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nerve block for diagnosis?

AnonymousUserAAnonymousUser Posts: 51,465
Has anyone ever had their doctor use a nerve block to diagnose where their pain was coming from? My doc is going to inject a block into my S1 nerve root to numb it. I have scar tissue on that nerve, so he told me if the pain goes away after the block (even for 10 minutes), they have located the source of pain. Kind of wondering if this procedure is painful, helpful or just a waste of time.

csp
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Comments

  • Have had multiple selective nerve root sleeve injections. If your pain goes away 100% then that is the level. Most of the time they do not like to give you sedation because they want you to be able to tell them how you feel afterwards. The numbing medicine is very short acting. Sometimes your leg will be temporarily "paralyzed" while the numbing medicine is there, but it will wear off quickly.

    I wish I could have a permanent pump installed that injects the numbing medicine at a couple of my levels. It took away that ouchie burning leg pain and I was upset to know that it was going to come back shortly.

    As far as injection goes, it is a little more painful than an epidural. Mine was a bit more uncomfortable because of the amount of scar tissue and having to try to go thru bone growth around nerve roots. I have to admit, I dropped the f bomb multiple times, but was able to tolerate it with no sedation.

    In my case, very helpful. Work comp approved the surgeries, proved BMP induced bone growth on the nerve root. I had many of these injections. I was nervous each time, but definitely not a waste of time. If the nerve pain goes 100% away, that's your trouble nerve.

    Good luck, keep updating.
  • thank you so much for the input. That helps me to understand the injection a little more. What is a BMP? I'm not familiar with a lot of these initials I see, because I've only had laminectomies. Do you know if I'll be able to relay to the doctors whether or not it's that nerve root that day? Or do they wait to hear from you a week or two later?

    After you had these injections, what was the next step for you? Since they found the problem, did they fix it? Were they able to fix it?

    I have the injection on the 26th of this month. Excited, but nervous too.

    Thank you again for your knowledge on this procedure.

    csp
  • IF this injection is for diagnostic purposes, you know right away. If the numbing medicine(it's like the stuff they use for stitches) takes away the pain 100%, then that nerve root is the problem is that nerve. You know by the time you are getting off the procedure table.

    The numbing medicine wears off after 30minutes-1 hour or so, that's why they don't really like to sedate you in these situations. That way you can be perfectly clear headed on the relief you do or do not experience. Sometimes they will also inject a steroid which takes a couple of days to kick in to help with pain.

    You will have your answer that day. Kicker is you can't really take pain medicine for a little bit before hand(check with your doctor) because you need to hurt to know if injection works. If you don't hurt, they don't do the injection(at least at my doc's office.) They'll make people walk stairs to induce nerve pain if they come in pain free so that they can get a good study.

    BMP is something to help bone grow with fusions. Yes, they were able to help me with surgery because of that problem. My scar tissue is a different story, I'm kind of a whole hodgepodge of problems.
  • My experience was slightly different from ernurse's. I had a nerve block to test the L-5 nerve root. The procedure was similar to having an ESI. I was injected, and then got up, got dressed and was supposed to go about my regular activities. I kept a pain journal for 24 hours and was to record any change in pain levels and what, if anything I was doing at that time. It took about 24 hours for the numbing agent to wear off. Then I called the doctor's office and gave the nurse the report of my experience.

    The day I went in I was not in any pain (I never had pain when I was lying down or sitting.) I had the injection, went home and pushed myself with activities I would normally try to avoid. I could then make the pain happen.

    For me, the procedure was briefly painful...and in my case didn't really confirm anything.
  • Thank you for the info. I was actually a little skeptical of this procedure. I was thinking the dr. just was giving me pain medication such as cortisone. I also thought maybe he was just saying that it was diagnostic so I would do it and give him a little more income. Crazy thinking, I know. But when dr. after dr. say they don't believe what you're saying (this happened when I was 20 years old during my first surgery), you tend to be suspicious of everything. I'm glad to know that there really is such a thing as a nerve block for diagnosis. I hope (and I know this is also crazy) that this doctor gives me the option of having a fusion. I would like to have this area stable and not have to keep wondering why every little movement causes me pain.

    Thanks again.

    csp
  • Are you sure you want this doctor operating on you, especially for a big surgery like a fusion? It doesn't sound like you have much faith in him!

    The nerve block is sometimes done instead of a myelogram as it is less invasive. It does not involve the introduction of dye into your body near your spine. Some doctors no longer perform myelograms unless there are no other options.
  • I bet they don't want to do any kind of myelogram on you if you have possible arachnoiditis.(I think that was you, right?) Any extra dye and proceedures can contribute to more adhesions. There will be a little dye(for the fluorsoscopy) but not like for a myelogram. Think nerve root block might really be a better option for you than a myelogram or MRI with contrast since you've got potential arachnoiditis.

    I always think get a second opinion, it's always a good idea. But I think your doc is right on about a nerve root sleeve injection. If it works, you'll beg to have the lidocaine in there all of the time! :)
  • I've already had a myelogram actually. That's what showed the clumped nerves. Nothing else had ever shown them before. So, unfortunately, I've already had the needle in my spine.

