Tag Archives: epidural

Living With Pain

Hi Everyone. I’m new to this wonderful site. Received an email from Vitali and have been encouraged and comforted to meet more folks and their loved ones trying to make a life IN SPITE of chronic pain.

I read Jana’s entries about her husbands experiences with Myelograms. I had my first AND LAST… in Oct.’03. It was terribly painful. I begged the doctor for even a little versed and he wouldn’t budge. WHY?!! The worst part was that the test only confirmed what we already knew WITHOUT the test!

Allow me to bore you for a moment, with a bit of MY STORY:
I was born with Spina Bifida which is a neuro-tube birth defect. But I was quite fortunate as a child and experienced much less complications than most children born with this. I walked, ran, attended school and was involved in everything from horseback riding to dirtbikes! I met the love of my life at the tender age of 16 and we were married. ANd then when I was 19, I defied the doctor’s predictions and had the first of our 3 daughters.

Unfortunately it was when I reached 30 that all “hell broke loose” 🙂 I began having increasing pain in both legs from top to bottom. I went from Dr. to Dr. and received diagnosis such as “depressed housewife”…. “just wanting drugs”….”minor arthritis”..etc. I’m gonna do my best to keep this really short, so I’ll skip ahead a few years now. AFter more than 3 yrs. of increasing pain with nothing more than Tylenol, Motrin, or if the doc was feeling REALLY generous… “Tylenol 3” (Yes, Jana… “bandaid on a heart attack”!)… finally through some miracle I met Dr. Molnar… the first Dr. to actually LISTEN to me! He NEVER treated me like a drug addict or a depressed housewife.He said “the first thing we have to do is to get you comfortable. THere’s no sense in you living another moment in pain with all of the potential treatments out there”. Back then we started with a low dose of Neurontin and some Oxycontin. ANd for the first time in years, I had some relief!! My family couldn’t belive the difference in my moods and attitudes. No more thoughts of suicide! I actually saw HOPE of actually “LIVING” life rather than just coasting along beside it! Next, Dr. M ordered a whole series of MRI’s and exrays and blood work.

Over the course of the next few years a lot would happen. In ’93 my left leg was amputated after more than 20 unsuccessful surgeries to scrape out a severe infection in the ankle bone (a.k.a.”osteomylitis”)… which the docs felt was a large source of my pain. The day after that surgery, the pathologist found that there was also a high level of Melanoma within the ankle. CANCER had been in there for God knows how long… and no one checked until Dr. M! A long stretch of rehab and treatments followed that and for a time, the pain level did improve. Bbut gradually it returned… and with a real vengeance! The Neurontin and Oxy. were like candy. So the Neurontin was increased tremendously and we added MS Contin, Baclofen, Wellbutrin and some M.S.I.R. (morphine sulphate immediate release). THe pain became bearable as long as I did not overdo it in any way. ANY slight change to my days can cause a terrible PAIN ATTACK which means 2-3 days in bed. A new series of MRI’s and exrays diagnosed more problems in ’99. As a result of the Spina Bifida, scar tissue formed around my spinal chord. This is called “Tethered Chord Syndrome”. Another common complication of Spina Bifida in adults is “Syringomyelia” which means that there are cysts…known as “Syrinx”… that form within the chord and fill with fluid. As they expand, they damage any nerves in their path…which then affects various body parts and functions. In Jan.’99 I had 2 surgeries on my lower back to attempt to decompress or release the tethered chord and to drain the cysts. The surgery was a disaster, infection almost killed me, and I spent 6 months in a rehab. facility. I did regain my ability to walk short distances there.

Now, it’s 2004. My spinal chord has “re-tethered” itself even worse than the first time. It is pulling my chord down much further into the spinal canal than it should be. I also have all new cysts within the chord as well as serious damage to the spine itself. 2 places in my neck and several in my lower spine are collapsing and crushing the chord. My pain level is barely managed with HIGH doses of 2 kinds of morphine as well as several other drugs. If my daily activities consist of anything more strenous than washing a few dishes or folding some laundry, then I have uncontrollable pain. Doctor’s in my hometown of Cincinnati told me there was NO ONE there that could offer me anything else. THey referred me to Cleveland Clinic and those docs there said they didn’t feel surgery was an option…wasn’t a high chance of success, but HIGH for complications, plus my risk of infection, etc. THey felt my only HOPE is intense rehab. to retain what mobility I have left for as long as I can. We recently moved to Phoenix where the Barrow Neurological Institute is located. I’m told that they are “The Best” there and so I have an upcoming appointment with them.

