Injectables?

[Diandra]

Hi All,
I so often read on this forum about all the different injections that people get to cope with their chronic pain. As I search for non-opiate solutions for my pain I was wondering if those who have "injections" can enlighten me on the details of injections they receive(what the med it, how long it lasted, what kind of doc gave it, where do you get the injections(butt, arm, spine), did it work for you and do you recommend it.)

The reason I am asking is because all of a sudden my pain mgmt doc is reluctant to give any injections and told me to find a neurologist and I don't know where to begin or what to ask for. I know about botox for chronic pain my pain mgmt doc gave me. Many years ago I had a neurologist give me a series of injections of toradol(an anti-inflam) along with some kind of numbing agent that lasted about 12 hrs(maybe that is what trigger point injections are????). Decades ago a rheum. gave me cortisone.That is the extent of my knowledge and experience.

Thanks for any input from your experiences with various injectables.
Diandra

[Kathi49]

Diandra,

Forgive me for not remembering but what are your issues again? Can you tell us why the pain doc doesn't want to do injections? And why he said to find a Neurologist. To answer you though, I get spinal injections and could go further with your post. But I would rather wait until you reply.

[Diandra]

Hi Kathi,
Thanks for responding.
My worst pain is neuralgia. The entire right hemisphere of my head with my eye socket, cheek and jaw area being the worst, down my neck and into the right shoulder/trapezius area and down right arm. Sensitivity is so bad I cannot wear eyeglasses for very long or put a barrette, headband or hat on at all and some days cannot wear a turtleneck sweater or any clothing unless it is very loose. Wearing a bra is out of the question unless I plaster lidoderm patches on shoulder/trap area. Numbness and tingling down right arm all the time. Almost daily mild headaches and occassional migraines.

Also, have alot of muscles spasms in right shoulder/traps and lower back.
DDD worst at C5/6 and arthritis issues in spine/hands.

All this was triggered by Lyme Disease. When I was able to do treatment for LD I get much better but cannot tolerate it anymore. Was dx'ed in 1991 and took antibiotics for better part of 10 yrs and this caused other problems so had to stop. Theory is Lyme bacteria has neurotoxins and that is causing all the neuropathy, migraine, headaches, seizures.

I don't know why he does not want to do injections anymore. He used to do them all the time. It is not just me, he has stopped doing them for other patients. he never said why a neurologist but my issues are "complex" and in general, docs don't like dealing with my issues.

Diandra

[Mark N]

Sorry to hear you are hurting so much. I don't have a lot of experience with cervical treatments so someone else will have to bring you up to speed, Kathi is a good source. I hope you find some answers that help reduce your pain.

[lobelsteve]

The distribution of your pain makes it extremely unlikely to be any one thing causing your chronic pain.

I am not your doctor and we do not have a doctor patient relationship.

Differential for describe pain is broad.
Cervical radiculopathy, Cervical myofascial pain, Cervical spondylosis, Occipital Neuralgia, Transformed Migraine. Many other things such as Lymes can get listed but without imaging and 5+/10 bands on IGG testing should not be considered.

Things to boil it all down:

1. MRI C-spine
2. ESR, ANA, TSH
3. A good history and physical by a Phyiatrist. You should make an appointment with XYZ Physiatrist and ask for an IME. Tell them you only want an IME and do not want any treatment, just answers. Cash prices for an IME are $500-1000. Insurance will pay it is a level 5 new patient visit and you may throw extra money at the right doc to get you a better answer. It will take 1-2 hours.

Possible treatments:

Medial branch block and if successful RF neurotomy (neck pain only)
Cervical epidural steroid injection (avoid transforaminal approach, it is much riskier) (arm pain and possibly neck pain)
Occipital nerve block (head pain only)
Occipital nerve stimulator (head pain only)
Spinal cord stimulator (arm pain only)

traction, TENS, myofascial release, aquatic therapy, home exercise program

[Kathi49]

Hi Diandra,

I apologize for not having written back right away. :o Hubby is home from DC and my daughter wanted help with some paperwork. Needless to say, yesterday was hectic!

