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  • Last stop before epidural injection...

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    Old 03-12-2013, 07:51 AM   #1
    Califoguy
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    Last stop before epidural injection...

    Hello,

    New here. Hoping to get some opinions before getting injection.

    It's been 3 months since back pain. It starts in lower back, then it moves to right buttock. Other times it's right in the hip where I can't even walk.

    Always had some back discomfort but I could function.

    This time, it's really affecting my daily activities.

    I thought it was priformis. Had a shot. Worked for few days and then back in pain.

    Had MRI and it's a herniated disc. He said about 4mm. Dunno what that means.

    He recommended epidural injection and take it from there.

    The only thing that works is coedine but I'm being carefull not to get hooked on it.

    Yet I see a lot of mixed reviews about shots and surgeries.

    I'm thinking to still wait it out.

    Any opinions would be appreciated.

    Last edited by Califoguy; 03-12-2013 at 08:04 AM.

     
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    Old 03-12-2013, 08:18 AM   #2
    teteri66
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    Re: Last stop before epidural injection...

    Sometimes it is better to get the epidural steroid injection sooner rather than later as it can help the tissue repair itself and reduce inflammation before any pain becomes acute.

    4mm would not be considered a large herniation. The hope is that you will be able to deal with it with conservative treatment modalities such as a course of physical therapy, oral medications for pain and inflammation and a series of ESIs.

     
    Old 03-12-2013, 08:21 AM   #3
    Califoguy
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    Re: Last stop before epidural injection...

    Thanks.

    I'm wondering why most of the pain is right in the hip
    and he wants to do the injection in the lower back..

     
    Old 03-12-2013, 08:32 AM   #4
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    Re: Last stop before epidural injection...

    You are feeling it in your hip, but they think that pain is coming from the nerve being compressed and irritated where it exits your lower spine and/or the mild herniation hits it. That is where the actual inflammation is thought to be.

     
    Old 03-12-2013, 08:46 AM   #5
    Califoguy
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    Re: Last stop before epidural injection...

    Yes, that's what he said.
    How effective is Durascope?

    I hear often that most back surgeries don't work.

     
    Old 03-12-2013, 08:26 PM   #6
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    Re: Last stop before epidural injection...

    Hello Cali-
    I find myself in the same position right now as you do. I've had back pain for years but have been able to control with Meloxicam until a few years ago I started having pain in my buttock. On and off. Then pain and sparklers started going off in my lower leg and foot. Now my hip seems to be weaker and if I lie on my side the hip goes completely numb. So I have finally gone to a spine specialist and got an updated MRI. Severe DDD, moderate to severe stenosis at L4-L5 and grade 1 spondy. But my back does not really bother me. Just my butt and leg. Tried a chiropractor and it didn't help. PT found that my piriformis muscle was very tender. So my pain is in the hip,butt and knee on down. But not my back much at all? So a couple of weeks ago I did get an epidural shot to the back. The first 5 days were worse and now its settled down to the pain and tingles just like I had before I got the shots. So I'm going to try one more shot to the back this week again. If it doesn't help than I'm not sure what we'll do next. Very discouraging. I want to get a shot to the piriformis too. To me by the location of pain it is the piriformis muscle and below the knee. I'm having alot of trouble wrapping my head around the idea that this is all back related. But things are slowly getting worse and I can't ignore it anymore. Good luck to you.
    Mart

     
    Old 03-13-2013, 07:20 AM   #7
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    Re: Last stop before epidural injection...

    Just a little basic layman's anatomy: think of the central nervous system as the body's communication center. The brain interprets the messages that are transmitted up and down the spine by the nerves. The main lines are contained within the central canal, with trunk lines branching off at each vertebral segment. As the nerves branch off, they become smaller and smaller as they travel out to innervate the limbs and then fingers and toes.

    In order for a message that the little toe is hurting to get to the brain, it begins in the tiniest little feeder nerve and runs up until it joins the bundle of nerves located in the cauda equina, then into the main spinal column, on up to the brain where the message gets interpreted.

