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    Old 03-31-2011, 11:52 AM   #1
    Brnt2acrisp
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    Unexplained "new" pain after a Caudal Injection

    HI Everyone,
    I was wondering if anyone has experienced more pain- after having a caudal injection. I had my 2nd one done back in 6/2010- from that day till now I have had more pain . It almost feels like it's infected, but the area where it was done is fine. It feels swollen, and nothing relieves the pain- I take pain killers, and muscle relaxers 3-4 times a day for my lumbar and cervical issues- because of the chronic pain- these don't even touch that pain- I also ice that area 5-6 times day with minimal relief. I've been back to the PM doc, every month since June, only seeing his NP- finally HE saw me last month. Mind you during the procedure he said something was wrong with the syringes- he claimed they were malfunctioning, as I could feel the medicine on my back side. He had to double inject me, with twice as many needles and twice as much meds. He said I would be in a bit more pain that day, but should be fine after that. I asked about this on my follow up in July and every month that followed, and the NP looked up the chart, and said there is nothing documented in there about "malfunctioning syringes".
    So, needless to say, he said to me last month that he feels I'm blaming him for this . HELLO - it started the day of my last procedure, and hasn't stopped yet. He never admitted to doctoring up my chart- so that he was covered. Then he says he wants to do facet injections...... yup , sure that is exactly what I want - you and me in a room, and you injecting me with more stuff that will probably hurt me in the long run- NOT going to happen. I just want to find and end to the pain, a reason why I'm in more pain- what went wrong ?,.... and a remedy to it . The new MRI, shows improvement.... how can this be ? The old pain / and now new pain are there 24/7- is it nerve damage? IDK- Has anyone had an experience like this- where the injections have left you with a new kinda pain, along with the pain you had when you walked into the PM doc's office. Really need some advise on this, I'm exhausted from this whole ordeal . Thanks in advance for you opinions and guidance.
    Chris

     
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    Old 03-31-2011, 02:54 PM   #2
    teteri66
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    Re: Unexplained "new" pain after a Caudal Injection

    I have not had that particular experience, but I'm sure you signed a release prior to having the injection, so you know sometimes things happen.

    A caudal is done somewhat differently from the typical epidural injection, and sometimes, at least from what I found, there is more generalized pain for a day or two...but beyond a week, this certainly is not a common experience.

    I would suggest you go to another interventional pain management doctor for a second opinion. It doesn't sound like you're going to get anywhere with the doctor who did the injection. If you're interested in what can now be done for your pain, I would suggest you start over with a new doctor...being careful how you explain to the new doctor what happened. You need to factually explain what happened without adding any editorial comments so as not to throw up any red flags to the new doc.

    If you would care to describe your issues and what the new MRI indicated, people could perhaps hazard a guess as to whether it might be a nerve problem or something else going on.

    Did you immediately have this new pain as the injection was being performed, or did it develop later? Additional medication shouldn't really make much difference, particularly when it is a caudal. That method bathes a larger area with the corticosteroid, rather than going into a specific location. To have damage this far past the date of the injection, I would think a nerve must have been nicked or something similar. Is there any other reason why you might have developed this new pain?

     
    Old 03-31-2011, 03:15 PM   #3
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    Re: Unexplained "new" pain after a Caudal Injection

    I have had caudal injections done after my lumbar surgery. I found I could feel these injections more (even with sedation) and I did have pain & tenderness for several days after. Turned out these didn't help my pain that much, either, but I didn't have any other new pains. The pain & tenderness I had for a few days was to be expected. I do have a lot of scar tissue and such in my lower lumbar spine, so I wonder if that had something to do with the tenderness as well as the medication not working so well.

    The worst thing in medical offices is.....if it is NOT documented, then it never happened. I noticed that some of my medical records have quite a few errors in them from one former doc (not a PM) such as stating my pain was on the right when it was really on the left and the around way around. I've also gone complainging of low grade fever, rashes, etc, and they never took my temp, and made up temps on my reports, never mentioned why I went.

    If I were you, I would change doctors if possible.

