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advise - RAF vs Epidural Injections

baffledbbaffled Posts: 375
edited 06/11/2012 - 7:46 AM in Neck Pain: Cervical
My RA doctor wants me to be referred to a PM doc for an epidural injection for the bulging disk. I guess she doesn't realize that I have a pm doc....but anywawys....I have gone thru the diagnostic injections and then the RAF from c1-t5 in 2008. It gave me some pain decrease and increase in ROM, but the back between the shoulders to sternum, it never touched.

My question is this, Since the RAF was only minimally successful, is the epidural about the same? She said to forego the PT since we have been treated for that 2 times at PT. This was all via the phone. Have I already tried the epidural sorta of since I did the RAf?

thanks for your advise, patti


  • when I had a RFA the doctor explained it to me as he would be burning nerves, cauterizing them with a small electrode that is inserted thru the needle. All the epidurals I've had have been injections of pain killer and anti-inflamation medicines. So to me they are very different proceedures. I had extreme pain levels recovering from the RFA, those nerves were very angry for about 10 days. But once they died completely..the relief was adequate. just didn't last very long for how much the proceedure hurt.
  • Is that RF's are intended and mostly benefit when the issue is facet pain, such as facet arthritis, or nerve pain involving structures of impingement outside the spinal canal (epidural space); like where the nerve roots exit the spine. The epidural steroid injection more to decrease pain within the epidural space - such as herniated/bulging discs, compressed nerve roots, etc.
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  • When you put it that way, it really makes sense. When I did have the RAf (nerve burning) it was before I had had the mri of neck....in 2008. and their thinking was the facet joints. I have lots of pain in my elbows - but not alot of numbness in my hands.

    I am going to get my new mri pics and have them to take to the pm. it will be interesting to see if there are changes in my mri. The one in 09 was taken at one hospital and these thru another (my RA's hospital).

  • I agree with Optimist about the difference between an RFA and ESI. For my lumbar issues, I had a bulging disc, stenosis and facet hypertrophy (swelling) as well as loss of lubrication and was initially treated with an ESI and facet injections. The ESI, along with a Medrol 5-day pack (to reduce inflamation) took away the sciatica that the bulging disc was causing and it has never returned. But the facet injections did nothing for the stenosis and facet joint pain. So they did a diagnostic nerve injection to see whether an RFA would help the remaining pain and it didn't, so they decided that the stenosis was too advanced for an RFA to help.

    However, with that said, that was all lumbar, not cervical. I think that cervical is a little more difficult to treat with injections, but the results differ from person to person. I'm glad to hear that the RFA helped you with your cervical bulging disc.

    It also could be that the remaining pain you had between your shoulders could be muscular, thus having muscle ralaxants could help with that pain. Obviously I'm not a doctor and this isn't a difinitive answer to that pain, but it might be something to talk to your doc about if your upper back pain is still there and you're not taking any muscle relaxants.

    Take care and please keep us posted.

  • I am caught in the agony of cervical pain. I tried the facet joint injections and when I told them it was a failure they ordered me for an epidural, and that didn't work either.
    My MRI showed 4 bulging discs but the NS said he didn't think that that wasn't causing my pain. What in hell's name am I supposed to think is going on. He blew me off ordering accupuncture, a soft collar,and a referral to a PM doctor he knew well. I find it hard to believe that just inflammation is causing this constant torture.
    Sometimes I think it's easier to check out of life so there are no more test and useless dr.'s visit.
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  • I also had both (although lumbar) and I was the opposite- I found the RFA more helpful than the ESA the first time. The second time (after I took a couple of falls and really annoyed my lower back), the steroid injection was really helpful.

    So... it totally depends on what is causing your pain. If the inflammated tissue is in the epidural space somewhere, like an interior herniation, the ESI is going to be really helpful, because the steriods are going to relieve the inflammation of the nerve and make it forget it thought it was injured. If the inflamed nerve is in a facet joint the RFA is going to work great. If you have both, you'll love your PM doctor.

  • happyHBmom said:
    If the inflammated tissue is in the epidural space somewhere, like an interior herniation, the ESI is going to be really helpful, because the steriods are going to relieve the inflammation of the nerve and make it forget it thought it was injured. If the inflamed nerve is in a facet joint the RFA is going to work great. If you have both, you'll love your PM doctor.
    HBMom, Seeing your summary in black and white makes it appear simple. Oh how wonderful life would be if only it were really that easy.

    Patti, I hope whichever procedure you end up with gives you some relief. It seems as if many times doctors have to try different procedures before finding what works for each individual patient. Listen to what your doctor tells you is best for your situation. There are videos here on this site that will illustrate the different procedures. A quick search using the search box at the top of this screen will bring up some interesting things to view and read. :)

    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • Hi Patti..Firstly what is a RFA?? I live in Australia and havnt hear of it before..

    Ive so far had 16 procedures where they inject steroids into your facet and SI joints and then they have burnt the nerve endings..Here in Australia its called "Epidural Catheter" as he always has to insert the needles via an epidural to reach other areas of your spine...I found this to be of great relief to my hips and lumbar spine but no relief from thoraic pain and now Im going to trial 2 stimulators, one in the Thoracic and the other in the Lumbar region

    The last session last week , the PM couldnt even get a needle thru the scar tissue and adheshions around L4/5.

    Personally I didnt mind going into hospital every 2 weeks to have it done as the overall drop in pain level was enough to make me keep going..
    Always remember its your body and you are the one to make the ultimate decision.
    Take care
  • i have made the appointment with my pm - and don't get to see him until oct 6...but I have decided to follow my RA doc's opinion and get the epidural.

    Shelly - from your discription - that sounds like the RFA procedure here - just a different name.

    I figure at this point I have nothing to lose and maybe this will give some relief.

    what complicate things for me is I have Lupus - which is an autoimmune disease - the body fights itself, there is inflamation and lots of pain. But I have been able, with my RA doc's help to get that under control. But it is tough for a patient to hear, yes you have this bulge/herniation, but that is not causing your pain....then what is?

    I can tell you my right foot is numb @ 50 % of the day, my big toes go numb every time I lay down...which tells them I have a lumbar issue as well..but there is only discomforting pain that bothers me when I drive for long. I don't care about this because there is not the constant pain as in my neck and upper back. So why can't it be the bulging disk?

    oh well - please take care all
  • Good luck with your epidural(s) I've had to have a series of them if the first one provides some relief. It's really helped my sciatica pain, numbness and tingling a lot as well as I take Cymbalta for the sciatica also and have up to 40% relief from numbness and tingling. Although I did have a L5-S1 herniated disc and tear that's resolved I still had nerve pain from compression somewhere as my PM Dr. says if you have sciatica there's inflammation somewhere and the epidurals would help me. And they have. Of course not everyone gets relief but hope you do. Take care. 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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