time truthful. Take care and I wish you only the best.

J.

 
Old 06-18-2008, 06:53 PM   #10
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

I had two of them with little success. Also had medial nerve ablation (burned it) with little success. I also had the new proceedure called an IDET. This is where they thread a wire into the disc and burn the center out of it (L5-S1). Personally, I think all of these procedures work just enough to keep the insurance companies paying for them. In other words, they usually don't work but might.

I'd really think long and hard about fusion. Get at least 3 opinions. This is a big surgery with a long recovery period, up to a year. The problem a person has seems to dictate the effectiveness of relieving pain. One surgeon I saw measured success of the fusion in how well the vertebra fused, not in pain relief. A 95% success rate ain't squat if it hurts just as bad or worse. The condition of the adjacent disc needs to be evaluated as well. If 1 or more of the 5 lumbar discs are fused the other ones have to pick up the slack.

My problem was 3 bad discs with spondylolisthesis. Not a good surgical candidate.

 
Old 06-18-2008, 08:50 PM   #11
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

I have experienced a couple of different types of injection, done by different doctors.
The first was, what my present doctor called an epidural, he said that there was a small hole in the tail bone that he pushed the needle through, then injected an anaesthetic and steroid. This seemed to numb the area a bit but did not last very long.
After that he reffered me to a hospital to have injections to the facet joints. They would only do 2 injections at a time. They gave me a local anaesthetic first, then marked the place using a CT scan with a cross, then push the main needles (2) in place and checked again with the CT scan. When the needle point was in the correct spot injected the mix of steroid and local. This helped a little but I would have to go in too many times to do all the places that needed to be done.
After a couple of months I rang to make another appointment but my doctor was on a holiday. Because I was in so much pain I decided to go back to the first PM doctor I saw originally. I was a bit hesitant as I had trouble communicating with him. (He is Arabic) This doctor is an anaesthesiologist and pain specialist with very good reputation. He said he would do all the injections at once. He injected 6 places, both sides of L4 & L5 and also lower down on the pelvis(not sure of the name of the joint).
I was shocked that he just whacked them strait in before I had a chance to move. Wow that was a shock, but it did numb the area and give me some relief for a couple of weeks.
He had me make appointments for every 5 weeks or so, and I did so for about 6 months.
The last time I went to the appointment I was just about in tears and on the verge of a breakdown or something. I was really upset and scared. So I told him that I could not go through the cycle of having the injections, taking a week to get over the needles, then I would have some relief for two weeks, then the pain would get worse until I went back for to injections again.
The doctor shook my hand and wished me well and said good luck. So that was it for me and injections. No one ever mentioned burning any nerves So I don't know anything about that sorry.
I have had to go back to the other doctor and work with medication to manage my pain from now on, or until I am offered another option.
I wish you luck with any injections you have, and hope you don't have to go through the bad experience I did.
Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 06-19-2008, 10:22 AM   #12
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Re: Has anyone ever had Facet Nerve Injections - need advice re Pain Management Pleas

Thank you Jack24 - I've read about spondylolisthesis. I'm sorry it didn't work for you either. The more I think about it the less inclined I am. Given that the pain relief is so short and I can't agree more about these procedures and insurance!

Boy, Allanbruce, I cannot believe your story. Six at once and then a goodbye wave? How did you keep pushing for help - I would have felt so rejected and kind of mad.

I'm sorry I'm typing just a sort bit because I am soooooo tired. I don't like how tired the Flexeril make me feel but at least I could get packing done as we're going away for a couple of days.

I've learned a lot and I appreciate it. I haven't had time yet to check Shawley's experience but I will and I wish you all a pain-free day.
T

 
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