Shot (epidural) in the Back

Just got to enjoy a steroid injection to the L5 region. After a couple years of increasing trouble walking distances I finally saw a Doc, got an MRI, tried some PT, and today's treatment was the next step before surgery. Stenosis and age is pretty much the diagnosis. I was not expecting the pain during the injection. Dye was first used and the pain in my leg nearly made me pass out. I think I scared them a little. Good. Of course it'll be worth it if I can walk more than fifty yards before having to stop or sit a minute.

Anyone out there had good experiences with back injections, or have they just postponed surgery?

Geoff

hmm im not sure if you are having the same thing done as my dad. sounds like it. (never looked it up in english but shots in the back to lube and numb them sound so familiar to me... it is rare treatment i believe but common to my dad)

my dad has been getting shots between his disks for ..hmm i dont recall ..three years now..? about 6-8months apart he gets a shot in his back every few weeks for 3-4 weeks in row.

shots right in between the disks. and he has said that the 1st time it hurt like sob but/and followin ones have been easier. it is mainly something to do with the doctor and his skill and learning to do it right to your back. all are different they say. and if done little off/wrong it hurts more and bleeds more. also the numbness of his feet stay on longer.. (calling it numbness is a bit lowballing it in his case.. but ability to use the legs.. brief (few hours) semi paralysis or something) a bit too deep and they pucture the spinecanal and can cause hell of troubles and infections.

it takes a certain size needle and just certain location to push it in and pull out and also some modification on the shape of the needle on my dad.. (the doc bends it ever slightly to gain better access to area where it goes into the location the best.. or least restiction)

as far as i have witnessed it helps him. the aches do go away for few months. and he can function a bit better. (three bulging and worn out disks on top of each other in his back..) one or two should be either replaced by titanium disk (as has been done in his neck few years back) and/or should join/lock the vertabraes permanently. as time passes between the shots it gets worse faster now than it did in first sessions. so i guess the back gets more worse still and the shots wear out sooner and pain returns faster.

they are trying to postpone the surgery. one he is already an "old guy" over 60 and has been retired by sickness for decades. so they are not very energetic in getting him fixed any more. if he would be younger and in working force things might be different.

they are not sure how it would go if they would try to operate the disks and vertabrae. as he has other underlying problems with his neuropathia so he cant stay in bed the time it would normally take to heal from the surgery or he might not get up at all anymore. his last few nerves in his legs and hands would/could just shut down during the time he would be stuck in bed.

he is some kind of medical miracle that he still somehow is able to move around on his own feet.. well sorta. it is more half controlled falling foward than walking.. but persistant fighter he is. just refuses to lie down and go into wheelchair. originally he was diagnosed to be in chair around the time i am born or by the time am starting to walk.. years 77-78. still havent stayed in wheelchair more than few days when things have been worse.

like the time the disk in his neck pressed the spinecanal so tight that paralized his legs.. surgery helped for years..now there is 2 more disks in his neck that could be replaced the same way if they would want a perfect health.. one above and below it.

and 2-3 in his back. same thing when the back pains got too hard and before the back was numbed by the shots he could hardly move. -and to say that from him (cant walk or get around) means it wasnt a little pain or numbness.. that is normal. well. numb is his middle name. he can walk a day in rubber boots without actually knowing that there is fistful of nails inside

all these spine problems are caused mainly by his nerve disease that stops his muscles to work and hence no support to the spine. i think it was 10years ago that they diagnosed he had 70-80% of all the muscles in his arms and legs gone and the rest try to compensate. nerves just seize giving inpulses foward.

sorry for long response. i just got started and couldnt stop

and what has our dad beeing doing today. the part invalid that shouldnt even walk. and definately could be paralysed or dead on every time he falls down or stumbles if he hurts his neck or back. (and he falls down constantly btw. once a day is a good day)

he is in the woods picking blueberries. on his own. yesterday he was mowin the lawn. and tomorrow he is going to help my sister in their house renovation. its all in attitude. some are stubborn fighters.

hope your back gets few years of working time before trying the more drastic surgery. just do not wait too long that it gets destroyed too far. (if its cortisone it also "eats" away bone and such in long run)

My problems aren't too different from your Dad's, NonSenCe. Maybe I'll get some good results from this, but if I read what the Doc didn't quite say, I think he figures it will require surgery. I'll definitely be getting a second opinion.