     
    Old 04-01-2011, 07:34 AM   #4
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    Re: Unexplained "new" pain after a Caudal Injection

    Tetonteri66,
    Thanks for your response, yes I know I signed a release before the procedure. I believe they are human and make mistakes just like us, but to not document what ( supposedly) happened- scares the H#LL out of me. But I gave him a chance to correct it, and try to find out what happened to me. First it took 7 months for him to see me personally, and then all he was consumed with- was that I had said " it started from day I had the procedure " If I was to even consider going after him, I would have done something long ago- that's not what I want- and I told him that- when he said I was blaming him ! My main goal, was to find out what happened, what is causing all the pain now- that's all I want. I got no where with him, so I'm not going back to him.
    I did immediately have increased (more than the first time) pressure / pain- I couldn't find any relief for days. I couldn't sleep longer than 1 at a time- But he said I would be a bit more uncomfortable because he doubled everything- so I just road out the storm - thinking it would go away.
    I did , just yesterday- get a referral to another local PM Dr. - and yes I will need some guidance as in what NOT to say.My new MRI reads :
    New- L2-3 & L3-4 & L4-5 minimally bulging disc - with minor ligamentous hypertrophy facet arthropathy @ L3-4 & L4-5( No spinal stenosis or foraminal narrowing)
    L5-S1- Near total spontaneous reduction of previously noted mild left paracentral disc protrusion herniation , with inferior migration with minor residual. Development of subtle tear posterior anulus.Slight loss of lordosis, minor scoliosis. Minor retrolisthesis L5/S1.
    Maybe you/or someone can see something here that I've missed. I didn't fall, or do anything else that would increase my pain- and symptoms. Thanks for listening .... again.

     
    Old 04-01-2011, 07:57 AM   #5
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    Re: Unexplained "new" pain after a Caudal Injection

    Baybreeze,
    I knew what to kinda expect, as I had my first injection done by him. This new pain/pressure was immediately, and has not stopped. I don't know how one gets scar tissue- I haven't had surgery, can it be from the needles used for the injections ? Like I said earlier, I don't blame him per say- but I do know it started with the last injection. Really just want to NOT feel this pain anymore. I don't care if he covers his own b#tt in all of this, I would just have thought that he would have been able to suggest something to do about it. We all suffer enough daily, and to go to get help for that pain- and come out with more is just very frustrating to say the least.
    Believe me I know all too well that the medical field makes mistakes, I used to work in an area hospital- I've heard and seen many horror stories. I'm grateful to be alive, as for when we sign a consent there is always the risk of death involved. I know with the last procedure, my BP went through the roof, and he even gave me a miracle antibiotic pill- just in-case of poss. infection. They are human, things happen - we as patients just want to find a way to feel better - and trust is a major issue- without it - we are left alone. I'm sure I'm not the first person in the world to experience this, so I would think there would be an explanation- and possible remedy. Something that I could say at least... I'm not losing my mind .
    So I will be seeing another PM Dr. , got any suggestions as to how I should present my last experience to him- without causing any more problems. I really want to ask what it could be, so I have to say that I've seen another PM Dr.- I don't want to go for more shots without an answer to the last procedure. I hope this makes some sense- getting a bit confused myself LOL.
    Either way, ty for your help .

     
    Old 04-01-2011, 09:02 AM   #6
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    Re: Unexplained "new" pain after a Caudal Injection

    This is just my suggestion...so take it with a grain of salt! What I think is important is that you convey to PMdoc #2 that you are there seeking help for your pain and looking for answers as to what is causing it. I would let him look at the test results, etc. before bringing up that you saw another PM doc earlier, or going into what happened with that injection. You need to somehow convey that you are seeking his help, but not dwell on what PM doc #1 did and what you think caused it to happen.

    You want to create the impression that you first tried Brand A and didn't find it satisfactory, so now you want to try Brand B and hope that it will be more successful. Try to avoid personalizing it in any way. You may even need to wait a bit to ask everything you want to know until you have established a relationship with this doctor.

    I'm probably preaching to the choir here since you have worked at a hospital and I just stop in every couple years for spine surgery but interventional pain management as a specialty seems to be a tightly-knit group of physicians who to stick together. It is easy for a patient to be identified as a "drug-seeker" and find her reputation sullied when she tries to move on to a new PM doc or clinic.

    I can't comment on what happened during your procedure. I fully understand that you just want to understand what took place...but I doubt that is going to happen. Frankly, I doubt the PM knows what happened --he expected the caudal to have its normal result, and probably doesn't recall your procedure being any different from ten others he did that day.

