[Lilly]

Hi....I have a question concerning this.
Why can't they just do a nerve block & restrict the pain message that travels to the brain????
I feel it's ridiculous and cruel to let people suffer in agony!
Lilly

[lostinconnecticut]

I think everyone is right when they say that the injections treat the symptom and not the disease. In my state it is common for the insurer's to request a treatment plan from the worker's chosen doctor.
These treatment plans state what the doctor will do, when, and why.
The insurers later use this to criticize the treater if everything doesn't go according to plan.
I see no reason that you couldn't request a treatment plan regarding your care. It can remove a lot of the mystery about what will happen to you over time, allow you to propose alternatives, and may help you build a case to change physicians if you need to in order to obtain the best cure.
A very wise doctor once told me that when you have surgery, three things can happen. You can get better, you can get worse, or you can stay the same.

[lostinconnecticut]

Lilly,
I once had it explained to me that nerves are kind of like telepone wires. Each house has a couple of wires like each finger tip. These wires come together in bundles at the telephone poles and you may have hundreds bundled together along the street, like the many nerves in you hand which bundle together and run up your arm.
The hundreds of wires from each street come together into bundles of thousands, like your spinal cord and head to a central processing center, your brain.
It is easy to find and block the nerves that control your finger tip, so that if you cut your finger and need stitches, you only need to disconnect the phone sevice to a few houses, so to speak.
By the time you get to the spinal cord (where herniated discs are)
you might disconnect service to half of the city if you disconnect those wires. Nerves unfortunately don't have colors and stripes like wires to help in their identification.
Since our nerves do more than just conduct pain impulses, they also control our muscles and organs, blocking spinal nerves can disconnect some lines which you may not want to disconnect. If you were to block the spinal cord, which is done, you will also lose control of anything below the block, like your legs and become temporarily paralyzed. You won't feel pain, but you won't be walking either.
Forgive me for oversimplifying this, but it helped me to understand

[vickinat]

Nurse 83,
I can give you my experience. I had bulging discs at L3-4,L4-5 and L5-S1, and Radiculopthy of the L5 or S1 nerve root. I was told that W/C does conservative treatments first. I had a series of 3 Transforaminal Epidural Injections at L5, none under sedation all were with flouroscope guidance. The first one was very painfull and the Dr. hit the nerve and said he knew he was at the right spot, the next 2 were'nt as painfull. None of them helped me. I later found on a website that the ESI's are not FDA approved for low back pain, because there wasn't much evidence that they help pain for any determined amount of time. I'm not sure of the website, it may have been Spine health.com or Web md. They have been proven to help in the joints.

I also have SI joint dysfunction and my Ortho did an injection into the SI joint, which couldn't be determined if it helped or not because I had a car accident 5 days later. They tell you that the first 2 days may have more pain and it can take up to 2 weeks before the steroids begin working. They also did one in my left hip joint. I did'nt get any relief.

I have had the trigger point injections in the periformis muscle and around the SI area that did give some temporary relief. I had 2 cortizone injections into my left shoulder 6 weeks apart and both of these helped.

So, in my opinion only, the ESI's in my back did no good, the shoulder joint and the trigger point ones helped. I was originally told that if the back ESI's didn't work, we would discuss surgery, now I'm told my lumbar back can't be fixed and I will continue to have pain which will get worse as the years go by. I did over a year of PT, I go to pain management and take medications to function daily. My Ortho has switched my care now to my pain management doctor since injections didn't help. He does have me going to see a surgeon for my cervial spine problems, who looked at the MRI's as well, he said the neck may be fixable but not the lower back.

Do alot of research before agreeing to anything. I will not have anymore ESI's in my spine area because of my experiences. Sorry this is so long.

Good luck and take care.
Vickie

[nurse83]

thanks Vickie and don't worry about being too long............any help i can get from people who have actually undergone these is huge............research and doctors (ha!) can only tell you so much............despite my pain and desire to return to work asap i am not going to be rushed into anything................i am not a big fan of anything epidural so i have that to overcome

[firechick]

HI Nurse,
I'm new to this site but I have exactly what you have. I could not walk for over a month more or less and going to the bathroom forget about it. So here came the shots. I was awake it was like an alien probeing around...horrible. Number one not much relief, number two...better now using the bathroom and walking to the kitchen. Third was a charm....I am now mostly pain free and working out at the gym. I don't want surgery and can't say enough for the shots. I hope you get them good luck to you.

[sparkey]

My husband is finally going Wed. this week to talk about the injections again. I guess they need to go over it with him, look at his past records from there and then set up the appt. for the shots. He was the same way, first shot somewhat worked, second got better, and by the third one he was running around like nothing ever happened. He cannot wait to get the shots again. As much as he hates needles, he is soooooooo looking forward to getting another to get around much better.

[chrischris]

"Invasive techniques (e.g., local injections and facet-joint injections of cortisone and lidocaine) are of questionable merit. Although epidural steroid injections may afford short-term improvement in leg pain and sensory deficits in patients with nerve root compression due to a herniated nucleus pulposus, this treatment offers no significant long-term functional benefit, nor does it reduce the need for surgery. Despite the fact that proof is still lacking, many pain physicians believe that diagnostic and/or therapeutic injections may have benefit in patients presenting in the transitional phase between acute and chronic pain."

This was copied from the ACOEM 5th edition, chapter on lower back pain treatment.
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ESI's are just a way to relieve some pain and provide some relief for the patient. Many times the symptoms go away before they become "chronic." If after at least 3 months and none of the conservative methods of treatment have relieved the patient, then surgery becomes an option. Surgery is always optional and never required.

WC delays surgery way longer than ACOEM recommends.

For me, I had a cervical ESI and it backfired, flaring up RSD in my neck and entire arm. I've heard that the ESI's work much better in the lumbar region, and in most cases, do provide some short term relief. Go for it, and at least try one injection.

Now two years later, surgery has been approved for me. My doctor says because of the WC delays, I will have permanent nerve damage. I hope it isn't another year before it is scheduled.

Stay on top of your treatment and insist that the ACOEM guidelines are followed.

Have a good day. I'm off to yet another doctor appt.

[backache]

I had 2 with no relief, they actually made my pain worse after the second one. The 11-7 nurse on the other hand told me they were the only thing that helped her pain. We both have bulging discs L3, L4, L5, S1. From what I have gathered its a 50-50 shot.

[hurt at work]

good luck with the shots they did not work for me.i ended up getting fusion.shot are a short term fix to get you of work comp and then they can fire you because your high risk to your employer.i got fired after my fusion and they covered everything under work comp until the doctor said i needed surgery then they would not pay for anything.so dont put off your treatments or surgery if there covered under workers comp now they will cheat you if they can.