This hasn't been bad enough to stop me from mowing and gardening. It's funny, but pushing the mower (slightly bent) doesn't bother me at all. Guess that's not too far removed from a walker.

Thank goodness my wings still work.

Geoff

I would highly recommend seeing an Osteopath (they are MD's). At the very least, if the proper support muscles are not stretched and toned, it will only make your back/lowerback/knee issue worse. Proper foot and arch support is also very important. I know how painful chronic back issues can be so I wish you the best of luck.

I'm 33 years old now and have my first injury when I was 24 years old which caused HNP (Slipped disc) between my L3,L4,L5 and S1, so in total there are 3 total disc slip. At first I tried medication such as traditional chinese massage which includes relaxing the muscles first, then it was kind of pulled and in between 2-3 sessions, given the injections to ease the back pain. After having about 15 sessions in a row, I decided to stop the treatment because it would seem that I got dependent on the treatment, and it's like having my "normal" life only for about a week before the pain, numbness and everything comes again.

At least the last doctor that I visited gave me other options should I really stop this treatments and that includes :
- sleeping on flat and rough material, in my case I use wood covered with very thin sponge about 5mm and cover bed. Flat bed tend to force your muscles to stretch out which will eventually relax your muscle
- Doing some fitness, and strengthening especially the abdominal and back muscle by doing some sit ups and burden lifting using your back muscles. By strengthening these muscles, the cervical disc burden is half supported by the muscles and lessening the tension on the disc
- try to go on diet if you're little bit overweight. In my case I'm 170cm height so the ideal weight would be 70kg. So being 80kg doesn't really help easing but rather giving more burden to the spine.
- Try not to lift objects heavier than 5kg, especially from bowing down position. If you really have to lift it, just squat down first and lift up using your leg muscles, rather than back muscles and spine.

Based on those advice, I managed to keep me out of surgery for 6 years. The scariest thing is that how well the advice is that eventually I don't really feel the pain anymore but the slipped disc is still there and seems to got worse because I don't heed the advice especially about the burden limitation because I've been carrying backpack with photography equipment with at least 12 kg weight. So in the end in the MRI comparation in 2001 and 2007, it was shown that my spine is only 10% active because the rest is compressed by the disc.( imagine a channel/river that has 10 metre width and 9 metre of it is blocked by big rocks). Finally took the jump to have the disc removal and decompression of the spine on 2007 just 4 months before my wedding.

Hope the sharing helps.

I had a compressed disk a few years ago that led to shooting pain down my right leg and eventually numbness in my foot. It seemed like I could only walk shorter and shorter distances without getting the pain and numbness. The first doctor I went to sent me to an anesthesiologist for a series of 3 steroid injections which he said usually cured the problem. The shots weren't that painful, but they didn't help at all.

Then I went to a seminar being given by a Penn doctor on back pain. He said that the injections were not a cure, and that the only reason for getting the injections was to relieve the pain to enable you to start physical therapy. I told him I wasn't in pain that would prevent physical therapy, so he prescribed 6 weeks of physical therapy. He was very particular about which physical therapist I went to, and after talking to a few other people I can see why. Physical therapists are all over the place in terms of the methods they use to treat problems like this.

To make a long story short, after 6 weeks of physical therapy focused on stretching and strengthening the muscles that support the lower back and a regimen of stretching exercises over the next 6 months, I was symptom free and pretty much have been ever since. My wife and I do 6 mile walks on the weekends without any problem. A few years ago, that's something I never thought I would be able to do again.

tygger said:

I would highly recommend seeing an Osteopath (they are MD's). At the very least, if the proper support muscles are not stretched and toned, it will only make your back/lowerback/knee issue worse. Proper foot and arch support is also very important. I know how painful chronic back issues can be so I wish you the best of luck.

