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No myelogram yet, instead facet injection- will it help?

QuiltinouslyQQuiltinously Posts: 152
edited 06/11/2012 - 8:38 AM in Neck Pain: Cervical
Hi Neckies,

Last week I was asking you all for advice based on my health history, and you thought that I should have a myelogram and an EMG and I agreed.

However, my GP talked with the pain clinic doc who wants me to see him for a facet injection next week and someone else for an EMG later on. Questions:

1) Shouldn't I have the EMG first to see if the facet injection is a good idea?

2) Doesn't the pain clinic doctor have a conflict of interest in recommending the facet injection since he gives it?

3) Who would likely administer the myelogram when they do allow it? I guess I can have one if the facet injection(s) don't work.

4) Has anyone had success with the facet injections? My doctor told me that these can even "fix" the pain. Really? I'll take ten then.

Sorry that I have a bad attitude. Nothing has worked yet, so the thought of "more pain and no gain" kind of stinks!

Any thoughts on this? I sure appreciate it!


  • You haven't said what sort of pain or problems you have, in this post, though it may be elsewhere. And I see you have a good level of skepticism with the medical fraternity. Good!
    I looked up EMG and it seems to be for detecting muscle weakness, so it may be of use. I've never heard of it until now.
    Facet injections are for settling down inflammation in the facet joints, but are relatively short lasting, say 6 weeks or so.
    Worth a shot, but results vary, and may work one time but not the next.
    I have had about 9 sets of these, with some but variable success.
    The doctor was a specialist anesthetist, so was not strong on alternative treatments.
    If you are concerned about why your doctor is suggesting this, ask him what your treatment options are, and the expected success of each.
    When my injection doctor retired, I had to find a replacement, and luckily chose a pain doctor, also from a pain clinic, with a more modern and appropriate attitude towards pain treatment.
    Briefly, instead of facet injections for my neck and shoulder pain, I now have fortnightly remedial massage, which has reduced my pain levels and episodes dramatically.
    It seems that my neck, on examination, had very tight and rigid muscles, which were causing my headaches, ON etc.
    In turn, these neck muscles were being drawn tight by the shrunken back muscles.
    Once the masseuse relaxed the back muscles, the neck got better and the pain all went.
    I will need this massage for the rest of my life, but it is so great to know the cause and treatment.
    Tight muscles can be a result of spinal problems and can also cause them if untreated.
    Whatever the case, there is no doubt that a remedial massage will be of great benefit.
    Doctors don't seem to appreciate the intense pain and problems that muscles can generate, and would probably never suggest massage.
    But there it is. My pain Dr has found that so many patients just need regular massage, no injections or surgery.
    You may want to raise it with them, and give it a try. You have nothing to lose, but lots to gain.
  • Dee,

    The Facet injections are a good place to start. Sometimes injections as this are used for diagnostic purposes and not just for relief. I would assume almost any test that your pain clinic is going to suggest they offer as a treatment form. They more than likely do the EMG studies as well. Keep in mind EMG studies are hit and miss, type thing. It is one reason not all surgeons rely to heavy on these and rely more on their clinical findings as well. Now as far as myelogram it would need to be a facility that conducts e-rays and is using contrast dye. Not all facilities will do them. The last one I had was a out patient facility that was setup with a recovery area. The prior ones had been completed in the hospital outpatient side.

    But go into the facet joint injections with a open mind and be sure to keep a journal following the injections to keep track of your pain. Keep us posted on how you do.
  • I don't think you have a bad attitude, I just think you are a being a bit skeptical. Asking questions and researching different procedures and options is just being smart and being an informed patient.

    As tamtam pointed out, surgeons rely far less on EMG studies than a good old fashion diagnostic block or injection. It's kind of like a mechanic opening up the hood on your car and checking all your electrical connections by hand to make certain they are tight vs hooking up the diagnostic computer that talks to your car's computer. The computer may say that your $2000 thingamajig is bad, when all it really was, is a loose connector halfway in between. The facet injection is a great hands on way to check and see if that is the "root" of your problem and does at times calm things down.

    Myleograms are generally done by a radiologist that is specially trained in this technique. As tamtam pointed out, not all clinics are set up for this sort of testing, so it may be something that requires a referral.

    Let us know how it goes.

  • Hi Peter,

    Actually, I made an appointment for my first massage in years. In the past, I'd get a migraine from the massage and especially bad if I was lying down on one of the tables. A massage chair is what I'll have this time and hopefully it will allow me some pain relief.

    I definitely have muscle spasms in my neck and near my shoulder and in the upper back area - among other pain issues. The masseuse is supposed to be the best one in the area. I'll ask her if she has heard of remedial massage, but except for you talking about it in the forums often, I've never heard of it. Does it have another name it goes by?

    It's exciting to hear that someone like yourself has found something that actually helped!

    Thanks for the input.
  • I appreciate your input. And I wish that my doctor had mentioned that facet injections are diagnostic as well as a pain reducer. Your idea of a journal following the injections is great.

    They are referring me elsewhere for the EMG... I did not know that EMGs are hit and miss! Dang, I've had about five of them over the years, just none since my surgeries. That explains why the results weren't as helpful as I'd wished. Now I'll go into this one, which is at a new place in a major metro city, ready for anything.

    Do you think that it's good to ask or tell the EMG doctor anything during the procedure?
  • Hi "C",

    I love your analogy! I don't know much about spines or cars, so that ties in nicely too. :-D I feel much more likely to have a facet injection due to what you and Tamtam said.

    Do you know if there is a typical number of injections one is given? I was not told much and I think that for some reason they think they've told me info that I still need. I guess I ought to call the office and ask.

    The myelogram will come after the facet injection(s), so I guess it depends on how that goes as to if and when I'll get one.

  • Remedial massage may also be called sports or even deep tissue massage. Depends on the clientele they are trying to reach.

    When you explain the pain areas the doctor will then be able to determine which facet joints are involved, as there are quite clear nerve paths.
    He will also decide whether it is just one side or both, for each one.

    The most that I ever had in one session was 7, but that was just a bit much to bear, as it is an unpleasant nervy feeling each time, and I was really gripping the bed.
    Not painful, just unpleasant.

    So take good note of exactly where the pains are to enable him to determine the injections needed.
    Should work immediately, as there is anesthetic included, and if effective should give you at least 4 weeks relief.
    But don't expect total pain relief, more of a considerable reduction.

    Remember that if your muscles are sore, they will still hurt.
    Also-take a pain killer an hour before the procedure to lessen the needle sting.
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