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Sinem84 posted:
I have slipped discs in my back and my family doctor had given me pain medication and muscle relaxers. He then referred me to a pain management doctor. Well, this doctor wants to give me cortisone injections and burn the nerves around the discs every so often. I told him that I don't feel comfortable with injections or the burning thing. He told me its the injections or nothing. Why is he pushing injections? Would he make more money by giving me injections rather than prescription medication? Is injections my only option or do I need to find a new doctor?

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davedsel57 responded:
Hello, and welcome.

I have never had the steroid injections nor am I able to take prescription pain medications. Click on my user name or avatar picture to read my whole story. I've been managing moderate to severe chronic pain due to multiple degenerative spinal conditions for over 30 years.

From what I understand, the injections are a way for the doctor to earn extra income. Statistics show that there is only a 50% success rate in pain reduction from injections. The burning of the nerves, aka 'nerve ablation', is a permanent procedure that also does not have the best success rate. BTW, I voted "No" in your poll.

There are many other ways to manage chronic back pain. Prescription medication is a good option if you can find one that works for you with minimal side affects. Physical therapy helps many, and even more helpful is hydrotherapy - some type of activity in water. My wife and I invested in a hot tub last year and it was one of the best investments for our heath ever. We also invested in a Sleep Number bed and that has also helped a great deal.

Keep doing your research regarding all pain management approaches. Yes, if you don't trust or like this doctor it may be time to find someone who can work better with you to manage your pain.

Praying you can find the solutions for pain relief soon.
Blessings, -Dave
 
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fenton04 responded:
First of all good luck on THAT poll. I let the poll slide. On my 2nd injection I was standing in the window registering. I looked at my watch when I started. 5 minutes later I was in agony. My pain was at 6-7. Sitting and laying down was my only comfortable positions. I got the shot and I could feel the pain subside in my back to a dull ache. I was immediately able to stand for long periods of time almost pain free. Me I would pay any amount of money to be free of the most horrendous pain I was subjected too when the disc bulged at S1 L4 and L5. Maybe one can take solace any doctor who treats himself has a fool for a patient. Good luck in all your future endeavors.
 
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bj1208 responded:
hi Sinem84 - like Dave I don't have good thoughts about the injections or the nerve ablation procedure - i went through 2 pain mgmt docs before my surgery - i had all the injections(there are so many ways they can inject - i had too many to remember) and I had the nerve ablation done 2 times - the only relief I received was from the numbing agent that was used which only lasted for about 30-45 minutes. then had my surgery (Anterior Lumbar Fusion L5-S1 was 2 1/2 years ago) and have had numerous injections, spinal cord stimulator implant trials, TENS Unit - you name it and I've had it done - only thing left is the pain pump - which my husband and I keep discussing it -

so now that I've had surgery and my L5-S1 disc removed and a plate, screws and cage put in place - the pressure has messed up my back - now I have 3 more bulging discs - L4, L3 and L2 - saw surgeon but he said cause of chronic pain issues surgery is out as it would only add to my pains (I also have nerve damage in both legs).

So - If I knew then what I know now then I would have never had the procedures done - as I said I had gone to 2 PM docs before my surgery (change jobs/changed ins) and all they want to do is push the injections - they make quite a bit of money doing that - at least $1500 where I live - and that's a lot - no to mention the other procedures -

BUT - there are quite a lot of people who do get relief from the injections - and as Dave says it's a 50/50 chance - we are all different and react differently to everything - from procedures, surgeries etc.

hope this helps - you will get good responses and not so good responses. take care - Joy~~
 
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DUKE MEDICINE
Joe T Minchew, MD responded:
Unfortunately, it is difficult to tell from your description of your symptoms and situation as to whether your major problem is lower back or leg pain. As I have indicated before, this is a key distinction with respect to the appropriateness and potential efficacy of various treatments. All the injections that spinal specialists recommend or perform are "cortisone" injections. They are usually a combination of a local anesthetic (numbing agent) similar to Novocain and a steroid. The "success" rate of these injections varies a great deal depending on the injection type and the problem being treated.
Based on the information and your comment about the recommendation to "burn the nerves", I am assuming that your major pain is back pain. I am also assuming that the recommended injections are facet injections. Facet joints are the small joints in the back of the spine that work in conjunction with the disc (also a type of joint) to allow the spine to move. While the discs and facets work in cooperation and aging of one affects the other, "slipped discs" are a different issue than facet joint pain. The facet blocks or injections are either an injection of medicine directly into the joint (like a knee injection) or of the medicine in the area of the very small nerve branches that supply the joint. If the "facet block" provides significant relief, then a facet joint nerve ablation is considered a more "permanent" way to treat facet pain. This involves using a radiofrequency "probe" or needle that heats up at the tip to "burn" the nerves. I put permanent in quotations because these small nerve endings can grow back as the treatment does not destroy the nerve cell just some if it's branches. A procedure to "burn the small nerves supplying the discs would be very different and I assume this is not the procedure being recommended. As Joy and Dave indicated the scientific evidence as to the effectiveness of injections is limited, particularly with respect to facet injections. Furthermore, no procedure is without possible risks or side effects and any patient can have significant reactions to procedures and medications. However, the risks associated with this procedure are very small and if all other treatments have failed, it may be an option.
Epidural injections are also cortisone injections. They are usually used to treat leg pain. There is also limited scientific evidence supporting epidurals but there is more than that for facet injections. Approximately 75% of patients will respond positively to an epidural injection. Unfortunately, the positive effects are temporary for many patients and can last from minutes to months. It is impossible to predict if any given person will have long term or short term improvement. If the patient responds positively to an epidural with effects longer than just minutes to hours, they may be a candidate for 1-2 more injections over a period of weeks to a few months. Most physicians feel like patients should not have more than 3-4 epidural injections in a few month period. The injections can be repeated if they have been effective and a significant period of time has passed since the last injections. One study demonstrated that in patients with herniated discs and sciatica, less patients had surgery in the end if they had a special type of epidural called a transforaminal injection.
While clearly the physician performing the injection is reimbursed for his or her work and there are some "injection mills" out there, the majority of physicians are very conscientious about ordering injections. Furthermore, while there are possible sided effects of injected cortisone (increased blood sugar in diabetics) the risks are much less than oral steroids or even many other oral medications. As long as the physician is not recommending numerous injections, more than 3-4, it is not an unreasonable treatment option.

Good luck!

JTM
 
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Geradine4733 responded:
I had the cortisone injections in my spine in 2002, 2004, 2006, and they did not hurt nor did they help. I had them done by a Pain Doctor but I had a cortisone injection in my knee, and that helped. my knee.

I found the Pain Doctors pushed injections, procedures, their psychologist, etc. When I refused anymore of the above, they pushed the SCS and the Pain Pump, etc..

I felt that they were in it for the money because nothing they did for my spine helped. I now go to my Primary Doctor. He helps me more than the Pain Doctors did.
 
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maltlover replied to davedsel57's response:
After 6 lumbar surgeries and 1 cervical (2 levels), I don't think I could survive the pain without the cortisone injections. I get no more than 3 a year as my pm is very cautious...as he should be! I have also had nerve ablations done twice and both time found them to be very helpful. While it is true that there are some who don't get relief, I have found that technique is a big part of that. Of course, there are always people who just don't get relief, period, but I am happy to try just about anything if it will lower my pain levels, as long as I am well-informed and know that my doctor is very proficient at his job. Too many pm's do use the steroids unwisely because it pays well, but a responsible, caring and informed dr. won't do that.
If you don't have confidence in your pm, keep looking for one that you can trust. Best wishes.

Carol


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