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"poke and hope"??

swingsswing Posts: 6
edited 06/11/2012 - 8:44 AM in Spinal Injections
maybe its just me but it seems to me these docs just poke and hope with these injections. had one a few weeks ago when my mri showed 2 herniations. no help whatsoever. actually went to a new doctor and she said "well, maybe your facet is where your pain is coming from, lets try a facet injection".

are backs that difficult? i can get a monkey heart but cant get my back "fixed"?

also, is there an alternative to a rhizotomy? thats what she said she would do if the facet injection works but havent read/seen much good from rhizotomy.

anyway, just venting. sorry.


  • I have very mixed feelings on the injections. I think sometimes it is good because if they work they can pinpoint where the pain is coming from. But with a stated 50% (read probably less) success rate they might be in the right spot but the drug isn't working for you.

    The sceptical part of me thinks that doctors do this to 1 - make more money and 2 - make the insurance companies happy that they are trying conservative treatments.

    Anything done this close to the spine with just xray imaging scares me. They claim less than 1% complications. But those complications sound pretty nasty.

    Oh well thats my 2 cents. PM doc is gonna love me tomorrow.
  • Interesting thread...

    I think there are certainly plenty of PM docs who fall into the trap of chasing pain with injections. If one thing doesn't work they just move on to the next thing to inject. I once heard this referred to as the "kitchen sink" approach to pain medicine, where they basically throw all they have to offer at you and just hope something will work. In my opinion, this is a poor approach to pain management, but I do believe it is a result of the atmosphere of medicine where doctors often don't have time to stop and really think through what they are recommending.

    I think as a patient it is our responsibility to ask the right questions and do the research so we are able to make informed decisions about our treatment. Of course we have to place our trust in physicians to make the best recommendations, but getting more information about *why* they are making those recommendations often leads to a dialogue that either confirms that the injection/procedure is a good idea, or it leads to alternatives being presented. I think communication can go a long way in preventing the "poke and hope" approach :)
  • work for many people. For me, having epidural injections were a part of conservative treatment. When I made the decision to have a fusion, it was after exhausting all conservative methods. In doing so, it allowed me to know that I did everything in my power to avoid surgery...and no regrets!

  • See, I disagree. If 50% of people can go in, spend 10 minutes, get poked with a needle, and walk out feeling better, why not give it a try? The risks are just so much lower than surgery, it's worth a try.

    The success rate is only slightly less than surgery, and yet everybody thinks of surgery as the big fix and injections as the big scam. I really don't get it.

    I have 2 disk problems (they were a protrusion and a bulge last year, no idea what they are now) and a severely deformed verterbrae. Heck yeah I was willing to try injections. My surgeon wanted to try conservative treatment, I wanted every conservative treatment I could get. I got ESI, facet block, and rhizotomy. Unfortunately, none of them gave me much relief. I'm very disappointed, because I don't WANT to go through surgery.

    The way my doctor explained it, for a simple herniated disk, the ESI reduces the swelling/pain engough to allow a good amount of physical therapy to occur and strengthen the back to the point that that part of the back is well supported and the disk space is actually increased. Then the stress is reduced on that disk, the herniation can heal, and voila, no surgery needed. Sounds like it's worth a try to me.
  • happyHBmom said:

    The success rate is only slightly less than surgery, and yet everybody thinks of surgery as the big fix and injections as the big scam. I really don't get it.

    I've always figured that its a matter of perception that really plays into this. For instance the co-worker or family member who says "your back couldn't have hurt that bad if just an injection fixed it" ... "Stumpy Smith down the road had a 20 hour surgery and has poles and sheet metal screws in his back ... now that's a bad back!"

    I've even talked with some folks who feel that having surgery validates their pain, even if there's a non-surgical alternative that would help.

    I was always told that injections are meant to buy us time. Which isn't that what we want? Time to heal, time to regain strength, time to allow inflammation to run its course.

    Anyway, that's my $.02


  • I've had interesting results from injections. I had sciatica down both legs to my feet from a disc bulge at L4/5 and lower back pain and hip pain from stenosis and facet hypertrophy at L4/5.

    I had an ESI that helped the sciatica slightly, but after a followup with a medrol steroid pack, my sciatica went away completely. It never returned.

    However, I still had lower back pain and hip pain, and began to have a different leg pain that I can only describe as wider and deeper than the sciatic pain I had experienced and these were all due to the stenosis and facet problems. I had injections trying to treat those problems with absolutely no success at all. Thus, I had to have an L4/5 fusion.

