Non-steroidal injections??

[jena1225]

Just wondering if they are used by PM's. If so, what do they do and are they as good?

[oh_snap]

trigger point injections.

Here's a link: http://www.neurologychannel.com/tpi/

botox is also an option (depending on condition), but some people don't like the idea of injecting a toxin into any part of their body.

Now, if you are referring to epidural spinal injections (ESIs), I would assume the benefit of that injection is to address "inflammatory" processes, and that usually requires the use of some kind of steroid in the mix.

You might benefit from addressing Lobelsteve, as he is the "king of swing" when it comes to PM, injections, etc.

[lobelsteve]

Just wondering if they are used by PM's. If so, what do they do and are they as good?

I have no idea what you mean. THere are many things this could imply. Toradol is a Non-steroidal injection given in the muscle for acute pain. Trigger points are sometimes useful for an hour to a week of relief from myofascial pain (but not fibromyalgia). A trigger point is best when it is a dry-needle technique, but can contain anything from steroid, to lidocaine, to pitcher plant extract (Sarapin). Diagnostic injections often contain only local anesthetic like lidocaine and are diagnostic depending on what structure is being targeted. Acupuncture would be a non steroid injection. So would EMG. I think blood injected into a tendon is a pretty good option for tennis elbow. Prolotherapy is a non steroid injection- though the literature is of poor quality and the science behind it is not very strong. Sympathetic nervous system blocks can be therapuetic and not contain anything but lidocaine or bupivacaine. I'm sure there are more, but you'll have to pick one so we can narrow in on it.

[oh_snap]

LS,
I think Jenna has MS, so injections perhaps for spacicity (is that a word?)

My personal favorite of "injections" is the one where a radiologist "injects" dye into my spinal cord. ;) ugh. :D

Remember, some posting here are new to PM, and may not be "able" to ask the "right" question, the first time.

I do appreciate that you answered the post in your own "witty" fashion. Have missed that. :D

[Kathi49]

I believe Jena is speaking of injections for her lumbar issues; ESI's, facet injections, etc.

[jena1225]

I have no idea what you mean. THere are many things this could imply. Toradol is a Non-steroidal injection given in the muscle for acute pain. Trigger points are sometimes useful for an hour to a week of relief from myofascial pain (but not fibromyalgia). A trigger point is best when it is a dry-needle technique, but can contain anything from steroid, to lidocaine, to pitcher plant extract (Sarapin). Diagnostic injections often contain only local anesthetic like lidocaine and are diagnostic depending on what structure is being targeted. Acupuncture would be a non steroid injection. So would EMG. I think blood injected into a tendon is a pretty good option for tennis elbow. Prolotherapy is a non steroid injection- though the literature is of poor quality and the science behind it is not very strong. Sympathetic nervous system blocks can be therapuetic and not contain anything but lidocaine or bupivacaine. I'm sure there are more, but you'll have to pick one so we can narrow in on it.

How can you not know what I mean when you pretty much just answered my question?

The question pretty much just that.. What type of injections do PM's typically do that do not include steroids. I thought that was pretty straight to the point.

[jena1225]

LS,
I think Jenna has MS, so injections perhaps for spacicity (is that a word?)

My personal favorite of "injections" is the one where a radiologist "injects" dye into my spinal cord. ;) ugh. :D

Remember, some posting here are new to PM, and may not be "able" to ask the "right" question, the first time.

I do appreciate that you answered the post in your own "witty" fashion. Have missed that. :D

Not exactly sure I would call that witty, sorry :rolleyes:

[jena1225]

Yes Kathi :) I also wanted to ask about ESI's, facet and selective nerve root injections? - they have been highly spoken about but do you know if they contain steroids?

[Kathi49]

Jena,

In my experience yes, as the whole goal is to stop the inflammation and thereby calm the nerve(s) down. And diagnostic as well as therapeutic. I think what you are really trying to ask is....based on your MS and your previous reaction(s) to steroids, what type of steroid would be the best for you. Is that right? And what was your reaction?

[lobelsteve]

Yes Kathi :) I also wanted to ask about ESI's, facet and selective nerve root injections? - they have been highly spoken about but do you know if they contain steroids?

ESI= Epidural Steroid Injection
SNRB= Selective nerve root block
Facet injection

SNRB can be truly selective and involving no steroid, just a 1/2 cc of lidocaine or bupivacaine on the nerve root. The majority of these are actually just a transformainal steroid injection. Where an ESI is interlaminar, a SNRB if a transforaminal ESI- it uses roughly 1/2 the volume of an interlaminar injection.

ESI- 4cc 2% lidocaine, 2 cc normal saline, 2cc Celestone (12mg)
SNRB - 2cc 2% lidocaine, 1 cc normal saline, 1cc Celestone

I know of no two doctors who use the same cocktail of medications in their injections and there is no good science behind the efficacy of one cocktail over another. THere are reports of certian steroids not being as safe as others, but this is mostly hearsay and conjecture.

Facet injections- the literature is pretty weak for injecting into the facet joint directly and pretty strong for injecting local anesthetic to the medial branch nerve that innervated the facet joint. Appropriate guidelines were developed by ISIS (www.spinalinjection.com) where 2 injections on different days using different anesthetic agents to produce near complete pain relief were of sufficient diagnostic accuracy to provide a patient the next step of radiofrequency denervation (neurotomy of the medial branches). No steroids are used in this protocol.

Every time a needle goes in the body- your doctor goes cha-ching, the insurance company goes oh crap, and the placebo response rate is ~33%.

A sharp skill set of performing an appropriate history and physical and a doctor with a modicum of ethics will be able to control your pain in the least amount of expensive pokes with the fewest pills.

If we were to dissect each intervention, we could create a separate thread that could run on and on. So when you ask about an injection- chances are I have a powerpoint lecture on the topic that I teach to my current class of fellowship trainees. Most of these lectures take 45-60 minutes and that is without the lively discussion that ensues.

[oh_snap]

Not exactly sure I would call that witty, sorry :rolleyes:

Jena,
I am sorry, I wasn't clear.

The emg as an "injection" was "funny" [to me] IMHO. I don't think his [LS] intention was to be demeaning (not that he needs to be defended).

I appreciate a straight "shooter" (hahahhahaha) who doesn't mince words.

[Lea]

Every time a needle goes in the body- your doctor goes cha-ching, the insurance company goes oh crap, and the placebo response rate is ~33%.

A sharp skill set of performing an appropriate history and physical and a doctor with a modicum of ethics will be able to control your pain in the least amount of expensive pokes with the fewest pills.

If we were to dissect each intervention, we could create a separate thread that could run on and on. So when you ask about an injection- chances are I have a powerpoint lecture on the topic that I teach to my current class of fellowship trainees. Most of these lectures take 45-60 minutes and that is without the lively discussion that ensues.

Dr. Steve,

Do you cha-chinggg?;)

Having been on the receiving end of many a "needle jockey" and one nasty Pain Nazi it's good to know that there are some good practicing diagnosticians still out there.

My PM is fortunately very good at cutting through the crap and left his big hospital contract to practice on his own because he was sick of the bottom line, which looked more at the patient's wallet than their symptoms.

I don't do many ESI's but the RF ablations saved my butt!

[Kathi49]

Lea,

LOL! Ditto that!

[Kira]

Steve,

Could you say a little bit more about trigger point injections? I was wondering if some version of them would help with some of the areas where I have the most scarred-up, knotted-up, painful muscles from repeated rhabdo attacks. I could look this all up, and I will, but I was curious what your take is on it and if that is even something that is done very often.