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Cortison Injection Question

AnonymousUserAAnonymousUser Posts: 49,671
I have had sciatica and sciatica spasms my entire adult life (I'm 34) and I recently had a spasm episode that was fairly short compared to my previous ones. It was on and off for about a week, sometimes being in full spasm for hours and then, between, being on the verge if I made the wrong move.

Since then, January, I have had pretty constant sciatic pain in my left leg from a 2 to maybe 6 on a pain scale. I recently started going to a doctor about this and have been doing physical therapy for a few weeks but have had no improvement. So the doctor sent me for a cortisone injection which is supposed to be one of three. I've had one so far and have no improvement after a week now.

So I have been researching and have found several things saying that if the first one doesn't help then you should not continue because 3 isn't likely to help. Also that it isn't a permanent fix anyway and the pain comes back in a few months.

I have my next one on Thursday and I wonder if I should do it.

I guess my biggest fear here is having some kind of permanent nerve damage or having to have surgery or something.

Does anyone have any experience with this?

Thank you!


  • dilaurodilauro ConnecticutPosts: 9,848
    ESI (Epidural Steriod Injections)
    Here is a video provided by Spine-Health that can show you some details:
    ESI Video

    Here is a link to several detailed articles by Spine-Health discussing these injections:
    Spinal Injection Details

    Generally patients are given a set of 3 injections within a year time frame. Many people have success with the first injection, while others may not see any results until the second or third injection. So, please disregard what you read about if the first one doesnt work, stop them. Many times its based on individual situations. ESI's are used to help reduce some of the inflammation causing some of the problems. For some, that may be enough to correct the situation and the patient may not be bother again. It all depends on the situation. For myself the ESI's were just temporary fixes until surgery was required. I think one of your bigger fears would be IF you do have some nerve impingement and it is not corrected by surgery (depending on the severity) you could have long term nerve damage.
    Discuss all of this with your doctor to get the details and figure out the Pros and Cons of the Injections, what are your long term plans and if surgery is an option.
    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
  • thank you. I do worry about long term as my mother hs had similar issues and has had 3 discs rupture over time, requiring surgery.

    My issue is vertebrae that is slightly askew that is causing the disc to inflame, etc. They're trying to get the inflamation to go down so they can get the vertebrae to go back.

    I've had it for years, though, so it's hard to believe it could ever be different!!! ha ha!

    Thank you for the advice.
  • Hi Rhenry,

    I had one ESI in May 2008 and have nerve damage from it.

    I wasn't warned an ESI could cause damage or I would not have done it.

    It really increased my pain and changed my life. It has gotten somewhat better, but I am not back to where I was before the injection. And I'm on medications I wasn't on before. I am very depressed about it and feel victimized.

    I don't want to scare anyone, but this procedure is not without risk. My doctor said "I promise this will not increase your pain". He never warned me about possible complications. It never even occured to me that I could get hurt. And after I got hurt my doctor said he didn't know what was causing it and refered me to another Clinic.

    My new Pain Management doctor said I need to get used to this level of pain since after a year most of the healing has occured. It could still get better. But if I never had the ESI I would be much, much better off.

    I am assuming this complication is rare but maybe not as rare as what the doctors say.

    Just sharing my experience.

    I hope yours is much better.

  • Hi, Rhenry. I ruptured a disc (L5-S1) during childbirth in 2001. I did all the conservative treatments and then on to the ESIs. From what I've learned there are two ways they do the injections - 1) an injection in the general vicinity of the affected area, and 2) using an xray, they guide the injection down into the actual space between the affected vertebrae, shoot in some dye (xrayed) to make sure the medicine will go exactly where they want. It takes longer to find the optimal spot than the injection itself. That's the kind I get. My first set of three (two weeks apart) lasted for two years. And, I was debilitated prior to that - could hardly walk - bad sciatica down my left leg. My disc is herniated and the doctor recommended a fusion, but I always felt so good after the injections that I refused the surgery. So, in 2003 after 2 years, I had another large flare up - again three injections two weeks apart - lasted one year. I continued on about a year between injections until 2007 when I finally got a discectomy - because the pain had gotten intolerable and so severe (13 on a scale of 10 for several days constant). Even though the shots helped until the surgery, I didn't want to be in that much pain again. Still at one year after that, I had another flare up and got another round of shots. Basically, the shots seem to last about a year. I've got about six more months to go. Definitely get all three before you make any decisions. And, my experience is definitely with the xray guided shots in a surgical environment (not a doctor's office). I could probably get the fusion whenever I'm ready, but for me, as long as the shots last for a year, that's my preferred course of action. Good luck - and let me know how it goes. Hopefully your shots will last a lifetime!
  • Rhenry, while epidural injections don't "fix" the herniation in your back, they can give you pain relief and buy you time, so to speak, to see if your body can heal the herniation on its own -- meaning you won't need surgery.

    Remember that the pain you feel is impingement on the nerve, which only takes a millimeter. If you can get the herniation to reduce (reabsorb, heal, all words used for this) just that small amount you'll have no symptoms and be -- essentially -- fixed. Worth it to try at least a second one.