    So I know that ESIs can help in certain situations and tend to believe that injections for disc bulges are much more successful that injections for facet and stenosis problems, solely from my experience.

  • Cath you got it just right. There are some things that injections can help and there are some it can't.

    My latest problem is a boney ridge that is pressing on the nerve root. Although the surgeon doesn't want to admit it I'm pretty sure this is from the fracture I had. Why else wouldn't he have removed it the first time --- or didn't he?? Funny part is I wouldn't blame him either way. I know things aren't perfect in surgery. I trust him to do the best he can and I want this fixed.

    Do a successful injection, meaning he gets it in the right spot and it works for me, would relieve the pain for a while it will never get rid of that bone.

    I think back to the original question that swing posed that doctors tend to do what they know how to do. So a doctor who does injections is going to believe that injections are the answer. A surgeon is going to think surgery is the answer. It is a very self-confident doctor who refers patients away from their practice. It's the way it should be but I believe it rarely happens.
  • Both my surgeon and my physiatrist have told me, with knowledge and honesty, that with physical therapy, aided by a bit of pain relief from an injection series, it was hopefully possible I could avoid surgery altogether.

    This with a fully collapsed burst fracture and a 6mm hunk o' bone impinging on the thecal sac, no disk at all between L1 and L2, severe retropulsion and kyphosis, etc etc and so on, AND other lumbar disks giving me issues because that mess of an L2 non-vertebrae had destabilized my entire lumbar spine.

    My surgeon told me to avoid it if I could, because the surgery itself and the recovery were going to be hell. So I did everything I could to avoid it. I certainly took them at their word that I could, and they had nothing to gain from suggesting that I do so- I am not a hard luck case, I have good insurance.

    I just don't understand it. The whole- "Oh, they said to try these conservative methods, but they are just lying." Do some research. Read THIS SITE! Everybody says the same thing! Surgery is hell, try conservative first!

    But when you suggest that, you do get the same thing. Well, maybe that's true for you, but for me it's different, I have REAL problems. Well, OK then. I will take my fake problems back to my physiatrist and my physical therapist and keep just a little while longer trying to avoid that hellish surgery (although it's looking a little less likely every day).
  • thanks for the input, good discussion.

    i guess my "vent" was aimed more towards the fact that they seem to be guessing about what is causing my pain. mri's, xrays, etc. and one doc was certain it was the herniations but the injection did nothing. next doc said she is certain its the facet (which the first doc never even mentioned). so she is going to do an injection next week for the facet.

    when i tore my shoulder up they did an MRI and said "this here is EXACTLY your problem and this surgery here is going to absolutely fix it". i guess i am wanting that conversation for my back. not "well, hell, lets guess" (my words, not theirs). i would also love to hear "we will fix you forever" and every option that has been discussed seems to be temporary fixes.

    like someone else said, my problem is just probably a lack of education.
  • swing said:
    when i tore my shoulder up they did an MRI and said "this here is EXACTLY your problem and this surgery here is going to absolutely fix it". i guess i am wanting that conversation for my back. not "well, hell, lets guess" (my words, not theirs). i would also love to hear "we will fix you forever" and every option that has been discussed seems to be temporary fixes.
    Swing, your quote above is what we'd all like to hear. Unfortunately, spine problems can be very difficult to diagnose, thus treat. The complexity of the spine doesn't generally lend itself to an easy diagnosis or treatment and there are many here that are fighting the same battle that you are.

    It's always possible that you'll be fixed forever once the problem is discovered and you go through treatment, but many of us find that's not the case. However, I do know people who have been members here that had surgery for a severe spine problem and they've never returned. That's kind of the way it works here - those that have successful treatment/surgery go on to live their lives and don't come here any more because they no longer need support. So those successes are out there.

    I've always considered myself lucky that my spine problems have been cut and dry - quick diagnosis and then successful treatment. Yes, I still have pain due to an incomplete fusion in my neck and my lumbar still has pain, but I'm only five months out from surgery. I doubt I'll ever be pain-free, but I'm much better than I was two years ago.

    Another issue is in finding the right doctor/surgeon. Mine is a fellowship-trained ortho spine surgeon (in a spine center with physios and PTs) who specializes in treating serious cervical issues. He is fantastic and has helped me in many ways, trying conservative measures, both surgeries, pain management, physical therapy and having the PT guy get me back on the golf course this year despite my lumbar surgery.

    You may need to go to a few more doctors before you find the right one, but the important thing is that you trust whichever doctor you end up with 100% and have complete confidence in him or her. That really is imperative.

    I hope you find a diagnosis soon so you can get on the right path to treatment. I know it can be a long and difficult journey, but hang in there. It'll come.