    I assume the caudal was done under fluorscopy, right? I think he would know if he had nicked a nerve or threaded the tube incorrectly at the time he did the procedure. I still don't see why having more medication than normal would have resulted in increased pain that has lasted until now. Does that make sense to you? The amount of steroid they use is not that great to begin with. I have been led to believe that it would take substantially more than double the amount to have any significant effect on the tissue. I would think it would have an effect on the heartrate, flushing etc. more than on any pain.

    I think what you're having problems understanding is that there is just a lot of pain associated with spine issues that cannot or is not treated effectively. My guess is that the PM doc did what he thought had a chance of helping with the pain. It didn't. Now he really has no idea why you're in more pain.

    I had a team of specialists who were baffled by what was causing my continued sciatic-type pain symptoms. Before my last surgery, I had many nerve blocks, several caudals, etc. and it was all done with a "let's try this..." attitude. Of course I knew going to the PM each time that we were either trying to rule in or rule out something as the pain generator. The PM doc thought he knew what was causing my pain, but my ortho spine surgeon felt the PM should stick to doing the procedures he ordered, and had a different opinion of what was causing the pain. Luckily for me, the PM turned out to be right. My surgeon was able to "fix" it and his opinion that it was just permanent nerve damage turned out to be wrong! My point is that whenever a PM doc gives an injection, there is a desired effect, but in reality, he never knows ahead of time whether it will really work, or not. It's pretty much a crap shoot.

    We don't have your earlier MRI for comparison, but from what you copied from the new MRI radiology report, it states that the previous herniation at L5-S1 shows "near total spontaneous reduction of previously noted mild left paracentral disc protrusion herniation." This would appear to be a positive change.

    Then it states "Development of subtle tear posterior anulus." Did you have a torn annulus in the older MRI? If not, perhaps this is the reason for your pain.

    What are your current symptoms?? And what symptoms did you have when you originally sought treatment?

    Last edited by teteri66; 04-01-2011 at 09:15 AM.

     
    Old 04-01-2011, 10:47 AM   #7
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    Re: Unexplained "new" pain after a Caudal Injection

    Tetonteri,
    Wow, ty for spending your time trying to help me - I so very much appreciate it. So what your suggesting is to NOT mention PM #1 to PM#2 ? My only worry with this, is if he finds out later, he may be offended that I didn't tell him. When I worked at the Hospital, PM was not really very widely noticed, so don't worry- you may very well be correct in assuming that they all stick together- so I will be careful with what I say, and how I say it. I'm not worried about the meds issue, as my PC handles all of that- Thank God.
    As for the procedure, it was done x-ray guided( is that flouroscopy ?). And yes , the MRI show marked improvement with L5-S1 ( which is why I can't understand the new pain - along with the old pain). And yes, spine issues seem to be a rule out kinda game, very understandable to a certain degree. I started out with this, in 06 I had DDD @ L5-S1 , in 08 I had a new central disc herniation that compresses the thecal sac in the midline and minimally left paramedian- it came in proximity to without abutting or deforming the left S1 nerve root. And new disc bulge at L4-L5- not impressing the thecal sac. Then in 8/2010 -after having the second injection- Finding are: Minor wedged configuration to T12, slight increase in mild loss of disc height L5-S1 and minimally elsewhere disc desiccation. Slight loss of lordosis, minor scoliosis. Minor retrolisthesis L5-S1 again noted conus is normal in signal and location.
    Impression:
    1) Near total spontaneous reduction at L-S1 of Lt paracentral disc protrusion herniation . NEW - development of subtle tear posterior anulus L5-S1.
    2) Minor degenerative change again noted elsewhere lower thoracic lumbar spine. No mass effect or displacement of neural structure.
    3) Slight loss of lordosis, minor scoliosis. Minor retrolisthesis L5-S1 unchanged.
    4) Minor wedged configuration to T 12, again noted most likely congenital less likely prior trauma.
    5) With the exception of interval change L5-S1, no other interval changes noted.