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I'm sorry but Osteopaths are not M.D.s. They are D.O.s or Doctor of Osteopathy. It's a different medical degree, they go to DO school, a different type of medical school than MDs do. It is easier to get into than allopathic medical schools. They do however function as physicians in most specialties in most states. They do however get extra training in OMT or osteopathic manipulative treatment which is along the lines of chiropractic manipulation, which may or may not help in back/neck pain.

Find a good pain management specialist and PM&R (physical medicine and rehabilitation) doctor and hopefully you can avoid surgery, but surgery may be needed and then you'll have to find a good spinal surgeon,which will be another pain for you altogether. Orthopedic surgeons and neurosurgeons both can do spinal surgeries. Neurosurgeons mostly deal with the spinal cord it itself (tumors, epidural abscess, etc) while the orthopods will deal with fusions and scoliosis etc... but even then you need to find one that specialized in spine surgery, meaning they should have done a spine surgery fellowship and most of their cases deal with the spine. Wait, where was I? Oh yeah, the injections mostly just treat your symptoms (pain) and some may give you steroids (which fight inflammation) but your underlying pathology (likely slipped/inflammed disc or spinal stenosis) will not be treated or reversed with these injections. With surgery, if successful, you may live a pain free life, but with injections, you live pain free for a period of time in between injections, but then again live with the pain when the injections wear off.

Best of luck with your back pain and pain management.

There have been a few threads on back pain here.

The fact that bending in certain directions relieve the pain point directly at a nerve that is pinched by a bone or a protruding disk.

A GOOD physical therapist can help work with that. How you sit, how you lay down, how you get in and out of a car are all areas they can work on. The PT did such a good job that I ALMOST decided against further treatment.

When you are lucky, the area around the nerve has become inflamed and that has caused it to swell, which causes it to rub which contributes the inflammation. The idea behind the steroid in the injection is to reduce the swelling and break the cycle. If the cycle is broken you will have a long pain free period. If you are really lucky that may mean years.

If you are not so lucky, the disk has collapsed to the point where it no longer keeps the bones apart enough to let the nerve through. Or the disk has developed a bulge that is pressing on the nerve. Or there is a bony growth that is pressing on the nerve. There are multiple treatments for that too.

In my case they did a Microdiscectomy. That is micro surgery where the doctor removed a small piece of bone and snipped out the protruding part of the disc. Between the two, there is now enough room for the nerve to pass unhindered. I was able to walk out of the hospital that afternoon pain free (well, except for the stitches in my back) for the first time in years.

There are risks in any surgery. The epidural is also risky, but less risky than most back surgeries. A bad epidural can leave you crippled (and sometimes dead). It pays to find a doctor who does them daily, not one that does them occasionally.

The best course of treatment (in my opinion) is the epidural to treat the current condition and top flight PT to find environmental causes.

Good luck

Daniel

Thanks for all the tips, folks. It appears that the shot has not helped, but it's only been five days. It would certainly be nice if PT would help. Might be time for another opinion, too. I'll see what the Doc says in about a week.

Geoff

i had 2 shots between the discs done, in 92, they were to take a sample liquid from the brain. (they said liquid from the brain and the spine are the same )
i remember a was on the side, wasn't laying straight, but doc bent my spine in a some sort compound bend, that he inserted a needle like 4-5 inches long, i didn't feel a thing, i was not under anesthesia, no such thing was used in ussr for that, (even root canal was done with no anesthesia)
i remember doctor asking if i felt pain in my leg, i didn't.
it is all depends on doctor, twice in 2 weeks i had it done, no pain whatsoever.

CaseyS said:

To make a long story short, after 6 weeks of physical therapy focused on stretching and strengthening the muscles that support the lower back and a regimen of stretching exercises over the next 6 months, I was symptom free and pretty much have been ever since. My wife and I do 6 mile walks on the weekends without any problem. A few years ago, that's something I never thought I would be able to do again.

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yep. muscle development in certain areas does the trick.

- a guy comes to a doctor, tells him his problem, doc checks him out, and says, thanks good you got to me in time, if you waited few more days....
- the guy asks, what?? would i die??
-the doc says, no , you would get well on your own.