    So, let's say you smashed your toe into the side of the door frame on your way to the bed in the dark. The toe itself is injured. You feel the pain because it registers in the peripheral nerve and the message then travels up to the brain. This is the type of injury/pain we are most familiar with.

    If one of what I think of as a "major" nerve is injured, a spinal nerve that is coming directly off the main nerves located in the central canal, you can feel the sensation of pain at any point along the pathway of the particular spinal nerve that is affected. So, if you have a situation in the spine that is causing one of the spinal nerves to be irritated or compressed, you can feel it anywhere along the path of the dermatome. You can look for a "dermatome map" online and you will see the pathway for any spinal nerve...so we know that the big toe is innervated by the L4, the three middle toes by L5, and the little toe by S1.

    The sciatic nerve is the largest nerve in the body, about the size of the little finger. They branch off the main nerves in the central canal (cauda equina) and divide into two where the legs split off the trunk...and then smaller nerves branch off the sciatic nerve going down the leg.

    So, Mart, with your DDD, the severe stenosis at L4-L5 and possible nerve pinching caused by the spondylolisthesis, it is no wonder you have lots of pain. You do not have an actual "injury" of your spine like a herniated disc so you do not feel pain over your spine. Your "injury" is the narrowing of the space that contains the spinal nerves -- which leads to a major spinal nerve that has less room than it needs to function normally.

    The piriformis is a large muscle that runs across the buttocks from the sacrum and attaches over by the hip. When it becomes taut, the pain often seems like "hip" pain. Also, the sciatic nerve runs directly underneath the piriformus muscle, and through the piriformus in a small percentage of the population, so when the piriformus is irritated, it can cause sciatic nerve irritation.

    In 2007 my spine problems were almost identical to yours: grade 1 spondylolisthesis at L4-L5, DDD and severe stenosis in the central canal and foramen...so I can sympathize with the pain you are feeling. I lived with my situation for several years because I could not accept that the only procedure that would help me was a fusion. Eventually I couldn't stand for more than about a minute and I was driving down my driveway to collect my mail as I couldn't walk more than a short length before the pain was just too much. No amount or type of drugs helped alleviate the pain...so eventually I gave in and had surgery.

    Sorry this is long, but I wanted you to understand why you could have pain in the leg, etc. but no pain in your back. Which spine surgeon are you seeing?

    Last edited by teteri66; 03-13-2013 at 07:28 AM.

     
    Old 03-13-2013, 08:34 PM   #8
    Mart16
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    Re: Last stop before epidural injection...

    Thanks for such a wonderful description. I had a particularly hard day today. I think in part because I had to go off my Meloxicam in preparation for the epidural shots tomorrow. I put some ice on my back and that seemed to help the flare. I sure hope this works. I am scared to death even thinking about a possible surgery. I am hesitant to mention my doctors name. Just doesn't seem right to say on a public board.
    Mart

     
    Old 03-14-2013, 05:08 PM   #9
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    Re: Last stop before epidural injection...

    I have been thru steroid injections several times over the years. I treated with various doctors as well and as a general rule it was let's try a round of 3 epidural injections.

    As to how they work, first keep in mind that what works for one person doesn't necessarily mean that it will work for the next. I can only give you my experiences.

    After the 1st injection I usually found some relief but it was usually short lived. Several days, week at the most. So we opted for the 2nd injection. But with the 2nd injection found that I didn't have any relief whatsoever from the injection. So since the 1st injection was so short lived & since the 2nd one didn't work at all, it was felt that injections were not the option for me. So I stopped. And I got the same results pretty much the same with each round of injections.

    But yet I have heard that some people rave about the help they got from the injections.

    My belief is "conservative" treatment. Meaning try physical therapy; medication to relieve the pain and the inflammation. Surgery should be the choice of last treatment. So rule out what works for you and what doesnt work for you.

    Surgery yes can be scary and yes as with any surgery there are risks. But there are risks/side effects from medication as well.

    If it ends up with surgery, then make sure you get someone that is a specialist in "spine" related issues. Either a Neuro or Orthopedic Surgeon. I usually, and this is just my preference, I tend to try to find a doctor that is affiliated with a major teaching hospital.