    I've been reading a whole lot on this site, and what stands out the most is a possible injury to the S1 joint. I took a hard fall in 8/07- coming down my stairs- because my left leg gave out. I landed with my left leg twisted up behind me, and me slamming my tailbone into the stairs( while still landing on the twisted leg).. I believe this is where the original herniation came from at L5-S1- now that is supposedly healed. Could all of this pain be from my S1 joint? it seems to be overlooked repeatedly with many ppl that complain of lower back pain. Or possible nerve damage- as my 9/09 EMG report shows Chronic bilateral L5-S1 Radiculopathy. Which was consistent with my previous study from 2008. I have severe pain in the Lt leg daily, sciatic pain- numbness, tingling, sharp shooting electrical like feeling in the Lt foot radiating up leg.The pain starts in the lower back (tailbone) and will run down the leg. It's a daily thing, and nothing help - laying down will sometimes- if I lay on my rt side and prop up the Lt leg. I mentioned the torn anulus, to my pt Dr. and he said it shouldn't be the cause- many have a tear in the anulus and don't have pain from it. IDK - running out of ideas myself- I just know that this pain is constant, and worse now- just really need a proper diagnosis- that alone would do wonders for my mind. Thanks again, sorry so long winded.

    Last edited by Brnt2acrisp; 04-01-2011 at 10:52 AM. Reason: wrong date - should read in 8/2010, not 8/09

     
    Old 04-01-2011, 01:03 PM   #8
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    Re: Unexplained "new" pain after a Caudal Injection

    Chris, I am wondering if you have seen a spine specialist recently or if the PM ordered your MRI?? If you haven't seen one of these specialists( either an Orthopedic Spine Specialist or a neurosurgeon who limits their practice to issues of the back and neck only), I would urge you to find one.

    An MRI is only one of the tools at their disposal and it could be that other testing may show more clearly any possible problems that weren't detected by the MRI. This MRI does mention an annular tear which means it could be leaking fluid on to the nerves which is quite an irritant. Can you describe the kind of pain you are having?

    I also agree that a new PM is in order. In the first place, I have no use for any doctor who consistently uses an assistant to see his patients without even stopping by for a minute. Either he is too busy, or he is only interested in making money to take personal interest in his patients. At least, that is my take on it. It sounds like your PM only wants to see you if he can do an injection....big money maker for them. Well, enough of beating up on this guy because it does no good, does it?

    Just be sure not to be critical of the lst PM and be as diplomatic as you can possibly be. Tetonteri has pretty well stated the best way to handle seeing a new doctor when you have complaints about the first one. The big thing is not to send up any red flags!

    I hope you will stay in touch and let us know how you are.

    Carol
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    Old 04-01-2011, 06:25 PM   #9
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    Re: Unexplained "new" pain after a Caudal Injection

    I don't know if this helps but here is my experience.
    To put it mildly Caudal's suck. I have had a couple and even though i was sedated I was in tears after and during the procedure. The last one I had was about this time last year and I remember being in pain for quite awhile afterward. Apparently I have a bunch of scar tissue there and getting thru it with a needle is tough. I remember also being afraid that I had an infection or something like that because the pain was bad and lasted for what seemed like forever. I have come to the decision that I most likely won't have anymore Caudal's because I think it would probably just cause more scar tissue and therefore more pain. I hope you find something to help.
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    Old 04-01-2011, 06:34 PM   #10
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    Re: Unexplained "new" pain after a Caudal Injection

    As I've previously mentioned, I've had caudal injections done also and did have increased pain and soreness around the area of the injection. However, I don't recall this ever happening when I've had them done transforamenally. Even though the docs and instructions say one can have some pain for a few days after, I never do, even when I've had them done bilaterally. I can say that having had a few bilateral transforaminal injections a few months ago, it finally identified where all the nerve pain across my whole pelvic girdle, hips, and groin was coming from. After I had these done, along with some meds, my pain was down to about a 1 !!! But..the meds in the injections don't last long and I have stenosis also, so the pain's come back. After these injections, though, my pain relief was instant.