Flying Turtle said:

Just got to enjoy a steroid injection to the L5 region. After a couple years of increasing trouble walking distances I finally saw a Doc, got an MRI, tried some PT, and today's treatment was the next step before surgery. Stenosis and age is pretty much the diagnosis. I was not expecting the pain during the injection. Dye was first used and the pain in my leg nearly made me pass out. I think I scared them a little. Good. Of course it'll be worth it if I can walk more than fifty yards before having to stop or sit a minute.

Anyone out there had good experiences with back injections, or have they just postponed surgery?

Geoff

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There are 2-3 excellent replies. I think Daniel gave the best 'visual.'

Stenosis can refer to the narrowing of the space that (in your case) the sciatic nerve passes through because of a compressed disk and/or pressure on your cord at the L5 area due to inflammation or a bulging or herniated disk. What specifically would be done if you had surgery?

It all depends to what degree your condition is. If you have inflammation causing the 'cycle' and the physical pressure is minimal, relieving the cycle may do the job. You will need to strengthen your back (core) and stretch.

The treatment that you received is usually done 2-3 times for maximum effectiveness. I had two injections when mine was done. I received relief from pain, but not for me to resume normal activities. I was able to move around, walk, etc. without pain, but anything strenuous would cause pain.

I was not instructed to strengthen my core or take PT. If I had, there's a good chance that I would have had better, longer lasting results.

My recent miracle was inversion - hanging upside down on a Teeter Hang Ups inversion table. There is a thread here in the Cafe and I'd suggest that you read it.

My pain had become severe and constant. I became sedentary and gained about 30 pounds. I used a shopping cart as a walker in the grocery store and Walmart and still would have to stop and rest.

I gained much of my mobility back after 2 days of inversion and was about 80% pain free in 3 weeks.

I now walk 2.3 miles a day and have lost over 25 lbs. I invert at least 1-2 times a day (3-5 minutes) and do crunches while inverted and pull ups when I finish.

Strenuous things still bother me, but I can do more and more with less pain and I can recover in just hours (or overnight) by inverting. Sitting is my biggest problem, which is why I say that I'm 80-90% pain free.

I just got a 'BackJoy' for sitting and it does seem to be helping. I got Lynco ortho inserts for my shoes and they have been miraculous, too.

The shots you got may be a pathway to recovery, but are not in themselves a cure. I would do everything possible to avoid surgery. I can't recommend inversion enough.

The other thing that I would highly recommend is decompression therapy. It's 'traction on steroids.' They typically have an 80-90% success rate and it's completely non invasive. It's offered by Orthos, Neuros, Chiros and Osteos, but mostly by Chiros.

I'm not a big fan of Chiros mainly because most are slow to pass you on (if ever) to other practitioners if their treatment is not successful. My choice is Osteos, they are 'considered' as MDs, or are at least fully recognized by the AMA.

Neuros and Orthos do surgery. It's a fact that areas that have large numbers of them, have large numbers of surgeries. I am not against surgery when necessary, but I think many more surgeries are performed than are necessary.

Good luck. I hope you have quick relief.

About 4 years ago I started having epidural injections for a problem that started in 1991. I bent over a bit too far putting something down. Sciatic nerve damage and compressed, bent spine. My Spinal Pain Management Doctor is a DO and he is recommended by every Orthopedic Surgeon in Northeast Florida. It worked well for awhile.. Then we went to Radio Frequency Ablation which helped for awhile. June 2, 2008, I had L4-5-S1 fusion and the sciatic problems have been gone since. Stenosis is still there and severe arthritis in my neck is still there requiring RFA about once a year and Tramadol 3 times a day. I hate taking the shots but even if they just delay surgery, if you get the right person it is well worth it.

As far as DOs? A bit off topic but, I have to defend DOs. The BEST ENT in Northeast Florida is a DO. Magic fingers in the OR and she has solved problems I had for 20 years and it's just, "Oh yeah, we can fix that easily." And she can. It doesn't hurt that she is by far the most beautiful person I have ever called Doc. But this DO is a far better physician than most MDs and a lot of her patients are MDs. She does a wonderful sleep-apnea surgery that works.

And I am 68 so YMMV.