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Re: Back Pain
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Posted by MLWhitworth, M.D.
on February 18, 2000 at 07:31:11:
In Reply to: Back Pain posted by Sandra on February 16, 2000 at 21:42:19:
Part of the docs response depends on his philosophy about spinal disorders. If he really hasn't a clue what the diagnosis is, some docs like to use cortisone shots (ie. epidural steroids) as a shotgun approach to the spine, blasting all the structures with cortisone. I do not subscribe to that type of philosophy....it is better to know what you are treating and tailor the treatment to be specific for the condition. If it is a radiculopathy, then a transforaminal fluoroscopically guided steroid injection may be indicated. If it is the SI joint as pathology, then an interarticular steroid injection under fluoroscopy may be used. For facet syndrome, either a medial branch block without steroids or an intraarticular zygapophyseal joint steroid injection under fluoroscopy is useful. If it is intradiscal degenerative disease, an IDET procedure is indicated. And so on....
Rarely is an interlaminar epidural steroid useful for any longer than 2 weeks and cost over $800-$1600 unless it is done in a doctors office, then only $400 for an injection that most of the time doesnt work.
If heart specialists approached the heart with the same laisse faire attitude some docs use in diagnosing and treating back problems, it would be considered malpractice. Imagine starting a patient on potent heart medicines without an ECG. It won't happen in cardiology and the parallel should not be acceptable in pain management.
: Hi Doc--I have seen a back specialist for my lower back I am limited on activities. This specialist has
: sent me to 4 weeks of physical therapy, but during the course of therapy I still had good and bad days
: when I went back for a follow-up he recommended a cortizone shot then a mri done if I still felt the same
: way. My question is shouldn't this doctor do a mri before recommending a cortizone shot? Pls advise.
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