     
    Old 04-02-2011, 06:28 AM   #11
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    Re: Unexplained "new" pain after a Caudal Injection

    Hi deeannek,
    Thanks for your response, I totally understand your reasoning for not desiring to have more caudal's done-I feel the same way now. Did you ever find out what was causing you more pain and discomfort? I've been reading so many posts here, and have seen many ppl were sedated for this procedure, I wasn't-to say it was uncomfortable was an understatement.. After the first one, I had an idea of what to expect for round #2. But #2 went terribly, I felt immediate pain and pressure- and to this day I still feel like it's swollen in the tail bone area- there is constant pain/stiffness- I ice that area a lot. When I lay on my back and roll to my side (either one ) it feels like a small tennis table size ball is there ( with pain ). IDK - hoping to find some answers soon. I saw my PC and Chiro this week- they are getting a referral for an Ortho Surgeon and a New PM Doc. Maybe one of these new ones, can get to the bottom of this The only reason, that I believe I would have scar tissue is from the injections themselves-as I have not had surgery- unless it's something I'm not aware of that causes scar tissue.
    May I ask, how did your Cervical fusion work for you- that is my next journey. or what else did you do for that before surgery ? Thanks again, may you have some pain free days ahead.
    Chris

     
    Old 04-02-2011, 06:41 AM   #12
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    Re: Unexplained "new" pain after a Caudal Injection

    Hi Baybreeze,
    Sorry if I'm driving you crazy with all my "lack of knowledge" issues Sometimes I think my meds fog my brain to much . But what is the difference between a transforamenally/bilateral transforaminal injections ? I knew from the first injection that I would feel pain/discomfort for a few days following- I even had bruising in the area. But the second one, no bruising and all this added pain. I know these work for some folks, and that's great. I totally refused this tx earlier on, as I hate needles- but as the pain was non-stop, I changed my tune, and agreed. Is it possible to get that much scar tissue from the two procedures ? I know I've looked into poss arachnoiditis- is that possible from the subtle tear of the anulus ? And who would be able to diagnose something like that ? I'm happy for you that the injections seem to bring you some relief, mine gave me nothing worth trying again- at least not with that one PM doc. Thanks again
    Chris

    Last edited by Brnt2acrisp; 04-02-2011 at 06:44 AM. Reason: spelling error

     
    Old 04-02-2011, 07:04 AM   #13
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    Re: Unexplained "new" pain after a Caudal Injection

    Hi Carol,
    I'm so sorry, I missed your post- I knew I had read something from someone new to me - so I went back to look and there you where- my bad- so sorry again- these meds totally mess with my short term memory at times. Now to get to your questions, Yes I've seen a Neuro Surgeon, went to PT at his suggestion, and it only made everything flare worse- I gave it 5 months. Now he says a Discogram, with a possible fusion to follow- if they can figure out what exactly is causing all the pain. My PM doc ordered the recent 8/2010 MRI- for the Neuro consult. But since that came back with positive results - my insurance company refused to pay for one with contrast- we were hoping that might show what the new problem was.
    I will hopefully be seeing a new Ortho Surgeon, and PM doc soon- going for second opinion for poss. surgery. Would the new- annular tear be able to cause such a non stop pain/discomfort ? I still feel like it's swollen in the tail bone area- there is constant pain/stiffness- I ice that area a lot. When I lay on my back and roll to my side (either one ) it feels like a small tennis table size ball is there ( with pain ). I had suggested the tear issue to my PT , and he said that many ppl have this, and they aren't in pain- so no - it's not that big in his eyes. I totally agree with you on if a Dr. has no time to see you for a min- then it's time to move on. I know they make a ton of money off of us with the injections, you would of thought that he could have seen me before 7 months had elapsed. Either way, done with him and moving on to better docs
    Will let everyone know as soon as I know anything.
    Thanks again
    Chris

    Last edited by Brnt2acrisp; 04-03-2011 at 10:44 AM. Reason: corrections

     
    Old 04-02-2011, 07:31 AM   #14
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    Re: Unexplained "new" pain after a Caudal Injection

    Hello Chris P, I'm sorry I should have clarified myself. I have a lot of scar tissue from previous lumbar spine surgery from L3 through L5. I found out about all my spine issues from seeing a rheumatologist. He kept tellling me he'd refer me to a spine surgeon, but never did, so I found one on my own (actually my Physical therapist referred one to me). I had severe spinal stenosis from bone overgrowth, disc herniations & tears, and a spine ligament that's grossly thickened and buckled into my canal. I had one surgery where they cut away a lot of bone, did multi-level laminectomies, foramenotomies and discectomies. I did PT again, for a whole year, after surgery and did all I possibly could to reduce scar formation, but sometimes there's just no way to avoid it. My scar tissues does cause me some nerve issues. My surgery was definitely successful being I could hardly walk anymore beforehand the pain was sickening, and I couldn't have my body straight at all. So my surgery helped a lot and I didn't end up with extra problems afterward that were caused by my surgery.

