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Spinal Injections - Help or no Help?

dilauroddilauro ConnecticutPosts: 12,303
edited 12/13/2018 - 9:39 PM in Spinal Injections

I think this is one of the bigger topics you will read on our forums.   There are many different types of spinal injections, but for the purpose of this discussion, I want to focus on Epidural Spinal Injections (ESI)

To begin with, the ESI is not intended to be the cure for your spinal problems.  What the major objective is , is to reduce the inflammation in the area that the injection is targeted for. By doing this, there should always be a decrease in your pain levels.   But if you follow our forums, I would say that there is about a 50-50 success rate in terms of ESIs.   Some people find that they get some immediate and short/long term relief, while others do not experience any benefits.

When you look into the details of these injections, you have to wonder why there isnt a better positive rate?

But one thing that keeps cropping up on the forums are those folks that have intense pain after these injections.  It is always normal to have some discomfort for the first 24-48 hours after the injection.  The injection site may be sore and ice can help reduce some of the discomfort.   But there should never be intense or more pain after these injections... IF they were adminstered correctly and if the procedure did not have any mishaps.

I say that, because I was a victim of poorly adminstered ESI and had to deal with a unnecessary discomfort.  The biggest problem about doing ESI's is that they are not being done using the proper x-ray or fluoroscopic aids.   This allows the doctor to ensure that the injection is being done to the exact location and not hitting any nerves.   The problem I had and many others may have experienced is when the needle hits a nerve root!.   That will cause a lot of pain for a while.

It is so important that whoever does these ESIs, that they do it in a proper manner.  It should be in an operating like room environment, vitals taken, more than one person involved, and the guidance devices should always be present and used..   Some people who are naturally afraid of needles, may ask for some sedation.  But in reality, the ESIs  should be nothing more than a bee sting.   They first will freeze the area, then inject some lidocaine to numb the area (just like dentist do)   Then with the aid of the x-ray device the steroid injection is given.

The entire procedure should take no longer than 15 minutes.  Then you are brought to a recovery like room to rest for about 15 minutes    They will take your vitals again and assuming it all looks good, you will be release.  99.9% of the doctors that do this procedure will insist that you have a driver , so that you do not attempt to drive yourself.

So, when you read new posts talking about the intense pain they were in after an ESI, you have to step back and think about how it was done.

For formal documentation, please read  All about Epidural Spinal Injections and other injections



  • Excellent read with much needed explanation. Thank you.

    The only thing I would add is that if your injections are done in the proper manner (in an operating room like setting and with precision guidance on a monitor) and you don’t get any relief whatsoever a good pain management doctor will explore other potential reasons for the pain.

    I’ve talked to numerous people who initially thought they had a hip injury when they really had a back injury. And the opposite can happen as well.

    If steroids are being injected into the “wrong” place in your body due to what appears to be causing the pain, then that’s another reason why the injections weren’t helpful.

    Just like in real estate, they always say LOCATION LOCATION LOCATION!!

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  • I wonder if 50% of the time, epidural steroids are given to those that obviously should not be, purposefully or not.

    I have 2-3 bulged discs in my neck which happened about two years ago. Through working with and paying attention to my physical therapist, I've learned the problems with my knotted shoulders, stiff neck and numb hands all stem from the herniated discs (recently verified via MRI) in my neck. I've learned how to maintain myself with traction, stretching, a Back Buddy (S-shaped stick) and can mostly keep myself out of pain by being mindful of the signs. A doctor recently recommended epidural steroids to me. i asked several questions about it she wasn't really able to address in my opinion, which is why I'm here.

    From what I'm seeing online, cortisone (epidural steroid) shot's working mechanism is reducing inflammation. It's difficult for me to determine how that actually works; the working mechanism isn't really described in the paper she gave to me which, isn't really surprising after my failed google search and it seems like not many people really know. Additionally, the reports I see all indicate any relief is temporary. "Reducing inflammation" is mentioned in regards to steroids without much clarification but seems to apply specifically to nerves. My understanding of my own symptoms tells me that I don't have chronic nerve inflammation; I.E. when I don't move my neck a certain way, I don't have nerve inflammation which, to me, seems largely structural (disc) and something that reducing inflammation isn't really going to address in my case. For instance, if I get somewhat 'inflamed', I can address it with ibuprofen and taking it easy for half a day. Bending my head down for too long can make my hands go numb; I can't visualize steroids having any effect.