Depression is a constant battle these days. My life has changed SO drastically in the past few years! I’ve lost both my parents at the early age of 55, my health has declined, I lost a wonderful job because of it, I’m loosing my ability to walk, some of the use of my arms/hands, I have difficulty swallowing, I have CONSTANT urinary tract infections that make me very sick, AND my husband and I are both suffering from “Empty Nest Syndrome”!! So I believe that so much change can cause depression issues.

I can’t begin to tell you how much help it is to know there are others out there who “Get This”. I think you have to be a Chronic Pain Suffered OR love someone who is, in order to really grasp how all-consuming life with pain can be.

Sometimes for me, when the pain is really bad… it’s as if PAIN is all I can feel, hear, see, smell or taste. It’s like a very loud, constant SCREAM throughout my body. I know that my PAIN has had a negative impact on my ability to be a good mother, wife, daughter, sister and friend. THe PAIN rules your life. The PAIN makes the decisions of whether or not you go to the family picnic or the grocery store. The PAIN decides whether or not you take your kids to the amusement park or go to their softball game. The PAIN decides if you will sleep tonight or not… and for me, my pain even affects my appetite and ability to eat.

I AM TRYING to learn to rise above the pain… to take back the control in my life. I don’t like depending on pain meds. to keep me mobile… but if that’s what it takes to keep from just giving up and being in bed all the time, then I’ll do it. I’ve recently been thinking about the fact that PAIN “stold” a large portion of my life from me. Now, I have the chance for a whole new start… a new city, my girls have families of their own and live in 3 states, and for the first time in 23 yrs. my husband and I are ‘on our own” again. We should enjoy this time in our lives. My husband DESERVES to enjoy this time in his life!

So I’m trying some things I’ve never done before…some things I’ve wanted to do for years but didn’t have the courage. I’m going to be getting involved in a rehab. program that involves some real dedication and exercise in order to rebuild some of my muscles that have become so weak. I’m getting involved in some community projects. AND…something just FOR ME… I have (finally) found the nerve to enroll in some writing and literature courses. I’ve been writing since I was a child, I’ve always loved writing AND reading! I’ve been working on a few manuscripts for a few years and I have several other projects in mind. I’m even going to be taking an Art class!

All of these things are ALL NEW for me.Pain has tried lately to convince me that I’m fooling myself if I think I can “pull this off”… I’m not “able” to do these things. But that makes me more determined to PROVE PAIN WRONG!!

Thanks SO much to those of you who have “stuck it out” and actually read this thing to the end! ;o) It has been a bit of “therapy” for me to share this with you.

Thanks to all of you who contribute to make this site a “safe haven” to pain sufferers everywhere.
Blessings,

Denice

Selective Nerve Root Block

What is a selective nerve root block?

A selective nerve root block is a procedure that is used diagnostically to identify whether a spinal nerve is the generator of pain. Additionally, coincident injections of corticosteroid along with the local anesthetic block can be therapeutic and relieve pain.

What can I expect at the Pain Center?

A Pain Management Specialist at the clinic will assess your pain condition, take a medical history, and examine you to see if the procedure is a potentially beneficial option. At this time any precautions that need to be taken based on the status of your health may be discussed. Additional or alternative treatment options can be discussed. After this examination, the procedure can then be scheduled.

What should I do before the procedure?

Do not eat or drink non-clear liquids 6-8 hours prior to your procedure. You may drink a small amount (a few ounces) of clear liquid (water) up to 2-3 hours before your procedure. Take your routine medications the day of your procedure as you normally would with a small amount of water, unless instructed otherwise by the physician. If you take pain medications, do not take a dose 2 hours prior to your procedure time, unless otherwise instructed by the physician. If you take blood thinners (such as Coumadin), or you are a diabetic, you will need to follow special directions which the physician will give you prior to the procedure. It is mandatory that you arrange for someone to drive you home from the ambulatory surgical center after your procedure. Additional instructions may be given by the physician if necessary depending on your health status.

Where will the procedure be done?

In the ambulatory surgical center as an outpatient.

Will I be asleep for the procedure?

Monitored anesthesia care with light sedation may be medically indicated, based upon your health status, or to reduce unintentional movement during the procedure. Your physician will discuss this with you at the time of your appointment.

When will I have some relief of pain?

You may receive immediate pain relief after the procedure. If a patient receives partial improvement, then repeat injections may be indicated.

Will I be able to drive afterward?

No, do not operate motorized vehicles/equipment (ie cars, lawn mowers, power tools, kitchen appliances, etc) until the day after your procedure, especially if you have received sedation.