    Good luck
  • I presume that you have taken Ron's good advice and you have looked at the ESI Video and read some of the articles. That will, I am sure, give you an insight to ESI methodology and some opinions and reactions. Basically, as you have read in some of the posts here, ESI's can be a temporary fix or sometimes longer term or in some rarer cases they just may last a lifetime.

    What you need to know about ESI's is that it very often can depend on which doctor does them and whether they hit the spot or not. I have had many and varied experiences with this procedure. Even with Fluoroscopy and a moving x-ray machine (C-arm) used to precisely guide and place the needle in the correct location, the skill of the doctor is still a major factor.That skill begins with identifying needle placement from your MRI which could possibly show more than one alternative. I have had some ESI's that did nothing and others that were really excellent.

    Remember that Cortisone is neither a pain medication nor an anesthetic. It is merely an anti-inflammatory drug. It is a compound similar to that which the body normally produces at times of stress, except longer-lasting.It is delivered into your system mixed with local anesthetic and most often has reasonably good success rates of varying longevity.

    My advice to you is make sure that you have a reputable PM Doc and if you do then persevere with the ESI's even though you have had a somewhat negative first experience.
    Good Luck

    John B

  • I wish I could reply to everyone individually. I appreciate so greatly all of the help here. I will try to address as many of the suggestions, etc. As possible.

    I did do the research before I went forward. I think it's vital. I was aware of the risks and that no procedure was without them. I had already read the articles and watched the videos that were given before I came to this forum. Now I was ready to hear some personal experiences.

    I did not experience relief from the first one, which was done as an epidural with the x ray. The doctor was very good, highly recommended, and I do trust that he did it correctly.

    My pain changed a bit afterward, moving into both let's, across my butt andit was sharper and more constant. My main doctor said I should go to the second but if it did not work we would go another direction. I went yesterday and it was less unpleasant though I bled a bit more than usual. Today I am not yet sure if it is working. It comes and goes so it's hard to tell. I did have pain this morning though not as sharp.

    For me the big thing is this:

    I've been hAving severe spasms about twice a year for 12 years. The come on suddenly, always sciatic in nature but for one experience with a bad one in my upper back. They are debillitating for sometimes weeks. Even once the main episode is past I am dealing with small ones every time I bend or stand and they ca. Go on for a month. Then this pain fills the gaps.

    After 12 years I find it difficult to believe that this one bulging disc has been there that long. There have been multiple bulging discs and my vertebrae is not in it's correct position so they will come back again. My mother has had multiple ruptures and I know I'm prone.

    So what are these shots doing but dealing with the symptom of a greater issue. Maybe the vertebrae will always be crooked but that makes me feel like it will always be irritating the disc and it will become inflamed as much as ever.

    Obviously I Am still going forward with an open mind, in some regard but I just wonder if there is more to it then theproblem will persist.

    I'm late to work three times a week for therapy which I cannot do forever.

    On monday if it's not better I will have an MRI with dye this time.

    I've been having weekness in my right hand and shooting pain in both arms.

    I wonder what else they think they might find?
  • I understand what you are saying and I am so very sorry that you have been suffering for so long. I know that there have been many discussions and posts on second opinions due mainly to the insurance issues but there are some occasions when that route is by far the best bet. Maybe that is what you need to do in order to get to the bottom of your problem or problems. You can't beat knowing exactly what your situation really is and then you can deal with it in a positive manner. Guessing what might be wrong will only cause you more stress. Your own attitude is very important to whatever your issues are and knowing where you are going and why is paramount.

    In the meantime, I hope that your last shot shows some improvement soon and that can take up to two weeks sometimes.

    Finally, I wish you luck with the MRI and I would be interested to hear the result either here or by PM.

    John B
  • They said about the MRI that it showed nothing out of the ordinary except for the vertebrae being turned like it is. They were trying to get the inflamation of the disc to subside so they could adjust the disc.

    I went back to the doctor this morning and the second injection had not worked. The thing that is weird is that for the first couple of days it felt like it might be working but then it just stopped and also, after the fact, I find that my body is having even more pain throughout. Shooting pain in my elbows and in my head and neck. My legs are having sharp pain on top of the sciatica and now my fingers even.

    So the doctor said this morning that we would stop doing physical therapy and also stop the injections because it was not working (at all)

    Now he is sending me to be evaluated by a neurosurgeon. Not for surgery but to see if there is anything they are missing. He is sending my MRI with me. He says that people in my situation, people who do not respond to injections or surgery, usually end up having surgery down the road.

    But he did say that I am nowhere near being ready for surgery, that there isn't even anything to operate on.

    I am now worried they are just going to say I have to live with this.
  • in my view. You clearly need to be re-evaluated.

    However you will not help yourself by worrying about what they might find. That will only do you harm. Be happy that you are on the right track and that you are dealing with a doc who is actioning stuff in your best interest. Until there is something to worry about why worry!. You probably will not have to worry anyway as you probably will get to the bottom of where your pain is really coming from and then they will help you get rid of it.

    Good luck with the new teats and please let us know how you are doing as we do care here.

    John B
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