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Several Epidural Injections and Side-effects
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BrandiG79 posted:
The neurologists that I was seeing, for Fibromyalgia and sciatica, administered 3 or more epidural injections EVERY month. Every three months, he would perform a RFA (radio frequency ablation), sometimes in multiple sites.
This system of treatment went on for two years with no improvement. I decided to seek a second opinion and have been diagnosed with RA and Lupus.
Since the epidural injections have stopped, I am experiencing physical and hormonal side-effects.
Is this normal? What is the epidural injection protocol and possible side-effects to expect after long term, high dose treatment?

I've searched everywhere and can not find an answer.

Thanks in advance!
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annette030 responded:
I believe we all must take hold of our medical care. Why on earth did you keep allowing him to stick you with needles every month for two years if you had NO improvement at all?

The only long term side effect I have found on reading about steroid injections with long acting anesthetic is that you can develop thinning of the bones of the spine adjacent to the injections.

What does your rheumatologist say when you ask him this question?

Take care, Annette
 
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Kelly_30 responded:
Hi Brandi,

I also have sciatica and I receive an epidural every 3 months. I am amazed by the amount of medicine injected and the frequency you mentioned! I have heard of folks getting ONE epidural injection per month at the most. But I never heard of 3 in one month!

My anesthesiologist has already harped on me coming in every 3 months, saying that I am turning my bones to mush so I couldn't imagine the harm that is being done with 3 injections every month for two years!!!

I agree with Annette. Why would you continue this type of aggressive treatment for two years with no relief?

The injections have to be done precisely on the right nerve for them to work well. Have the doctors been using X-rays or other imaging to guide the needle to the correct location? If not, I would RUN not WALK!! It is so important for the needle to be placed precisely near the affected nerve. I have had mediocre injections in the past and also really good injections. All used imaging to correctly place the needle but if it is not close enough to the nerve or the needle moves a hair out of position (I am assuming here...that this is why some injections were not as effective), the pain relief is minimal.

Have they reviewed your MRI? They are supposed to review your MRI to see which nerve is being displaced and then position the needle precisely where that nerve is located through the use of imaging. If they aren't doing this, then it could explain why they aren't working well.

I have noticed even the "good" epidurals have subtle pain relief. The main change that I notice is that pain is not shooting down my legs or my glutes anymore. I get waves of back pain relief that is inconsistent but I take pain meds for that type of pain. The opioid pain meds don't help much with the sciatica, I don't know why that is but if I take an Alleve, I get much more noticeable pain relief from the sciatica. But Alleve doesn't do much for my back pain. I think it muffles the pain for about 15 mins...lol!

Are you taking any OTC or prescription pain meds to combat the sciatica?

Annette, thank you so much for researching the long term effects of these injections! Thinning of the bones does sound mushy. Yikes! I wonder how long it takes for the thinning to progress? 2 years, 5 years, 10 years? Knowing the timetable would help me plan how I am going to treat the sciatica long term. I do plan on asking my PCP for a bone density test to see where I stand as of today.

Kelly
Living one day at a time.
 
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fenton04 responded:
I had a radiculapathy on my left L4 and pain scale was 10 and a 5 on pain medication, I went in for my first epidural and found no relief. On my second visit after the mandatory wait period. When I laid on the procedure table my pain was 10 and after the injection my pain was a 3. After the epicural I was not pain free, Pain scale at worst 7 to 8 and with pain medication 2-3. So not sure why mine worked. But I would be a little wary of more shots.
 
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annette030 responded:
Could we have a professional reply here, please?

I am not sure we are all talking about the same thing. I understand epidural injections to be injections into the epidural space of the spinal column for pain control and/or anesthesia. Injecting the nerves outside the epidural space would be a different procedure, I think?

Dr. Abaci or Dr. Maine, could you chime in on this with proper definitions please?

Take care, Annette
 
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Kelly_30 replied to annette030's response:
Hi Annette,

Perhaps if I clarify that the steroid injection bathes the nerve root (not the nerve) with medication, that would clear up any confusion. I posted a link to a rather educational video that explains the procedure in detail and how fluroscopy (live X-ray) is used to ensure proper positioning of the needle.

Still, I would love to hear a professional's point of view on this procedure.

Kelly

http://www.spine-health.com/video/epidural-steroid-injections-back-pain-and-leg-pain-video
Living one day at a time.
 
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cweinbl responded:

Research suggests that if initial injections don't help, future injections also will fail. Here is a link to the most comprehensive research for all major spinal interventions: http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf . It is also not wise to repeatedly inject steroids over a long period of time. But what scared me the most about your post was the repeated rhyzotomy (RFA). Rhyzotomy needles are large enough to create substantial scar tissue in proximity to your spinal nerve roots. A spinal nerve root impinged by scarring can cause significant chronic pain for the rest of your life. The last MRI of my spine revealed so much scarring from my one (single) rhyzotomy that it resembled a road map of New Jersey.

I cannot respond to your complaint of "physical and hormonal changes," related to the repeated injections. Your description is too vague and general. What kind of "physical and hormonal changes" have you experienced? Describe them.

Annette, there are numerous types of injections near the spine for chronic pain. Yes, the epidural requires injection into the epidural cavity. It's performed under radiography. However, there are also "nerve root injections" and "trigger point injections" used to help manage chronic pain. In these procedures, the needle does not penetrate into the epidural space, but is instead injected next to a nerve root. Finally, there is the rhyzotomy, in which large hollow needles penetrate to specific nerve roots where the nerve is deliberately destroyed. This is also accomplished via radiography.