    I don't know if I want any doctor doing a fusion on me. I guess that's why I have so many questions. I suppose it depends on how detailed he gets in explaining the procedure. I want to know everything that can go wrong before going through with it. I do trust this doctor, but a fusion is such a risk... for anyone. And I know how I've felt for 9 months with pain after a laminectomy. So, the thought of another long recovery...well, yuck! I don't look forward to that at all.

    csp
  • I can completely understand how you feel. I waited over 3 years before I decided to go ahead with my fusion. I wasn't offered any other option. But I kept thinking if technology was such that we can routinely do lung transplants, etc., surely there is a more sophisticated technique than fusion.

    But there wasn't and I finally decided my life was getting too compromised by my level of pain.

    I would like to be encouraging, but, really, there is only so much your surgeon can tell you. There are some elements of the surgery that are just simply unpredictable. The doctor can quote all the statistics and give you his personal experiences from his patients, but he cannot say with certainty what will happen with you. And, to me, that's the scary part!

    Let me know if I can answer any questions pertaining to fusion.
  • I guess my questions about fusion are mostly concerning scar tissue and bone fusing completely. It seems like this is a huge surgery compared to a laminectomy. So, if you're opened up and cut a lot more, it seems that scar tissue would also be more...scary, since I've got scar tissue now that's causing me leg pain.

    Also, the fusing part... What if the bone fuses too much or not enough. It seems like the dr.'s would have to keep going back in to fix things. I've also heard that the screws can get loose.

    The whole thing is scary, since the back is such a touchy area. All those nerves that get in the way....

    When you had your nerve block, did it irritate the nerve more? Did you have problems FROM the nerve root block itself later on? That's another fear of mine. It seems like every little thing can irritate nerves, and then we're back in pain again.

    Did you feel like your fusion was worth it? Did it help with your pain in the long run?

    Sorry so many questions. But the more stories I hear, the better, I think.

    Thank you for all your information.

    csp
  • csp
    I would not jump to any conclusions on the course of your treatment until you find out if the source is the S1 scar tissue. If it is the source, there are alternatives to address the scar tissue without doing an invasive sugery.
    Waiting to see your results
    take care
  • Just had a root block at S-1, partly diagnostic, partly therapeutic, 7 days ago. I got no initial pain reduction and have experienced no relief to this point so I guess I am in line for another at L-5. If your block produces immediate relief, with any luck the steroid will provide relief several days down the road. Hope it works out for you.
  • Thank you for your support. Maybe they'll find your pain at L5. Hope things go well for you as well. The less pain, the better, right?

    csp
  • Could you elaborate on what options there are for treating scar tissue?
  • This is for informational purposes only to make you aware of these procedures. This is not a substitute for consultation with your doctors. Some possible optionsfor treatment:
    1- Manipulation Under Anesthesia (MUA)has a good success rate for post surgical pain as long as there is no hardware or fusion. MUA breaks up scar tissue and adhesions which can be causing pain. This procedure is non invasive and has been around for over 70 years. I have a 7 page documenton this , if you want me to send it to you. Let me know.
    2-epiduralysis is an injection of hyaluronidase and saline into the epidural space that is meant to dissolve scar tissue. This is best done under flouroscope.
    3-The Racz procedure: Racz catheter is a small caliber, flexible catheter that is introduced into the tail bone under X-Ray guidance. The tail bone has a small opening at the bottom of the vertebral column, known as the sacral hiatus, which allows entrance into the epidural space. The Racz catheter can be placed into the epidural space through the sacral hiatus and can break up adhesions that may have been caused by surgery as well as deliver steroid medication into the epidural space. Patients that are candidates for this procedure have usually had surgery or have severe degenerative processes affecting the lower back.
    Any questions, please contact me
  • Thanks for the information.
  • You didn't discourage me at all. I want total honesty because I'm afraid of what might happen during daycare. I need to take precaution and I appreciate your honesty!!

    csp
  • Had a busy weekend. I actually had 4 great days (very little pain) last week. I went to physical therapy and learned some new exercises that I really like. But now, I did something over the weekend and am in pain again. In fact, now my back is hurting along with my leg. So, back and forth. I keep hoping that maybe the pain will get better. Maybe the scar tissue will loosen up, but then it seems like the pain is right back and lasts for days.

    I talked with my physical therapist about the orthopedic doctor I'm seeing. She says he wouldn't jump into surgery he doesn't believe will help me. So, I don't have to worry about him doing something unnecessary. If he says "fusion," I don't have to wonder if I really need it or not I guess. It will just be my decision at that point.

    Next week is the nerve block, so I hope I'm in pain then. That will let the dr. know if it's the S1 nerve root for sure.

    Fusion scares me, but one of the kids' (daycare kids) Grandma had one done and she had great results. She showed me what she can do as far as bending and squatting. And she says she has no pain at all. I don't think she realizes how lucky she is.

