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  • Increased pain S/P injection and diagnosis confusion

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    Old 03-29-2007, 12:45 PM   #1
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    Increased pain S/P injection and diagnosis confusion

    I left my doctor's office in tears a couple hours ago, and for a 30 year old guy, that's not cool or fun.
    Anyway, I'm still in the middle of trying to figure out what is causing thoracic spine pain. When I was 16, I was in a car wreck and had compression fractures to 3 T vertebrae. I had back pain since, but it has gotten worse over the last 2 years or so.
    I finally stopped ignoring it and sought treatment last July. Anyway, I've been to a phsyiatrist who did about 6 rounds of trigger point injections on me, with varying success. I decided to get a second opinion because while he got an MRI, I felt like I was just getting symptom control and not finding to root cause.
    I went to a spine specialist about 2 months ago. There is not anything significant to my x-rays or MRI except for mild scoliosis and some degenerative changes. The spine doc sent me to a rheumatologist because I had a weakly positive ANA at 1:80
    So the rheumatologist ordered a full body bone and joint scan, tons of x-rays, and labs. My x-ray shows changes to my sacroilliac joint and my bone scan was very "hot" at my SI joint plus both knees and ankles. All my lab work came back negative.
    The rheumatologist thinks I have some sort of spondyloarthropy, either psoriatic arthritis or undifferentiated spondylitis. The problem is, I have no psoriasis and I have no SI pain, even though I significant inflammation there.
    The rheumatologist just started me on Plaquenil, naproxen, and prilosec. I aslo take the lowest dose of Avinza for pain.

    My main symptom is persistent, deep, dull, achy mid-thoracic pain. I am in PT and do accupuncture monthly.

    Today I went back to my spine doc for worsening pain (just saw rheumatologist this week). The spine doc is questioning the diagnosis too. Anyway, he decided to do some injections on my back to see if we could arrest the pain. This set of injections was nothing like I have had before...I had intense pain and pressure during the injection, and though it hurt during, it didn't really start hurting until several minutes after. That's when the water works started. I checked out as quick as possible, choking back the tears and dragged myself back to work. Now it's a couple hours later and am still in significant pain. Their office called to see how I was and I told them, and they said to just check back tomorrow if I am still hurting.
    Could this mean something was wrong or they messed up the injection, or do you think just because I was sort of in a pain crisis I am extra sensitive today??
    Any suggestions? I know this is long but I really appreciate you wading through and offering advice.
    Thanks again.

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    Old 03-29-2007, 05:21 PM   #2
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    Re: Increased pain S/P injection and diagnosis confusion

    Did they do it under fluroscopy guidance?? If they didn't and you are in massive pain, please GO to the hospital.

    Old 04-02-2007, 06:17 AM   #3
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    Re: Increased pain S/P injection and diagnosis confusion

    No, they didn't use imaging because they were TPI's. Anyway, I seem to be getting slowly better, but still in worse pain than I was before hand. Talked to the doc through the weekend and he just told me to take 2 of my pain meds per day (instead of 1) and he would rewrite the RX.
    I'm just so frustrated and don't know what to do about this diagnosis and stuff too. I see the spine doc again in 2 weeks, so hopefully I'll get some more answers then

    Old 04-02-2007, 02:23 PM   #4
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    Re: Increased pain S/P injection and diagnosis confusion

    Wow - I'm sorry about that pain! Argh! I can relate to the disappointment of hoping injections make it better and they're worse for a while. My injections hurt like you're describing for a few days, but they did get better. I have thoracic problems, as well, and I went through a complex maze finding out what was wrong, too. The only advice I would offer after going through just about everything (water PT, land PT, chiro, RFA, TPI's, ESI's, yoga, acupuncture, rest, ice, heat, Egoscue and all types of Dr's) is this: keep persisting to take care of yourself and remedy your pain. Sometimes the remedy is pain meds to get you through until the next test or appointment. And that's only temporary, so allow yourself even temporary pain relief. Continue with an open mind and a persistent approach. I'm not "there" yet, but I'm only 8 wks out of surgery and I am definitely better than where I started. You may not need surgery and there are lots of strategies out there that help different people. This is a great community for support and ideas. Hang in there.
    - Margaret

    Old 04-02-2007, 03:11 PM   #5
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    Re: Increased pain S/P injection and diagnosis confusion

    Every time I had inejections I was very sore after. I usually ice the area. I've had some doctors say lay down the rest of the night and others say try to keep moving. But if the pain is that bad, you should probably go to the ER.

    I think it is a great idea to get several opinions, without telling them the other's diagnosis. I've had doctors tell me that I had degenerative disc disease and it wasn't a big deal, people walk around like this all the time. Well I happened to be one of the people that weren't able to walk around like that pain free.

    You have to be your own advocate and push push push till you find the answers. It's hard I know, and its easy to get so frustrated that you sometimes loose hope. But you can't. You have to keep pushing for yourself.

    I wish you the best, hope you feel better. vette

    Old 04-02-2007, 04:46 PM   #6
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    Re: Increased pain S/P injection and diagnosis confusion

    Hi! I have undifferentiated spondylitis, which causes my lumbar facet joints and sacroiliac joints to be inflammed all the time. Basically, spondylitis is arthritis which likes to attack the spine, and it causes a lot of pain! Did you test positive for the marker HLA-B27? This can indicate that you have spondylitis as opposed to an orthopedic problem in the spine.

    For me, the best injections have been into the facet joints and sacroiliac joints. It may be that the trigger point injections are not getting at the source of the joint pain. I know that my muscles are VERY tender when my joint pain is flared up, and that may be why you experienced such pain with the TPI's. You may want to ask about these joint injections, which are done under fluoroscope. I went on to have the pain nerve burning procedure, rhizotomy of the lumbar facet joints, which has helped a lot with pain.

    I have been on many disease modifying drugs for my spondylitis, some have worked and some have not. I have found that I need to pursue the injections/pain management route as well. I am also on low dose prednisone and Ultram for pain. Good luck, and take care, Kera4

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