  • I think most doctors would say that wanting that sort of "fix" would be unrealistic in spine care. The spine is so much more complex than the shoulder that just finding the problem is much more of an issue. And fixing a problem in the spine always brings about some issues down the road- for example, fusions add hardware that might cause issues later on, even if the fusion is perfectly successful.

    I think the problem isn't doctors. I think it's the spine. I think it's not quite ready for prime time, LOL!
  • dilaurodilauro ConnecticutPosts: 9,878
    Isolating a particular spinal problem can become like a detective working to solve a problem.

    Then once the problem is identified, finding the 'fix' for it can be just as difficult.

    There are some cut and clean situations where the doctors and you know exactly what the problem is and exactly what the solution is.

    But for many others, it does become a Try this and see what happens, if that doesnt work lets try this

    I've been there several times.

    First comes the Physical Therapy for x weeks, then seeing what results come from that.

    If there are no positive results from that, then it may be spinal injections and see what comes from that.

    Then it may be acupuncture, then perhaps traction, Tens unit, Ultra sound, Aqua Therapy, Relaxation Therapy, etc

    On the surface, this may seem like its a trial and lets see what happens situation, but some spinal situations are very difficult to treat.

    That goes for medications also. In the past 4 years I've been dealing with my physiatrist, together we have tried many different treatments, switching medications, trying this or that.

    Many times this whole process can take a long time.
    You need to be willing to listen and discuss the various options. Hopefully one of the combination will be the one to help you the most.

    Anything to avoid surgery should be good

    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
  • I agree with try anything before surgery. The worst part is not having a diagnosis. So many people have disk bulges, etc and never have symptoms. Finding the exact pain with spinal issues is what I call a "crap shoot." Sometimes you find it and sometimes your have to go to several Dr's to find one that is willing to look further to find it. Good luck swing. I have had some luck with injections and great luck with rhizotomy in the past.
  • It also depends on what kind of injections.
    Prolotherapy injections have a very high success rate if done properly.
    I agree with everything LaLa has said. Well put LaLa.
  • Except not in placebo controlled studies, which is the types of studies the medical community uses to determine efficacy of treatments.
  • happyHBmom said:
    Except not in placebo controlled studies, which is the types of studies the medical community uses to determine efficacy of treatments.
    You cannot do a placebo controlled study on Prolo.
  • Why not? Is it, itself, a placebo?

    Placebos are inert or sham procedures meant to mimic real interventions. How can you not do placebo controlled studies on prolotherapy if it is not itself inert?
  • Study? Study? I don't need no stinkin' study!
    If former Surgeon General Koop is down with Prolo
    If pro athletes are down with Prolo
    If olympic athletes are down with Prolo
    If MD's are down with Prolo
    If Hyppocrates was down with a form of Prolo
    I'm down with Prolo

    and if you don't know why you can't do a placebo
    study on Prolo then you don't understand how Prolo
    works and it's working for me now and it's absolutely
    beautiful baby!

  • well, i dont want to be one of those people who just dissapear. i had another injection...this time it was in the facet, not an epidural. pain went from an 8 to a 2 and stayed there for a while. hit the rehab hard and heavy.

    its been 2 months and i feel the pain creeping back in. i plan on staying on rehab until i just need another one. doc REALLY wants to do the rhizotomy but said we need to "prove" it first with another injection. told her i would prefer to go through life with just injections and rehab as long as possible.

    my rehab therapist told me that i have a really bad back and that i am just delaying a fusion. that shocked me, i assumed it wasnt that bad. she said my goal sould be to avoid the fusion as long as possible (young kids at home).

    at least it appears they finally targeted my pain source...good news. fusion is in my near future...the bad news.

    thanks again everyone!
  • Glad to hear that the facet injections worked. I, like you, had several sets of different injections before I had relief, and I'm so happy I persisted. I had two nerve blocks done before my rhizotomies; I had three over a two year period, and am just getting a referral back to my NS to see if he's ready to do #4. I was one of the lucky ones who had success, and each one gave me longer relief.

    The last time I saw my surgeon, there was no invasive surgery to "fix" my problems, so I have a variety of treatments to get me through the really tough times. Physiotherapy and IMS (a type of acupuncture) can be helpful, as can trigger point injections with Marcaine. I know how frustrating it is to feel like you're getting the runaround, but it is encouraging to at least have docs who offer up SOME type of relief....I've had some who said "just go back to work and forget about the pain!".....hmmmmm.....

    Take care, and good luck with whatever comes next for you.

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