    In my case, the pain caused by my nerve inflammation does have a benefit. When I 'overdo it', I have obvious symptoms telling me so which allows me to address it before things get really bad.

    My doctor mentioned insurance companies want to see a progression where steroids were attempted and failed before moving other treatment options like surgery. If my understanding is correct, jumping through hoops via steroid injections (with potential risks and complications) to satisfy some potential insurance agent seems folly. I can be a patient debater in regards to insurance. Frankly, I'm feeling a bit disappointed that epidural is really the only treatment being presented, pushed really. I'm more a potential sale vs a patient.

    My guess is the people likeliest to benefit from epidural steroid are those with chronic, never goes away under any other circumstances, pain and some have completely lost sight of that or never really understood it in the first place.

    I welcome other thoughts.

  • That mirrors my experience. A light bee sting and that's it. I never have had any pain afterwards. 

  • dilauroddilauro ConnecticutPosts: 12,303

    Each patient and situation is different.  The objective of many of the spinal injections is to help try to reduce the discomfort associated with the condition.   That includes reducing overall inflammation.  These are best done with people before their condition gets to be chronic.

    Your statement that perhaps some patients really did not need these injections.   I'd have to disagree, only because the approval for this treatment as well as any other treatment and diagnostic tests have to be approved by the insurance companies.  Which means, the doctor had to provide the proper rationale and justification for those injections.  Insurance companies are not going to approve these type of treatments unless they are warranted.

    I would also be very careful about the fact that it seems that you are using nerve pain as a gauge.   The major problem with nerve pain is that when the pain is caused by ongoing damage to a nerve, there is always the potential of semi or permanent nerve damage

    For more information regarding injections, please read  Spinal Injections

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  • Logically speaking, I'm not sure how you can disagree given you stated above there was a 50/50 success rate; obviously some people did not need those injections. Who cares if doctors or insurance approved it? Like I said, a disc is a structural component. In my, specific example, I see no evidence steroids will do anything in my, specific, case.

    Seems a bit like hosing down a concrete building that is also, not on fire.

  • dilauroddilauro ConnecticutPosts: 12,303

    But you cant disagree that the injections also help many people, enough so to avoid surgery

    Also,like you said you personal dont see any evidence for yourself

  • To answer the question...I had two CESI procedures.  I was sedated with Versed both times.   Fluoroscopy was used, and the procedure was done in ambulatory surgery.

    The first one I regained some feeling in my hands, but only for a few weeks.  I was a bit sore afterward, but was mobile the next day.  

    The second one...less relief, and a racing heart.  No more for me.  My surgery is at the end of the month.

  • Jerome001Jerome001 Cocoa Beach, FloridaPosts: 383

    I had epidurals, nerve roots burned, nerve roots frozen by several different pain management doctors and only 1 epidural by a single doctor ever helped me. I had no side-effects from any of the procedures. But I've also met people that had great success from one or more of these procedures. Although I gained no relief from the procedures, many others have and I'm glad I went through them before agreeing to fusions.

  • i've had a 'caudal' steroid injection last Sunday, under operating room standards with fluoroscope etc, with a very experienced consultant. I was hoping for a good result with the sciatica I have been suffering (l4/l5 herniation and stenosis, plus a few other minor bits). For the first 3 days I have had a little mild discomfort, but gained 80% mobility back (I'm now no longer dragging my leg along, or so it felt like) success, you think. That was until post procedure day 4. Sciatica has still gone, but the lumbar spine and pelvis feel very stiff, bruised, achy and I have sore spots, to the touch. I'm hoping this is temporary, and just my body reacting to the steroid crystals.

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