Will I be able to resume my normal activities after the procedure?

Yes, the next day. Just maintain good body mechanics and posture and continue with physical therapy or your home exercise program.

What are the risks of the procedure?

A full discussion of the risks of the procedure will occur when you meet the Pain Specialist who will perform the injection. Overall, the risks are relatively low.

The use of nerve blocks has also been criticised because of the lack of appropriate double-blind, randomised controlled trials. However, it must be appreciated that these are hard to carry out for non drug treatments, and in such a disparate group of patients as for instance those with low back pain and neurogenic pain. However, it is clear that trials are now being carried out and can show the efficacy of various treatments. On the whole I veer away from permanent lesions for patients with chronic non-malignant pain.

Facet joint denervations have been shown by Lord, Barnsley and Bogduk to be effective for both low back pain and neck pain resulting from whiplash injuries.

Efficacy and safety of epidural steroids have been investigated extensively and recent randomised controlled trials appear to show benefit for their use in limb pain and also in acute back pain or neck pain. It is essential for an appropriate dose to be used and for careful placement of the drug in the correct compartment. I would suggest the use of epidurography at least and the new technique of epiduroscopy is interesting, although as yet completely unproven.

It is understandable and tempting to think of a painful disc as the cause of a significant number of certain patients’ symptoms, and the new technique of disc denervation is another therapy under review at present.

Pulsed radiofrequency has been recommended by Dutch authors, but as yet I fail to see the rationale or the scientific evidence which would lead me to embrace this technique. At least it appears to be side-effect free, although it is a potentially expensive treatment, especially if it is only a placebo!

The use of Botulinum Toxin for muscle spasm is also under investigation at the present time. Clearly the agent has a powerful muscle relaxant effect, which is present from two to six months. Also it appears a relatively safe drug. However a great deal of work needs to be done now to identify the appropriate patients for treatment with this fairly extensive compound.

Epidural Steroid Injection

Overview

Epidural injection is the administration of medication into the epidural space. It is used to treat swelling, pain, and inflammation associated with neurological conditions that affect nerve roots, such as a herniated disk and radiculopathy.

Epidural injections may be painful and produce uncertain results. Studies show that epidural injection may provide short-term pain relief for patients when conservative treatments have failed.

Anatomy

The brain is covered by three membranes (dura, arachnoid, and pia), called the meninges that extend through the base of the skull and surround the entire spinal cord. The spinal cord travels down the entire length of the spinal column through the spinal canal. The epidural space is located between the dura and the interior surface of the spinal canal and contains veins, arteries, and fat. Epidural injection is the injection of medication into the epidural space.

Procedure

Epidural injection is usually given in an outpatient setting. An anesthesiologist usually administers the injection, but some neurosurgeons, orthopedic surgeons, and neurologists are also qualified to perform this procedure.

A mild sedative and a local anesthetic may be given prior to the procedure to relax the patient and numb the injection site. Medications, usually an anesthetic such as bupivacaine (Marcaine?) or a muscle relaxant, and a corticosteroid such as methylprednisolone (Medrol?), are injected directly into the epidural space. (The injection is commonly called a cortisone shot.)

Effectiveness

Approximately 30% to 70% of people who receive an epidural injection benefit from it. Some patients notice improvement within hours of the injection; others improve over a number of days; and others experience no improvement with the treatment. In some cases, two or three injections are given over weeks or months.

Complications

Complications resulting from an epidural injection are rare. Possible conditions that may develop following the procedure include infection (e.g., epidural abscess), bleeding into the epidural space, and headache caused by a cerebrospinal fluid leak. Approximately 2% of patients experience side effects from the corticosteroid, such as mild fluid retention.

Lumbar Epidural Steroid Injection:

Your physician may refer you for a procedure called an Lumbar Epidural Steroid Injection. This procedure is used to treat swollen and inflamed spinal nerve roots often referred to as a “pinched nerve.” The spinal nerves come from the spinal cord and exit the backbone to provide sensation to different parts of the body. Occasionally something rubs or irritates these nerves where they exit the backbone causing them to be swollen and inflamed. The source of irritation may be a ruptured, herniated, or bulging disc. Another source may be Spinal Stenosis, where arthritis of the spine, bone growth, or hardening of the ligaments begins to close the openings in the spine through which these nerves exit. Common problems associated with this inflammation of the spinal nerves include:

  1. Pain in the lower back
  2. Pain down one or both legs
  3. Numbness or tingling of your legs or feet
  4. Weakness in one or both legs or feet

Your symptoms may include some or all of the above problems. Your physician may treat these symptoms with oral medications and/or physical therapy or exercise. Another method for treating this condition is called an EPIDURAL STEROID INJECTION. This technique involves an injection of a steroid into an area of your lower back called the epidural space. The epidural space extends through the spinal canal from your head to your tailbone. The spinal nerves pass through the epidural space and are therefore bathed in this steroid (a solution of anti-inflammatory medicine). After the procedure you will be asked to reduce your activities at home for 24 to 48 hours to allow the medicine a chance to do its work. Within a few days after the injection, the medicine should reduce the swelling and inflammation of these nerves and thereby reduce your symptoms.

