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Epidural (caudal) steroid injections-So Many?

charryccharry Posts: 5,871
edited 06/11/2012 - 8:24 AM in Spinal Injections
Hi everyone, I had my second epi today and more trigger injections. My left foot feels numb but the tingling has decreased a great deal as well as the pain. Back pain is down on the pain scale. I go again in 2 weeks for a 3rd epi injection. I'm concerned about getting too much (marcaine) steroid epidurals. The Anaesthetist mentioned maybe 10 epidurals every 2 weeks apart. This time it was less painful just some pressure. I wonder if anyone else has had so many epidurals? Charry
DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
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Comments

  • From what I have reasoned based on a comment by a nurse, it depends on how much is given each time. So a doctor may decide to give lower amounts, more frequently or higher amounts less frequently. But overall you should not recieve more than a maximum amount in a given amount of time. I don't know what those amounts are though.
    This is all speculation, but it makes sense to me.


    I'm sure your doctor would not give you more than is recommended. You can always bring up your concern with the doctor though.
  • Treefrog is right, definitely talk to your doctor. The general feeling is that they don't want to give more than three steroid injections in a twelve month period (in the same location). The problem is that the body stops producing its own steroid if you're having it injected. The marcaine or other actual pain killers I don't believe is an issue. I wonder if they were talking about strictly pain killers?

    I had one ESI and one series of facet injections with steroid, the others have all been without. Of course I think the relief lasted less than a month each time so we've pretty much given up on them at this point.
    Jay
  • I have worked in Pharmacy for 30 years, so I know Marbaine (Bupivacaine) is a strong local anesthetic (numbing medication. Its the long - acting steroidal anti-inflamatory drugs that are known for side affects if used too much.

    I just had my first set of injections this last Sunday WOW PAINFUL!!! They used so much Marcaine on me I couldn't walk till late afternoon.
  • There are other medications in these injections.Some that can cause other issues,but as with everything it is a personal choice.Of course it's always good to be informed.

    The physician's responsibility is not to create clinically significant adhesive arachnoiditis which in the case of "epidural steroids gone wrong" can be associated with a lifetime of continuing agony.Clinically significant adhesive arachnoiditis represents a serious potential disaster for any unsuspecting patient in whom unsafe materials are injected.Despite the seriousness of this problem and good scientific documentation actually available in the medical literature on this subject there does not yet exist a general level of awareness among the medical profession regarding this potential patient disaster.Given this fact it is unlikely that many patients have had,prior to epidural steroid injection,legitimate informed consent.

    A remarkable amount of ignorance exists today regarding ESI. Many physicians performing epidural steroid injections on a regular basis do not even understand the relationship of this procedure to the possibility of creating adhesive arachnoiditis months later. The only sensible approach at this point in time is to require medical professionals to fully explain the procedure and other options before it is carried out.Only this approach provides true informed consent.

    If you search arachnoiditis~there was a person here a while back with many of the symptoms.He had been given quite a bit of ESI's and was in pretty bad shape the last time I heard from him.Even the pharmacuetical co. had write ups about it on their own website.

    I'm not trying to upset anyone,but these ESI's are serious business,and not to be taken lightly.They are not like getting a flu shot and can leave us sick,or worse.
  • I agree they are serious. There is a great article on this website concerning the Dr's lack of skill in using Fluroscopy during these procedures which can greatly reduce harm to the nerve endings. I would never have consented to a regular nerve block epidural without the Fluroscope. Also I trust my surgeon. I had 4 transforaminal injections last Sunday and am feeling much better, and down to half of the pain meds I was taking. I don't see many people on this forum talking about their MD using a fluroscope to guide the needle placement. I am wondering why so few?
    Granted my doc could astill make a slip, but since I work in the hospital where he practices, it was easy for me to get information on what sort of guy he was during surgery. Everyone said he was a "B---h" to work with, but that was because he is so very particular and a perfectionist. When I found that out I had no problem with doing my neck surgery, except I was still scared. But it has done very well and kept me at work and my daily activities which include horseback riding. I am not looking forward to back surgery, and am putting it off for as long as possible or until the shots no longer work.

