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Injection differences - many questions...

AnonymousUserAAnonymousUser Posts: 49,290
edited 06/11/2012 - 8:27 AM in Spinal Injections
Hi everyone. Even though my post count would indicate that I'm new here...I'm not. I've been around for a long while (back when the old forums existed).

I'm looking for some information on the various types of injections. I've already browsed extensively through the "Treatment" section, and read up on all there is out there on spinal injections.

Quick rundown of my situation. I'm 43yo female, who has been very active most of my adult life...and I would really like to remain that way for the remainder of my life. I have grade 2 spondy at L5-S1...along with severe DDD. I basically have no disc left at that level...it's pretty much bone on bone. I used to have terrible sciatica in my right leg, but that is completely gone now (yes, it REALLY is!)...thanks to daily use of my inversion table at home. But the low back pain remains, and it all but consumes my daily life. I feel it when I wake up in the morning, and I feel it after sitting for long stretches of time. My back just feels like it tightens and stiffens up almost the instant that I stop moving around. Exercise, for the most part, makes my back feel good...with one exception...running. I used to enjoy running, and lost tons of weight from running. But lately, whenever I run (even if it's on a soft surface), it feels like someone is taking a baseball bat to my lower back. I feel bone-jarring, crushing pain that recently has been extending into my left hip area...mainly the iliac crest region, which is the boney part of pelvic bone near the waistline. I am convinced that this hip pain is related somehow to my lower back issues.

I have already been to a NS, been through 6 weeks of PT...nothing has changed...other than my sciatica being eliminated through my own course of action. I have made the decision that I would like to try some kind of injection...but I don't know which one would be right for me. Based on what I've read/researched...a standard ESI sounds like it's more of a benefit for those with sciatica, instead of low back pain. The success rate for ESI given for low back pain seems to be quite low.

I guess my question is...if I get a referral to an ortho, and after his evalution, he sends me to a PM...who chooses which type of injection I will receive? Would it be the ortho doc or the PM? And do they always start a patient off with a standard ESI, just to see if it works? Or is it possible that I might be given a medial or lateral branch block, or trigger point, or facet injection right off the bat?

Sorry for the long post, but this has been weighing on my mind for some time now, and I really need some answers. I'm sick of this chronic low back pain and I'm ready to take the next step. Thank you all!



  • esi did nothin for me
  • dilaurodilauro ConnecticutPosts: 13,573
    perhaps most effective for low grade pain are the Trigger Point Injections.

    1- They can be done in a doctor's office without any special setup or operating like room environment.
    2- Multiple injections can be done in one visit
    3- The are really painless

    I have had about 25 different trigger point injections over the past 30 years. I would have to say the success rate has been in the high 90's. Some times those injections provided me with enough pain relief to get me over a hurdle. Many times that is just what we need, something that can move us on to the next stage without a lot of medication.

    Trigger points are done very easily. The area is first semi-frozen (standard cold sprays). The lidocaine based fluid is injected using small needles. You feel just a small prick and its over. Important thing to do is ice the area for at least 15 minutes after the injection.

    If these dont work, then you need to look at the more heavy duty injections.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
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  • I had 6 weeks of trigger injections and then the PM Dr did 2 ESIs then 2 more weeks of trigger injections. I've had it with trigger injections and felt they did a little relief. I went to another PM Dr who gave my 3rd ESI with Depo medrol instead of marcaine and 4 facet joint injections for L5-S1 area using lidocaine. I had some relief from the ESIS for leg pain and the facet joint injections helped the lower back. I'm going back for probably steroid facet joint injections next week. I hope to get a Rhizotomy to that area to burn the nerve if theses steroid injections fail. One year out with backpain, I'll try anything before surgery since no compression of nerves due to EMG readings. Good luck and hope something helps your backpain. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
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