You will probably be asked to return two weeks after your first injection. If all of your pain or numbness has been relieved, you will not need another shot at that time. Most often, however, the first injection will relieve most, but not all of your pain or numbness. At that time (2 weeks after the first injection) we will suggest a second EPIDURAL STEROID INJECTION. Occasionally you may require a third injection two weeks after the second one. After a series of three injections, you should probably wait six months before starting another series of injections.

EPIDURAL STEROID INJECTIONS work very well for most people with the above problems. While it will not cure everyone, this procedure can be extremely helpful to relieve the pains caused by “pinched nerves”.
If you have questions about this procedure, please discuss them with your anesthesiologist.

Here are some commonly asked questions and answers:

  1. Will this injection cure my problem?

    Although this procedure may give excellent pain relief, it will not fix the source of the “pinched nerve”. However, by reducing the inflammation of the nerve and with the help of some exercises provided by your orthopedist or physical therapist, you should have months to years of freedom from pain. And although you may have to return for a repeat series of Epidural Steroid Injections in future years, many people prefer this treatment than having surgery to repair the defect.

  2. Are you going to give me a shot in my back!?!

    Yes. This is the best and easiest approach to the Epidural Space. We do not inject anything directly into the spinal nerves or spinal cord. As stated above, by using the Epidural Space the medicine can soak into the nerves very easily without a direct injection into the nerve itself.

  3. I only have pain in my leg. Why are you giving me a shot in the back?

    As stated, the nerves which supply feeling to your legs come from the spinal cord in your lower back. The site of irritation of this nerve is usually in the lower back where the nerve leaves the spinal canal or backbone. Your Doctor referred you for this treatment because he feels this may be the source of your problem.

  4. Is this procedure safe? What are the risks?

    As with any procedure, there are always certain risks involved with injections. Epidural Steroids have proven to work very well and carry very low risks of injury. However, anytime you receive a shot there is a minimal risk of complications. It is rare that these complications ever cause a significant problem. The following are some, but not all of the possible complications:

    1. Bleeding or Infection at the site of the injection: Minimal bleeding is not uncommon, but it is extremely rare that this is a significant problem
    2. Pain during or after injection: This is not a common problem, but may occur when there is significant swelling and irritation of the nerve root prior to the injection. This is usually self limiting (it doesn’t last long) and does not usually occur with the second or third injection.
    3. Post-spinal Headache: Occasionally the needle enters the dura (the membrane that covers the spinal fluid and nerves). This is called a “wet tap”. This does not occur very often, but when it does, the patient gets a particular type of headache. As stated, this is an uncommon occurrence and there is a treatment for this type of headache when it occurs.
    4. Reaction to medications or nerve injury: Reactions to the medications can occur but are quite unusual. Injuries to nerves or nerve roots are possible, but extremely rare.


  5. Will these steroids cause my muscles to increase like the athletes that take illegal steroids?

    No. These steroids are anti-inflammatory agents, not the anabolic steroids like athletes use.

Cervical Epidural Steroid Injections:

Your physician may refer you for a procedure called a Cervical Epidural Steroid Injection. This procedure is used to treat swollen and inflamed spinal nerve roots often referred to as a “pinched nerve.” The spinal nerves come from the spinal cord and exit the backbone to provide sensation to different parts of the body. Occasionally something rubs or irritates these nerves where they exit the backbone causing them to be swollen and inflamed. The source of irritation may be a ruptured, herniated, or bulging disc. Another source may be Spinal Stenosis, where arthritis of the spine, bone growth, or hardening of the ligaments begins to close the openings in the spine through which these nerves exit. Common problems associated with this inflammation of the spinal nerves in the neck or cervical spine include:

  1. Pain in the neck or shoulders
  2. Pain down one or both arms
  3. Numbness or tingling of your shoulders, arms, or hands
  4. Weakness in one or both shoulders, arms, or hands

Your symptoms may include some or all of the above problems. Your physician may treat these symptoms with oral medications and/or physical therapy or exercise. Another method for treating this condition is called an EPIDURAL STEROID INJECTION. This technique involves an injection of a steroid into an area in the back of your neck called the epidural space. The epidural space extends through the spinal canal from your head to your tailbone. The spinal nerves pass through the epidural space and are therefore bathed in this steroid (a solution of anti-inflammatory medicine). After the procedure you will be asked to reduce your activities at home for 24 to 48 hours to allow the medicine a chance to do its work. Within a few days after the injection, the medicine should reduce the swelling and inflammation of these nerves and thereby reduce your symptoms.

