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Injection differences - many questions...

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Old 01-27-2009, 05:38 PM   #1
Join Date: Jan 2008
Location: Illinois
Posts: 439
nscrbug HB User
Injection differences - many questions...

I'm looking for some information on the various types of injections for pain relief. I've already researched extensively on all there is out there on spinal injections.

Quick rundown of my situation. I'm 43yo female, who has been very active most of my adult life...and I would really like to remain that way for the remainder of my life. I have grade 2 spondy at L5-S1...along with severe DDD. I basically have no disc at that's pretty much bone on bone. I used to have terrible sciatica in my right leg, but that is completely gone now (yes, it REALLY is!)...thanks to daily use of my inversion table at home. But the low back pain remains, and it all but consumes my daily life. I feel it when I wake up in the morning, and I feel it after sitting for long stretches of time. My back just feels like it tightens and stiffens up almost the instant that I stop moving around. Exercise, for the most part, makes my back feel good...with one exception...running. I used to enjoy running, and lost tons of weight from running. But lately, whenever I run (even if it's on a soft surface), it feels like someone is taking a baseball bat to my lower back. I feel bone-jarring, crushing pain that recently has been extending into my left hip area...mainly the iliac crest region, which is the boney part of pelvic bone near the waistline. I am convinced that this hip pain is related somehow to my lower back issues.

I have already been to a NS, been through 6 weeks of PT...nothing has changed...other than my sciatica being eliminated through my own course of action. I have made the decision that I would like to try some kind of injection...but I don't know which one would be right for me. Based on what I've read/researched...a standard ESI sounds like it's more of a benefit for those with sciatica, instead of low back pain. The success rate for ESI given for low back pain seems to be quite low.

I guess my question is...if I get a referral to an ortho, and after his evalution, he sends me to a PM...who chooses which type of injection I will receive? Would it be the ortho doc or the PM? And do they always start a patient off with a standard ESI, just to see if it works? Or is it possible that I might be given a medial or lateral branch block, or trigger point, facet joint or some other type of spinal injection right off the bat? I had an opportunity to get a standard ESI about a year ago, but I never went through with it because I felt that it wasn't the right solution for my particular problem. Can doctors determine exactly what kind of injection is needed for a specific problem? Or do they generally just try a bunch of different ones as a process of elimination? I really don't want to pay for something that isn't going to work. That would be [B]really [/B]discouraging.

Sorry for the long post, but this has been weighing on my mind for some time now, and I really need some answers. I'm sick of this chronic low back pain and I'm ready to take the next step. Thank you all!


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Old 01-27-2009, 07:58 PM   #2
Join Date: Jan 2009
Location: Washington,PA,USA
Posts: 9
lost70 HB User
Re: Injection differences - many questions...

I think most PM's start out with the basic Steroid injection series. I've tried them a few times and each time they made me stay in bed for a week and had worse pain for 2 wks following it. My PM has never spoken to me about a facet jont injection, so maybe he feels it won't work for me. They know what to try for each individual. I had to have a discgram and that was to see if the pain was actually coming from the discs and I tested positive on two of them. My PM wants to do a procedure where he would put a wire around my discs and heat it. That would repair the tears I have and it would help with my leg pain by deadening the nerve endings. But now that I have a herniated disc and my discs have gotten worse, I don't know what he'll want to do. Now I have 3 bad discs, instead of two. The domino effect.... I hope you find relief for your pain. It most definitely is not fun to deal with every day, 24-7.

Old 01-28-2009, 01:00 PM   #3
Join Date: Apr 2006
Location: United States
Posts: 372
kera4 HB User
Re: Injection differences - many questions...

Hi! I do know that the doctors who inject (pain management or physiatrists) have to try some injections first, then modify the plan based on results. I have a bulging disc at L5-S1, and arthritis in the lumbar facet joints/sacroiliac. My doctor tried a series of 3 ESI at L5-S1, but they gave only minimal relief. Then he tried the facet injections and I got a lot more relief. I ended up getting the radiofrequency nerve burning in my lumbar facet joints, which provides more lasting pain control than the injections. It was a long process, but it was gratifying to finally figure out where the pain was coming from. After so many years of just putting up with back pain, it was nice to finally have a plan. From where you describe your pain, you may have some sacroiliac joint pain as well as from the L5-S1 area. Take care, Kera4

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