    Thing is, I still have spine arthritis and DDD, and I have more stenosis again. I keep herniating discs which causes severe nerve pains in various places. A few months after my surgery, I developed a severe case of sciatica which ended up being caused by either scar tissue or disc material stuck inside a bony canal that comes off the spine where a nerve root travels through. I don't know if you've ever had a toothache, but just imagine something being jammed into the nerve 24/7. I ended up going back to my surgeon, who sent me to his PM for a nerve block, which worked. He told me I can just continue to see his group's PM. However, my surgeon and his group are too far away for me to keep going to pain management constantly, so I eventually went back to my local PM I had before surgery. They didn't have new films and since I went there in severe pain again, and practically begged for help they decided to do injections caudally this time. He said it was because of where i had my surgery. He might have thought my pain was coming from very low in the low back. Yep, even though I had sedation, those caudal injections hurt quite a bit and didn't give me the relief I had expected.

    My insurance ended up changing and it was costing to much to see that PM out of pocket, etc, so last Oct I saw a new PM. He sent me for all new x-rays and MRI's of both lumbar & cervical (since I told him I'd been having cervical pain on and off for years as well but it was never investigated by my Rheum who passed it off as fibromyalgia). I think I'm getting too long winded here. Anyway, I ended up getting more ESI injections and this PM did them at (I cant remember now if it was L1/L2 or L2/L3). He did them bilaterally,which means an injection into both sides of the spine. I know Jennybc on here can explain these things Soooooo well, so try to bear with me. There is bone that comes off each vertebrae in the spine that is tubular. This is where the nerves that come off your spinal cord, they run through these bony tunnels off the spine to other parts of your body. The transforaminal injections are much more location specific. When a doc thinks he knows which nerves are causing the problem, they can do in injection into the foraminal space from the side...in my case it was done on both sides. So it gets the steroid directly on the affected nerve and surrounding inflamed tissue. If it works, chances are that's where your problem is.

    In my case, I had been having nerve pain all the time (though not always severe) across my entire pelvic girdle, hips and groin areas. At times it felt as if my body was being crushed. I had had it checked into several times to try to figure out where the pain was coming from but no one could seem to find it. Then when i saw this new PM in Oct & he sent me for all new imaging, it was found I had stenosis & herniation in my upper lumbar spine. This new PM thought that might have been the culprit, so set me up with bilateral injections at that level. Well, sure enough, that's what it was. Only thing is the injections only give me about 2 weeks relief.

    In your case, I don't think you would have developed a scar tissue problem from having an injection. I mean when one gets a needle anywhere, it does form a tiny scar, but I wouldnt' think enough to cause more of a problem. It is always possible that the injection wasn't done correctly, or not placed into the epidural space. Or perhaps you already had a lot of swelling/inflammation in that area and the needle aggravated it, I don't know. Hopefully you can find some sort of answers, though.

     
    Old 04-02-2011, 08:49 AM   #15
    teteri66
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    Re: Unexplained "new" pain after a Caudal Injection

    I would disagree with the response you received from your PT regarding the annular tear. Just as with what is shown on a MRI, you cannot determine by size the amount of pain an "issue" might cause. Some people have an entire spine of herniated discs showing up on MRI and are asymptomatic. Or, a person can have one very small disc herniation and be in excruciating pain.

    The same holds true with an annular tear. It can cause no pain, or it can turn out to be the pain generator. Depending on how badly the annulus is torn, it can allow the proteins from the nucleus of the disc to leak out onto the outer third of the disc where nerves can become irritated.

    I'm eager for you to see a new doctor who hopefully will be able to figure out what's going on. I just encourage you to keep looking for answers. Sometimes we have to be very persevering in order to find answers to our pains. I know that was true in my case, and I had doctors who were cooperative and willing...I just didn't have a problem that was easily diagnosed, was not visible on any testing or imaging, etc. But my story has a happy ending, so I know how important it is to not give up!

     
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