Doc Steve pretty much nailed it. The only thing or things I can can add is that I have never had an ESI in the cervical spine; my own PM will not do them. Instead, it has been facet injections, selective nerve root injections(very few) and a couple of RF's in the lumbar. ALL have worked well for me allowing me to keep the meds low. And as you probably already know I have had two fusions. I can't speak to Lyme Disease because I have never had it. When I was first diagnosed I was told it was Occipital Neuralgia but the PMs I had then changed it to cervicogenic headaches with migraines. So, I can relate to what you said about the neuralgia being the worst of it. It is or was for me too. But I also have the nerve pain in the arms, fingers, spasms in the traps, etc. So, I THINK the C6/C7 is the one causing the issues. Another story and beside the point right now. I won't know anything until I see my NS.

As Steve is saying...MRI first and take it from there. He can correct me if I am wrong but it certainly sounds like ON to me based on your description. And Steve listed out everything I could have thought of. I see where he mentioned traction too. I did that in the beginning and have also done traction after the two fusions. It made me a lot worse or would send me into flare. I am not saying it is wrong just that it didn't help. As for the rest of the items he listed, yep, really helped; especially aqua therapy and massage therapy. That's not to say I don't get an ON headache from time to time; just depends on what I am doing and even weather fronts. BUT I will say a facet injection or injections into the C2/C3 DEFINITELY calm the headaches down. I am thinking that your doctor is more or less saying find a Neurologist to help with complexity; perhaps running more tests? I just don't know. I have a Neurologist as well and she ran a slew of tests for small fiber PN. But again, that's also another story.

And this is just my own personal opinion, but I think it takes quite awhile to get it sorted out. As Steve is alluding to...it can be many things. My NS said the same thing two weeks ago; possible that I can have a couple of things going on including carpal tunnel since my Neurologist found that as well.

Hang in there and this is kind of silly but I accidently ran across a uTube video the other day entitled "Occipital Neuralgia Part 1". The guy made me cringe because that was me 8 years ago or so. But in the video it shows him getting a stimulator if you are interested in looking at it. It's a little graphic but at least you can get idea if your symptoms are somewhat the same. He points out where the pain is and describes it.

Sorry for rambling but it looks like Steve covered all the bases. I hope you can get some answers and some relief. :)

[Lil E]

I've got to agree. I have C4-6 herniations and also have shoulder, arm, neck and hand pain. My ribs on that side hurt also. I've mostly had facet blocks and cervical injections.

[Diandra]

Hi All,
Thanks for your knowledgeable responses. I appreciate them.

Kathi,
You said,
"Instead, it has been facet injections, selective nerve root injections(very few) and a couple of RF's in the lumbar. ALL have worked well for me allowing me to keep the meds low. And as you probably already know I have had two fusions".

Can you tell me what a facet injection is, a selective nerve root injection and an RF. I honestly have NO knowledge of these things. What I mean is, are they just simple injection in the arm or are they something done on table with dye and some kind of xray to get the stuff in the correct spot?

Kathi, that youtube film was something else. Never in a million years did I realize there were things like that on youtube. I had no idea you could do a stimulator to block the pain.

Lil, as well, you mentioned facet blocks and cervical injections and I would like to know the details of how they do them and how long they last. Is is something you do once a year or 6 times a year. Obviously, I know nothing!

Thanks so much,
Diandra

[Kathi49]

Hi Diandra,

Go, to www.spineuniverse.com and key in "injections"...all kinds of info. on the various blocks will come up. I would list it all out and how it is done but it may be more beneficial to you if you read through all of these. Plus, there is some animation. :) What I noticed is is that they say it takes 30 minutes. They must mean from start to finish and maybe with an IV. But since I don't get an IV anymore it seems like it takes 15 minutes tops from start to finish...and I mean being prepped and all.

Okay, the trigger point injections I have received our fairly straightforward...no need for fluoroscopy. But for all the others, oh YES, xray guidance is needed! Don't ever go for a spinal injection without it! Oh, and and RF is radiofrequency ablation. Long story short...if the facet medial branch nerve block works, then the doc will ABLATE that nerve. The nerve will grow back in time but you can repeat the procedure. It worked very well for the lumbar facet issues I have at L4/L5 and S1. But I have to admit, I chickened out on the RF for the cervical spine and that was something like 8 or 9 years ago. Besides, I had already been told I needed a fusion. If I needed one today, I might reconsider. But so far the facet blocks I get in the cervical spine give me relief for quite awhile.

As far as the uTube video goes, I don't normally look at them LOL! I was actually looking up info. for someone else on occipital neuralgia and ran across it...I had never seen it before either. But that guy also had Trigeminal Neuralgia.

I know you were told to see a Neurologist and evidently your doc has reasons for that. But if you haven't had a C-spine MRI, I would be doing so. :)