The long-term success rate for these injections ranges from 40% (patients with prior spine surgery) to about 60% (for patients with no prior surgery). As you might guess, the culprit in lowering the success rate is fibrosis (a.k.a. adhesions, a.k.a. scar tissue). Spinal injections have a low rate of adverse outcome. The risk of paralysis or nerve damage is low. But so is the success rate. All invasive procedures, even injections, should be measured carefully against the likelihood of morbidity. When my first two injections failed, I decided to stop. When my rhyzotomy was a colossal failure, I stopped that too.

It is incumbent upon each patient to educate him or herself about every procedure. There are many "injection happy" physicians who love to perform repeat procedures so that they can continue to bill the patient or the patient's insurance. These physicians are damaging their patient's spines repeatedly when they know that the outcome will be poor - just to make more money. They have apparently forgotten the Hippocratic Oath. Meanwhile, as you can see from the research link above, it is foolish and dangerous to allow repeat injections if the first one or two fail. Let this be a lesson for all who read about it that you must know everything about all procedures before you allow a physician to perform them. Had I known that the success rate for spine surgery was 60% or less, I would never have allowed it. The same applies to injections.
cweinbl csw2@bex.net
 
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BrandiG79 replied to cweinbl's response:
Thank you for all of your replies. I was unfortunate in that I found a very crooked neurologist. I was diagnosed with osteoarthritis at age 16 in my T-spine and have years of pain. I live in a rural town and believed the testimonials given by his patients. I allowed the process to proceed for as long as it did, because my MRI, EMG, NCV, and fluroscope images showed significant damage and myelin degeneration along my entire spine. I've always experienced numbness and pain throughout my body; so, I went along with his treatments. The injections were monthly, but were in various locations. The RFA's were also given in multiple locations. Since I thought my entire spine would have to be treated, I felt that this made sense. However, the doctor never fully addressed my concerns and often dismissed other treatment options. Once I received my insurance statement and saw that he was charging for "surgery" and "anethesia" (when anethesia was NEVER used) at a charge of $2700 per visit, I decided he was dishonest and abusing me and the medical system for financial gain.
The "physical and hormonal" changes I asked about, are due to my menstrual cycle being very sporadic (an issue I've not had previously), as well as depression and weight gain. I've since been diagnosed with rheumatoid arthritis and an undefinable neuro/muscular disorder (by a new neuro and rheumy). I wonder if this possibly was the initial problem, or if it is due to the injections. Thanks again for your wonderful help, links, and support,
Brandi
 
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annette030 replied to cweinbl's response:
Hi, Charles

I thought the same as you wrote about the various injections, however, I have seen people post before and they seem to lump all pain management injections into the same barrel.

I think an explanation by the doctor of each type would be useful just as a learning tool for all of us.

Always good to read your posts.

Take care, Annette
 
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annette030 replied to BrandiG79's response:
I hope you are seeing a different doctor now, particularly perhaps a neurologist to figure out why you are having myelin degeneration at your age.

I don't know how much of your current difficulties are due to the injections and how much you may have had anyway.

Take care, Annette
 
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David Maine, MD replied to annette030's response:
Annette - There are several different ways to inject medications into the epidural space. Once approach is interlaminarly (between the lamina - a "midline injection") which results in medication being adminstered with little specificity. The transforaminal approach is another way to administer medication along a specific nerve root extending into the epidural spcae. This is commonly used in people with unilateral pain in an extremity. Regardless, the potential side effects and complications are similar between the two approaches. The keys to success (as with any procedure) are doing the procedure on the appropriate patient with defined goals. Hope that helps.
 
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annette030 replied to David Maine, MD's response:
Thank you, Dr. Maine.

Take care, Annette
 
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cweinbl responded:
Research clearly shows that if one or two epidural injections fail to help, then additional injections will also fail. You are being misled if they recommend further injections.. See: http://www.painphysicianjournal.com/2009/july/2009;12;699-802.pdf .

It does not make sense that one would experience hormonal changes as a result of stopping epidural injections. Seek another cause. There are also no common side effects from stopping the injections. Something else is causing the "side effects."

Injections are risky; they have their own morbidity. I've never heard of having one epidural per month, let alone three per month. This is dangeous. Not only won't it help, but there is a risk of nerve root impingement. The "protocol" is to have one injection every four months. If two or three injections fail - stop it immediately. Additional injections won;t help and will put you at risk of partial paralysis for no reason. Take control and put a stop to this medieval medicine.
cweinbl csw2@bex.net
 
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jessrasm replied to cweinbl's response:
to have had epidural spinal injections, with the first one i didnt notice anything differant. then 1 month later they did a selective nerve root block.........no change. two weeks later on july 6th i had the 2nd esi and oh my god......i have been in extreme pain ever since! My dr. wants me to go in for the 3rd set of injections on july 19th but because of the severe pain im in, im just not sure what i should do?
 
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RussellWB replied to Kelly_30's response:
Hello Kelly,
I had injections for many years, every kind known to man and then some from L2 down. The Veterans Hospital telling me there were no long term side effects, at 50 years old I was diagnosed with osteoporosis. The answer to your question I'm afraid and I am no medical expert but for me it took 12 years for the damage to show up on imaging because it happens very gradually.
I hope I am wrong about yours but I had injections for 12 years no x-ray guidance was ever used except for the last 12 injections that were done outside the VA. On 4 occasions they hit nerves while doing the epidurals causing permanent damage. Steroids are dangerous but doctors more often than not don't inform you of that part of the equation.
Good luck and God Bless.
Russell


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