You will probably be asked to return two weeks after your first injection. If all of your pain or numbness has been relieved, you will not need another shot at that time. Most often, however, the first injection will relieve most, but not all of your pain or numbness. At that time (2 weeks after the first injection) your anesthesiologist may suggest a second EPIDURAL STEROID INJECTION. Occasionally you may require a third injection two weeks after the second one. After a series of three injections, you should probably wait six months before starting another series of injections.

EPIDURAL STEROID INJECTIONS work very well for most people with the above problems. While it will not cure everyone, this procedure can be extremely helpful to relieve the pains caused by “pinched nerves”.
If you have questions about this procedure, please discuss them with your anesthesiologist.

Here are some commonly asked questions and answers:

  1. Will this injection cure my problem?

    Although this procedure may give excellent pain relief, it will not fix the source of the “pinched nerve”. However, by reducing the inflammation of the nerve and with the help of some exercises provided by your orthopedist or physical therapist, you should have months to years of freedom from pain. And although you may have to return for a repeat series of Epidural Steroid Injections in future years, many people prefer this treatment than having surgery to repair the defect.

  2. Are you going to give me a shot in the back of my neck?

    Yes. As noted above, in this instance the nerves involved are located in the cervical spine. This is the best and easiest approach to the Cervical Epidural Space. We do not inject anything directly into the spinal nerves or spinal cord. By using the Epidural Space, the medicine can soak into the nerves very easily without a direct injection into the nerve itself.

  3. I only have pain in my arm. Why are you giving me a shot in the neck?

    As stated, the nerves which supply feeling to your arms and hands come from the spinal cord in your neck (the cervical spine). The site of irritation of this nerve is usually in the cervical spine where the nerve leaves the spinal canal or backbone. Your Doctor referred you to us because he feels this may be the source of your problem.

  4. Is this procedure safe? What are the risks?

    As with any procedure, there are always certain risks involved with injections. Epidural Steroids have proven to work very well and carry very low risks of injury. However, anytime you receive a shot there is a minimal risk of complications. It is rare that these complications ever cause a significant problem. The following are some, but not all of the possible complications:

    1. Bleeding or Infection at the site of the injection: Minimal bleeding is not uncommon, but it is extremely rare that this is a significant problem
    2. Pain during or after injection: This is not a common problem, but may occur when there is significant swelling and irritation of the nerve root prior to the injection. This is usually self-limiting (it doesn’t last long) and does not usually occur with the second or third injection.
    3. Post-spinal Headache: Occasionally, the needle enters the dura (the membrane that covers the spinal fluid and nerves). This is called a “wet tap”. This does not occur very often, but when it does, the patient gets a particular type of headache. As stated, this is an uncommon occurrence and there is a treatment for this type of headache when it occurs.
    4. Reaction to medications or nerve injury: Reactions to the medications can occur but are quite unusual. Injuries to nerves or nerve roots are possible, but extremely rare.
  5. Will these steroids cause my muscles to increase like the athletes that take illegal steroids?

    No. These steroids are anti-inflammatory agents, not the anabolic steroids like athletes use.


Recent post

Ever Have A Bad Epidural?
Submitted by gregg on 15 May 2010 – 10:41pm

Treatments

Management of Acute and Chronic Pain

Anesthesiologists also specialize in treatment of acute and chronic pain disorders. There are many types of acute and chronic pain disorders as well as many treatment regimens. A very common treatment for back and leg pain or neck and arm pain caused by herniated discs, spinal stenosis, or similar disorders is called an Epidural Steroid Injection. The following is a description of this procedure. Please see the links section for other articles on treatment of chronic and acute pain disorders.

Wheelchair bound

Hello my name is Isla. I have had pain now for about 3-4 years. I have many doctors and such but still no luck in the diagnosis department. I am on trileptal, zoloft, and percocet. I have tried Kadian, but nothing. The pain is located in the lower left pelvic region and wraps around my hip to my back. The pain is so bad it has landed me in a wheelchair. I am 22 years old, am married, and have two step kids. So I guess… hello!