    :)
  • A lot of us are in pain, sure, and I see a lot of problems out there, but I would like to hear from the one's who's surgeries and/or shots helped them once in a while just to keep the right perspective.
    I had neck surgery - dissection/fusion C5-6 4/07 and am doing great. Back to work and my daily activities including riding my horse. I just had 4 transforaminal lumbar steroid injections done last Sunday by the same surgeon and I feel much better so far - still riding. I'm 52 and don't want to give up my lifestyle due to pain. I want to take as few pain meds as possible and live life as long as I can.

    I say Yea to being informed about your procedure, your Doctor and your issues. I talked to so many who waited so long to have surgery, their condition deteriorated to the point of almost guaranteed failure.

  • 52 is young..I'm 48 myself and putting off surgery as well.I do worry too about putting it off too long,and honestly only just started thinking seriously about that.

    It sounds like you are doing all the right things..and also I'm glad that you were well informed on your treatments and surgery and are going great.

    I only mentioned in my previous post the problems because there are so many UNinformed patients,and the OP had asked about too many steroid epidurals(or ESI's).My Dr uses the Fluroscope as well,and I trust him,but I still had the nerve damage from a direct hit with the needle.Proving only that even very good Drs can make mistakes.

    Nothing is ever a gaurantee I suppose.
  • Yes, I'm glad to hear your MD uses the Fluroscope as well, sorry about your nerve damage, hope it is not too bad.
    How many injections have you had so far?

    I went ahead with my neck surgery in 07 without trying the injections because my nerve damage was so bad, and I really needed to get back to work asap because my husband was without a job for a year. As it was I was out for 6 months. Now I am not quite ready to go through the healing process so soon again, so I will see how the injections work for awhile while I try to accumulate more leave from work. I have worked 30 years in the hospital pharmacy world which is a lot of heavy lifting and standing for long hours. I sooo wish I could retire early!

    PS how did you add your avatar? I can't see a link to do it :)
  • To put on an avatar go to your account at the top of the page and when in there look to the left of your screen and click edit.From there you can 'browse' through your files and add w/e you like.Don't forget to put your password in afterwards..the way it's set up I didn't even notice the first time that I would have to do that..and it might have changed I haven't been in there for awhile,but check just incase,otherwise you would have to do it over again.

    If You want to add something in your signature line[under your posts that shows up on every post],a lot of people add their surgeries/ESI's/etc.I added a pic there-you can do that while you are editing too,but you need a url for those pics.A host.I use photobucket[it's free],and provides you with easy uploads & url's to forum sites.Just incase you didn't know thought I'd throw that in there.

    Earlier I tried embedding a very short movie clip over in the 'lighter' threads and it didn't work.I was embarrassed as it was a topic starter...lol,oh well.. :))(

    ESI's--I've had 5 or 6 in my cervical~the last one in June was the bad experience I mentioned and I never had a scare before that.My first was in January.It sounds like a lot,but I had 2 each time.The last time,when I had the 'episode' I had a couple ESI's in my hip right after,and I had instant relief.I thought it was just the numbing agent and was waiting for that pain to come back,but it was amazing..gone,and I mean gone for 6 weeks..it has not come back full force yet,but is coming back slowly.I wish the ones in my neck worked like that.However,I shouldn't complain,at the time my hip was bothering me more and the pain was incredible.Sleep-almost impossible.So-I may get another ESI in the hip,but my neck...it's just too vulnerable and I'm too scared to do it again after that.

    If I had to have surgery I would,but I can't help myself putting it off~I've already had so many other types of operations and have rods in the heels on my feet~7 ops on those so far..I just can't imagine more..and my neck...

    Too bad you can't get disability from work.I'm on permanant disability,and I encouraged my BF to buy the long term along with the short term at his work.He's only 44,but he had broken his neck in Jr high football & I worry about him developing problems with age.As we know even a broken bone can cause early arthritis.
  • Well I don't blame you for not wanting more surgeries, you sound like my younger sister who has had multiple foot surgeries with no pain relief in sight.
    I keep telling her she needs to get on disability as she has been a CNA for 30 years.
    Thanks for the tip on the avatar, I totally missed the tiny "edit" at the top of the page. As you can see I got mine in there OK. This is me and my Tennessee Walking horse "Siren". She is the way I can still get out in the wilderness areas that I used to be able to do on foot.
    I am working to get some sort of accomodation at work so I don't have to do any heavy lifting. Even with the shots, over time my back issues are just going to get worse if I keep up the lifting. Not that my boss cares, I think they think I will eventually quit and they can hire some youngster who knows little and they can pay half as much.