    How is your pain? I saw in another thread that you're still doing well. You had said that the Singulair is already working? Would you really already have pain if it wasn't working? I know I didn't get more pain until 4 months after surgery. Does scar tissue start forming earlier than that already?

    Hope you're still doing well. You're an encouragement to everyone here.

    csp
  • Hard to believe that your leg pain is gone! Do you still have a lot of back pain? I'm still so up in the air about what to do about my back. If my doc says he could do a fusion, I'm scared that once it's done, I will want to go back to the pain I have now. I've heard so many horror stories about the pain from a fusion... constant leg pain, etc. At least I have off and on pain right now. I had 4 great days (not pain free, but less pain) and then lots of pain again. So, it's so hard to know what to do. I really only have summers that I can do surgery, because I teach preschool during the school year. If I can't teach preschool, I will have angry parents, and they will take their children elsewhere. So, either this summer or next are my options.

    One thing I know for sure... I will not have surgery without the use of Singulair. How much (what dose) do they prescribe for you to prevent scar? You said only for a month? I can't wait to hear in 6 months what your outcome is. To go from major scarring to nothing would be the most awesome thing! The more positive outcomes your surgeon has with this, the bigger possibility that other doctors will use it.

    I'm hoping my doctor will spend some time with me after the nerve block next week. Maybe if he figures out that it's the S1 nerve root, he'll talk about fusion outcomes with me, so I'll have a better picture.

    Well... back to work. Did I tell you that my son is also having surgery next month? He has to have his ACL ligament repaired. What a year!!

    Have a painless and great day!

    csp
  • That sounds like a plan. If my surgeon says no to Singulair, I will go ahead and talk to my family doc.- that's if I decide to have surgery. I'm so nervous about this. I'm in pain, but I wonder if it's not enough pain to consider more surgery. If back pain is what I end up with, that's better than leg pain, by far. But, if a fusion means opening me up more than the previous surgeries, then that could mean more scar tissue. I also worry about the fusion not fusing completely and having to have another surgery after that. What to do, what to do!!

    Are you only having back pain and no leg pain right now? I hope that's the case. I also read in another thread that your upper discs went back into place after surgery? I would call that a miracle!!!!! That is so awesome. I hope you don't have to have any more surgeries on your back. Your doctor is probably the best doctor I've heard about in... forever. I can't believe he spent 2 1/2 hours with you on your first visit. I wish he would respond to my e-mail. I hope he got it. I wonder if I called his office, if I paid him to read the x-rays I have, I wonder if he'd do it. I know it's odd, but I live so far away. And to be honest, he sounds like a doctor sent from God. Okay, I'm just rambling now, so I'd better get back to reality and start making breakfast.

    Have a great day.

    csp

  • Zach,
    I forgot to ask you... I saw in another one of your posts that your pain started 15 months after post-fusion? That wasn't from scar tissue was it? Maybe I misunderstood what you wrote, because I thought scar pain started just a few months after surgery. Was that pain from something else?

    csp

  • Lots to think about, I guess. I guess my main concern is that my doc is not a MIS doctor. The MIS doctor said no to surgery, so of course, I have my doubts. I guess patience is what I need. Not one of my strong points, especially when dealing with pain. Guess I'll just have to see what the nerve block shows.

    csp
  • Zach,
    The only reason I didn't go see the MISS doctor is because he said he would not do surgery on me again. I never saw him, just faxed over the reports I have from the MRI's and CT/myelogram. I would have to pay $300 out of pocket which would NOT go toward my deductible and take a day off from work without pay. I figured for $300, I don't want to just hear that my back isn't bad enough again. I don't know... maybe I should rethink that. I could set up an appointment with him later in April just to get his opinion on what could be done, if anything, I guess. It would maybe help ease my mind about the whole fusion thing too. It's weird, but every morning when I wake up, I think about a fusion. I worry about being in tormenting pain and the surgery making me worse instead of better. The MISS doctor saying he couldn't do anything about scar tissue was a shock to me too. If anyone could do it, it seems like they could.

    Well, time to go paint with the kids. Have a good day.

    csp
  • If there are evidence based practice trials showing Singulair works on scar tissue, great, but steroids inhibit fusion so I guess you have to take that risk?????? I know sometimes surgeons prescribe steroids shortly after fusion to try and calm down angry nerves, but it's kind of a tightrope you walk-do the benefits outweigh the risks? You're fused, Zach, so I understand you giving it a try.

    I highly recommend therapeutic scar tissue massage as soon as your stitches come out. It hurts, but breaks up superficial scar tissue and if done quickly after surgery, it can help keep new scar tissue from forming. I'm doing this right now. Not my favorite thing to do, but the PT can actually show you(with a mirror) the difference in skin that is fine and skin that is bound up to scar tissue. Your doc just needs to write a script for it. Work comp pays for it for me, so I assume most insurances would pay for it.
  • I've never heard of scar tissue massage. What kind of therapists do this? And does it have to be done right after surgery? Also, is Singulair a steroid??

    Thank you for you advice.

    csp
  • From what I have been told, there is about a six week window after surgery, when massage is most effective. ERnurse, do you know if that is true?
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