    Whatever doctor you pick for treatment, they should be able to communicate with you as to what your concerns are; explain the benefits vs. the risks of any treatment and which he feels is the best for you. Just remember that there is NO guarenteed outcome on any medical treatment. The doctor can only give you an educated guess and advise you how to proceed.

    Good luck and keep us posted.

     
    Old 03-14-2013, 05:23 PM   #10
    Califoguy
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    Re: Last stop before epidural injection...

    Thanks for the info.
    This has been going on for 3 months and it's been debilitating.
    He said there's 80% chance for good result meaning more to follow if it worked.

    For the uninitiated, one would think you get a shot and you're back in business. Not the case. I guess you have to follow a strict regimen. They don't tell you much.

    I waited an hour in pain. Saw me for less than 2 minutes and said Epidural. And he's a highly regarded doctor.

    I'm going to follow a strict regimen without any shots and see what happen.

    I heard about back discs and how painful it can be. But unless one goes through it, there's no way to know how debilitating it is.

    I'm a very active person and I feel disabled..

     
    Old 03-14-2013, 05:32 PM   #11
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    Re: Last stop before epidural injection...

    Califoguy:

    Yes, the back can really do a number on you.

    My first issue with spine issues was when I was 35, I will be 60 in June.

    I went from bed rest/medications to traction in a hospital at first then within a few years after that I saw my 1st spine surgery - lumbar.

    Then I saw cervical surgery and things began to snow ball. Everytime I turned around it was another issue.

    I have been thru 10 spine surgeries. Five of them were surgeries between the lumbar and the cervical spine.

    The other surgeries revolved around "implants" to control pain. First the Spinal Cord Stimulator which is similar to a TENS unit but after that didnt workin the long run I had it removed. Now I have an Intrathecal Pain Pump which was done 2 months ago and delivers medication directly to the spine. It is NOT a cure but it has given me some great relief. I still have some bad days but I do have now some good days too.

    I have been on disability 10 years now.SSDI.

    Prior to that I would work; go out on disability; then back to work then back to disability. It was a rollercoaster.

    It got to the point of having now severe nerve damage; arthritis and peripheral neuropathy.

    So if people think backs issues and whats the big deal then let them join this board and hear the stories of ongoing problems that affects your daily living.

    Yes you have to go thru something before you can truly understand something.

    Good luck to you and keep us posted.

     
    Old 03-14-2013, 05:38 PM   #12
    Califoguy
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    Re: Last stop before epidural injection...

    Pebblebeach, sorry to hear about your issues.
    I'm 46 but my body is much older. It's not the year. It's the mileage.
    I'm yet to allow myself some rest except for Sunday.
    I'm a one-man show in a shop and wear multiple hats.
    I'll have no choice but to slow down and take it easy for a while..

     
    Old 03-14-2013, 05:44 PM   #13
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    Re: Last stop before epidural injection...

    Calif:

    Only you know how you feel and will learn to judge as to what you can do or what you can't do during the day.

    I find when I do things and the pain starts to get worse, then it is a signal for me to slow down at the moment.

    While I am going to be 60 I certainly feel like I have a lot more mileage on me then my years. Yet at times if you were to look at me you would never know about the surgeries I have been thru. It isnt until you hear my story that you would be surprised as to what I went thru.

    I have been thru other surgeries beyond spine surgeries and found that I am a survivor. I am here for a reason.

     
    Old 03-14-2013, 05:52 PM   #14
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    Re: Last stop before epidural injection...

    Good to hear it..

     
    Old 03-15-2013, 10:26 AM   #15
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    Re: Last stop before epidural injection...

    The lumbar injections were a waste of time for me; they never did much at all. I did get a cerical epidural that helped but I went on to a fusion. So to me the injections just buy you time..

    Pebblebeach3...how many in a row are you fused in the lumbar? I have the lower three fused already and and am headed for an L-1 L-2 XLIF probably as eary as May, and I am wondering how much of a difference the extra two will have on mobility, such as bending and such. I already have to cross my legs to tie my shoes and minor tasks such as that, and I know I will be less able, but I am wondering how much?

     
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