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Nerve block or ESI?

Laur en PainLLaur en Pain Posts: 47
edited 06/11/2012 - 8:37 AM in Chronic Pain
I have an upcoming appt with my pain management doc on the 19th to discuss the 2 ESI's that I've had in the past month and a half. I think she wants to discuss whether or not to do the 3rd injection. I have been doing some research on nerve blocks and it seems that I may be eligible for one since I have had 2 ESI's with no relief. My most severe pain is in the lower left side of my back and radiates to the front of my left leg and hip. It's not sciatic pain down the back or side of my leg but more like a deep ache that feels like my bones hurts, kind of like a tooth-ache type pain I might say. I was wondering if anyone has had a nerve block that is willing to share their experience with me. Thanks. Lauren. :?


  • I had ESI and Facet Joint injections on Aug. 6 (both bilateral) and they have since worn off. So I'm going to have a nerve block done this Thursday.

    Nerve blocks are usually a diagnostic tool to find which nerves are causing the pain. If the nerve block is successful, then they'll do a Rhizotomy (nerve burn) on that (or those) nerve(s) in hopes of achieving long term pain relief. The success of nerve burns varies widely, so there's no way to tell if you'll get extended relief or not. But, of course, it's always worth a try rather than have to go through surgery.

    You might want to peruse the Injections area for more information on member experiences with these procedures.

  • I agree with Cath. These are both diagnostic tools.
  • A nerve block and an ESI can be the same thing depending on the location and how it is administered. The nerve block will have a first injection of a numbing agent followed by a steroid medication. Instead of going home and resting, the patient is usually asked to remain active and keep a pain journal. The idea is that after receiving a numbing agent, if you can recreate the pain by doing the activities or movements that usually cause you pain in the first several hours after receiving the shot, chances are that it is a different level that is causing the problem. If you just feel numb and/or painfree for up to about seven hours, then where you were injected is most likely the level that is causing you pain.

    Cath mentioned having a rhizotomy. I just wanted to mention that there are other diagnostic reasons for having nerve blocks...like just to see if a particular nerve or level is causing pain, to see if the hardware pedicle screws are causing pain, etc.

    At least in my experience the nerve block was just about an identical experience to having an ESI. Hopefully others will post with their experiences.
  • I've had a few nerve root sleeve injections as well as ESI's. The nerve root sleeve injections hurt a little more for me because they inject slightly off center and go in at an angle. Also, I have a condition called arachnoiditis where the nerves/blood vessels/scar tissue all clump together, so it takes a bit of fishing to find the right spot in my body. I also had BMP overgrowth so one injection the doc had to use 3 progressively larger spinal needles to bore through the bone to reach the nerve. Levels where I don't have these issues the injection really is not more than an ESI. Like an ESI, I always felt pressure that night in my back, but hurt less later from nerve injections than an ESI.(ice, ice, ice.)

    I tell you this not to scare you, but to tell you that I am the world's biggest wimp about needles! I used to pass out from blood draws(yeah, I am an ER nurse, I can stick others no problem.) I've had injections with IV sedation, but the 3 needle one was without, just my oral meds, and I still was able to lay on the table. Not that I didn't utter a few expletives. I took Valium to help me relax but didn't take a lot of pain meds because you have to know if the nerve pain goes away. But, I still did OK and didn't jump off the table like I figured I would.

    If you have no nerve pain on the day of the injection, they will ask you to walk stairs, etc. so that you are in pain before the injection. Ha, non-spineys have no idea what torture we put ourselves through trying to feel better! :) Unfortunately, this type of injection will only give you relief for about 30 minutes, if you get relief. Some docs don't believe in using steroids in a nerve root sleeve injection as it may irritate the nerve further. All of mine were done for diagnostic purposes to figure out which nerve roots were compromised and needed surgical attention. That 30 minutes of nerve pain relief was sweet, I just couldn't believe it and kept trying to hop, stretch, bear down, anything to see if I was just imagining my nerve pain was gone.

    I think the main thing in tolerating the injections is trust in the doc, making sure he/she uses fluoroscopy, and lots of local numbing medicine with a minute for it to kick in. I was also able to lay there and tell myself that this test would give immediate answers, and just kept repeating it in my mind. www.chirogeek.com can give you a dermatone map of which nerve roots from the lumbar spine cause pain in the areas of the legs.

    If you do not want to share, that's ok, and I don't want to start a flame war, but why were you diagnosed with fibro? You clearly have spine issues since you've had surgeries, so I guess I just am wondering if you feel like since an answer wasn't obvious, do you think they just gave you that diagnosis? I was just wondering if it is all from your spine issues and meds and would be worried that the docs are approaching this from a different angle if you have been given fibro as a diagnosis???

    Also, gotta say that hardware itself can cause pain. And, even though titanium is supposed to be an inert metal, when it is formed into the rods/screws, it is no longer pure. Folks can actually be allergic to the hardware. I read a study where patients who had successfully fused complained of generalized back pain more than what could be expected. When the hardware was taken out, the surgeons also took tissue samples. Lab studies showed that most of those folks had an inflammatory process going on in the tissue samples, presumably from the hardware. It was concluded that it could have been a cause for their back pain and even possibly that the chemicals secreted from the inflammed tissue might be irritating to spinal nerves.

    Wow, that was long, sorry! If you are looking for a diagnostic test for nerve compression, the injections did help my surgeons figure out which ones for sure were the pain generators. It's so hard to see anything on films when we have hardware in, so sometimes this is the best way. This is just what I've had done and have read, but hopefully gives you some thoughts to maybe run past your doc.

  • Angie,
    No need to worry about starting a war with your question about the fibro. I often have wondered the very same thing. I wonder if my back problems were to get straightened out, if the rest of the pain that I have would follow suit. I do have many many symptoms of fibro, but the problem with those symptoms is that they can mean many different things. I never had any pain before my first surgery but I have had CFS, IBS, chemical sensitivities and a few other symptoms ever since I can remember. The doctors seem to think that the surgery may have caused something that was dormant, to rear it's ugly head. So I guess the main question is this...is it fibromyalgia that is causing the majority of my pain including the back pain OR is it the back problems that are causing all of my aches and pains? This is the very question that keeps me searching for an answer. I have seen quite a few different doctors and specialists and will continue to do so until I find the answer that "feels" right, you know? It's like something keeps telling me to keep looking and I will eventually find an answer. The hardest thing about a fibro diagnosis is that you can never really know. I have an appt with my pain management doc tomorrow and I am going to discuss this all with her. It seems that she doesn't approach my treatment as if it were fibro, but more to attack the back pain. The neurosurgeon was the same way. So I see a rheumatologist for the "fibro" type pain and fatigue and a pain management doc for the chronic back pain. They both have a different approach but are both aware of the others' treatments and such. That way, we hit it from both possible angles to try to find the best solution. I hope this answers your question. And please don't ever feel like you will get a negative response from me, we are all here for the same reason and suggestions and questions that may eventually solve our problems are exactly what we need. Brainstorming is always welcome here. Lauren. :D
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