    What was the bad experience you had with ESI in your neck? Just interested because I decided not to go with them because I read that there could be many more problems doing the injections in that area vs the lower spine.
  • Guys and girls I've had DDD for 5 years and have 2 herniated discs at L5 and L4 with spondylosis. I've been in a massive amount of regular narcotics for over 2 years. I cannot stand or walk for more than 5 minutes and have very bad sciatica, numb leg and saddle. I want to go for the op as I have had enough, I can't sleep and have to be off work a lot. My surgeon wants to delay the op with these injections but I am allergic to anti inflammatories after suffering with 5 stomach bleeds. I'm thinking of getting a 2nd opinion but I cannot see any other options after trying physio, exercise, manipulation and the meds don't even touch the sciatica.

    I have to try to remain positive but if I lose my job I will be in trouble. I am scared of the injection risks........
  • sandisandi Posts: 6,556
    edited 02/24/2014 - 5:59 AM
    There are steroids not NSAIDs in the injections , as well as lidocaine to help anesthetize the area....the steroids are used to calm down the inflammation and soothe an inflammed nerve root that is suspected of being the cause of the pain.
    It might help to read a bit more about the injections, and the reasons behind them. I am including a couple of links for you to take a look at.
    The first is the Step by Step Guide to Getting treatment for Back pain. It is found at the link at the bottom of my post.
    The second is http://www.spine-health.com/treatment/injections/lumbar-epidural-steroid-injections-low-back-pain-and-sciatica
  • sandi said:
    There are steroids not NSAIDs in the injections , as well as lidocaine to help anesthetize the area....the steroids are used to calm down the inflammation and soothe an inflammed nerve root that is suspected of being the cause of the pain.
    It might help to read a bit more about the injections, and the reasons behind them. I am including a couple of links for you to take a look at.
    The first is the Step by Step Guide to Getting treatment for Back pain. It is found at the link at the bottom of my post.
    The second is http://www.spine-health.com/treatment/injections/lumbar-epidural-steroid-injections-low-back-pain-and-sciatica
    In the UK the injections are mixed with a powerful anti inflammatory medicine I think the surgeon says there us a choice if 3 or 4 different ones they can use plus steroid, epidural and something else which I forgot so I am not willing to risk another serious stomach bleed.

    My dad also had these and had a serious reaction to the dye used for the xray they use whilst having these injections. I'm a positive individual and a realist but I'm not prepared to take the risk if a reaction. Thankfully for me the discs are pressing into the spinal column and sciatic nerve (from the MRI) also had a moving x ray and my back is deforming when I move (the surgeon says will be causing my back ache) so I'm in for an op. This isn't an easy fix but a lifestyle choice. Good luck everyone with your personal choices but I will never risk a spinal injection. X
  • dilaurodilauro ConnecticutPosts: 9,743
    edited 02/25/2014 - 10:19 AM
    the USA and UK Epidural Spinal Injections, then anytime you create a thread or post regarding spinal injections, you need to make it clear (in bold letters) that you are from the UK and that their ESI in addition to steroids, NSAIDs.

    I can not allow any member here in the states to feel that the ESI's given here contain any NSAIDS.

    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • BrownevoBrownevo Posts: 24
    edited 02/25/2014 - 7:00 PM
    I'm not being funny but how was I suppose to know there was a difference between the two countries.

    Edited comments.

    Edited by Sandi
    Inappropriate forum comments.
  • one of the moderators took the time to check into whether or not there are NSAIDS used in any of the spinal injections either in the US or the UK and there are not. Steroids of various formulations are used, based on the choices of the doctors performing the injections and the purpose of the injections but there are not any NSAID's- non steroidal anti -inflammatory drugs.
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