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Patient says no to injections?

If your treating physician has offered ESI, etc. have any of you decided against them? How has the physician responded to that?


alex

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Comments

  • dilaurodilauro ConnecticutPosts: 12,230

    Alex,

    That depends on your medical situation and the doctor's overall views on conservative treatments.   I know that there are some pain management doctors that when their patients refuse ESI's, they will no longer treat the patient.

    Best thing to do is BEFORE the situation arises, talk it over with  your doctor regarding the various conservative treatments you will do before considering any aggressive ones.  No surprises is always best!

    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Hi aam

    Before my first surgery, I did not want the injections as I felt they would just be masking the pain and the problem as I had such a large herniation.

    I am in the UK and was told quite clearly, this was the pathway of treatment and if I didn't have the injection, I would be signed off and discharged from the consultant.  If I had it and it didn't work, I would be considered for surgery.

    These injections are used for diagnostic reasons as well in some cases.

    AJ

    AJGormit
    Spine-Health Moderator
    ---------------------------------------------------------------

    L5/S1 herniation Apr 2013
    nerve root injections Oct 2013
    L5/S1 discectomy Jan 2014
    L5/S1 nerve roo &, facet joint injections & edpidural Jan 2015
    L5/S1 revised discectomy, L4/L5 discectomy & Wallis Inswing Stabilisation L4/L5 May 1st 2015
    L4-S1 TLIF with decompression June 2017
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  • dilaurodilauro ConnecticutPosts: 12,230

    Alex,  AJ is correct about ESIs being used for diagnostic purposes.

    I had this done two different times.  I was having problems, that both my spinal specialist and hip specialist were discussing as to where the root of the problem was.  So first, I was given a ESI into L5.  If that helped with the problem, then there was a good bet that the problem resided there.  If I had no relief, then the next step was steroids into my hip.  Same scenario, if I had relief, that is where the problem lied.

    Now keep in mind that there were many other diagnostic tests done, MRIs, CTScans, X-Rays, Clinical examinations.  But this was a tough one for both doctors to isolate.

    Hips won!   Even though I was suffering from moderator lumbar stenosis, the bone on bone situation created by Osteoarthritis  resulted in a complete hip replacement.

    Again, talk to your doctor to better understand what they objectives are.


    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • LizLiz Posts: 9,445
    edited 08/30/2017 - 1:32 AM

    I am in UK too, I was offered ESI because of the pain but when I refused (after seeing for me a well timed documentary on depo medrone) my surgeon told me it had to be my choice and not problem at all. 

    I was given another appointment and by then was offered surgery for  severe lumber stenosis which had become an emergency.

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • aamaaam californiaPosts: 16

    Yes Liz. I an concerned about steroids in the spine and the doc that I see uses depo-medrol. If I refuse he probably will just show me out the door. I am also worried about repeated radiation exposure, as I have a history of a few large CT scans and many, many x-rays so the whole thing is a bit unnerving for me. 

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  • If you're seeing an interventional pain doctor, then he will probably only want to do an ESI. Read up on his philosophy to understand his approach to pain. If you want something more comprehensive, try a different doctor.

  • Certain Injections can/may be be required by your insurance company before surgery or other procedures are allowed.  Medicare requires lidocaine injections into the neck before a RFA is approved.  The injections must give 80 percent pain relief over, I think, 24 hours, as told to me by my PMD.

  • MrNyleMrNyle Posts: 101
    edited 10/23/2017 - 10:03 PM

    Yes, I have always refused ESI.  The reason I refused them is because they're not FDA approved for use in the spine.  The FDA also has a warning about them on their website.  There's a youtube video called "Dr Oz Dangers of Epidurals" which talks about it as well.  The National Library of Medicine (which is run by the U.S. government) says that there's about a 6-16% of getting adhesive arachnoiditis from epidural injections into the spine.  That's a severe chronic pain condition which has no cure.

    I printed out the quote and read it to my doctor and they got angry with me.  They were like "well I've never seen it happen with any of my patients".  And I told them that I'm still not doing it.  So then they were blackmailing me and said they weren't going to change my meds until I did the injections.  I found another doctor that wasn't so nasty about it.

    Here's the quote from NLM...

    "many other patients develop other complications that go
    unreported/underreported: Other life-threatening infections, spinal
    fluid leaks (0.4-6%), positional headaches (28%), adhesive arachnoiditis
    (6-16%), hydrocephalus, air embolism, urinary retention, allergic
    reactions, intravascular injections (7.9-11.6%), stroke, blindness,
    neurological deficits/paralysis, hematomas, seizures, and death."

    Here's the quotes from the FDA...

    "The U.S. Food and Drug Administration (FDA) is warning that injection of
    corticosteroids into the epidural space of the spine may result in rare
    but serious adverse events, including loss of vision, stroke,
    paralysis, and death."

    "The effectiveness and safety of injection of corticosteroids into the
    epidural space of the spine have not been established, and FDA has not
    approved corticosteroids for this use."

  • MrNyle,

    You are so right about side effects

  • dilaurodilauro ConnecticutPosts: 12,230

    The FDA has held off and keeps the warning about the Potential dangers of using Catabolic steroids for ESI.  Anyone considering an ESI should read up on them.  There are many articles, videos etc dealing with ESI.   As far as the warning given, think about the warning posted on all cigarette packages about causing death.  How many people do you believed stop smoking because of that.

    ESIs have become so common and when administered correctly should always be safe and without any pain.  The bigger question is DID the ESI help or not.   I would love to read statistics on the success rate of ESIs.   When I look at the number of posts we have hear about them, I would say they are about 40% successful (but thats not medical proof, just sampling of comments)

    I believe the decision to have an ESI should still rest with the patient, but also remember that how widely they are used not only for pain relief but for diagnostic approaches.


    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
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