Epidural and Facet Joint Pain Relief Injections


Over the course of my back injury I have had many epidural steroid pain relief injections in my back.  The very first one was in 2001.  Every doctor I have seen for this offers sedation for comfort.  I would not recommend that anyone try and have this done without the sedation because even with it, you can feel it.  Some doctors use IV sedation, others just give you a shot in the arm.  Almost always they use a medication called Versed.  “GENERIC NAME: MIDAZOLAM – INJECTION (mid-AZE-oh-lam)

BRAND NAME(S): Versed

Rapid intravenous (IV) use of midazolam can cause severe breathing problems which could cause brain damage or be fatal if left untreated. Therefore, when using this medication IV it must be used only under close medical supervision. Children, infants, elderly or weak patients are more sensitive to the effects of midazolam. Thus, lower doses should be used for these patients or when other sedating drugs are used with midazolam.

USES: Midazolam is used before operations or procedures to relax you, make you sleepy and to decrease your memory of the event.”

http://www.medicinenet.com/midazolam-injection/article.htm

 

This is also used during colonoscopy.  You are not completely asleep with this medication but it’s very hard to remember what happened the next day and that is a good thing.  The memory is vague and fussy but at no time are you unaware of what is going on around you.  You can respond to commands and right after the shot they help you up and you can walk over to wherever they will have you recover for about 15-20 minutes before sending you home.  Below is a description from Spine Health of the procedure itself:

  • The patient lies flat on an x-ray table or with a small pillow under their stomach to slightly curve the back. If this position causes pain, the patient can be allowed to sit up or lie on their side in a slightly curled position.
  • The skin in the low back area is cleaned and then numbed with a local anesthetic similar to what a dentist uses.
  • Using fluoroscopy (live x-ray) for guidance, a needle is inserted into the skin and directed toward the epidural space. Fluoroscopy is considered important in guiding the needle into the epidural space, as controlled studies have found that medication is misplaced in many (> 30%) of epidural steroid injections that are done without fluoroscopy1.
  • Once the needle is in the proper position, contrast is injected to confirm the needle location. The epidural steroid solution is then injected. Although the steroid solution is injected slowly, most patients sense some pressure due to the amount of the solution used (which in lumber injections can range from 3mL to 10 mL, depending on the approach and steroid used). The pressure of the injection is not generally painful.
  • Following the injection, the patient is monitored for 15 to 20 minutes before being discharged home.”

 

You need to bring someone with you to drive or they won’t even do the shot, they are not kidding, they ask to speak to your driver and have them sign in next to you.  Of course this is only if your doctor uses sedation but as I said, I would never recommend anyone have this done without it. 

I try and schedule these in the late afternoon so that afterwards I can just go home and take it easy.  You should not bend, lift or do anything strenuous for at least 24 hours after a shot, it can make the steroid migrate away from where it needs to be and then it won’t help you at all.  Your pain can be worse for several days afterward, this is something they don’t want to tell you but I have had times where I thought “Why did I do that? This is much worse now than before the shot”  The longest that I had increased pain was for a whole week after my last one.  It was pretty bad.  You can put ice on the area and I find that helps a lot but never ever put heat, no heating pads, no hot shower water on it, just no heat. 

If you have no relief at your 2 week follow up, they will recommend you have another shot.  Many times it does take 2 of them to produce any relief.  They always make an appointment for you to come back 2 weeks after every shot.  There a few different schools of thought about how many of these a person can have.  Some doctors will not do more than 3 in a year others will just keep doing them as often as you need them.  I went to a doctor who gave me 13 shots in a 7 month period.

http://www.spine-health.com/treatment/injections/epidural-injection-procedure

 

Many times, there is more than one reason that a person is having back pain.  It can be due to herniated or bulging disc but along with that, you can have pain in the joints of the vertebrae called “facets”  I have injections in the facet joints and also my hip at the same time as the epidural shot.  I think I actually had better relief when they did this than when they only did the epidural space.

Cervical, Thoracic and Lumbar Facet Joint Injections

 

Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury or mechanical stress to the back. A cervical (neck), thoracic (upper back) or lumbar (lower back) facet joint injection involves injecting a steroid medication, which can anesthetize the facet joints and block the pain. The pain relief from a facet joint injection is intended to help a patient better tolerate a physical therapy routine to rehabilitate his or her injury or back condition.Facet joint injections usually have two goals: to help diagnose the cause and location of pain and also to provide pain relief:

  • Diagnostic goals: By placing numbing medicine into the joint, the amount of immediate pain relief experienced by the patient will help confirm or deny the joint as a source of pain. If complete pain relief is achieved while some of the facet joints are numb it means those joints are likely to be the source of pain.
  • Pain relief goals: Along with the numbing medication, a facet joint injection also includes injecting time-release cortisone into the facet joints to reduce inflammation, which can often provide long term pain relief. The procedure may also be called a facet block, as its purpose is to block the pain.

Anatomy of the Cervical, Thoracic and Lumbar Facet Joints

The facet joints are paired joints in the back and neck, one pair at each vertebral level (one joint on each side of the vertebrae). These joints have opposing surfaces of cartilage (cushioning tissue between the bones) and a surrounding capsule that is filled with synovial fluid, which reduces the friction between bones that rub together.

 

 

It is important to try all of your options for pain relief and be open to them.  You may need to do a combination of these things to get relief.  They are combined with physical therapy, heat, ice, core exercise, walking and wearing of back braces when lifting or bending.  It is only when all of these things fail to provide relief that your doctor will consider surgery.  I do not take having surgery lightly, rather, I have suffered with this for so long and have honestly tried everything without long term success.  For me, the time has come for surgical intervention.  I hope this information helps you, if you have any questions, feel free to post them as a comment here on this post.

 

http://www.spine-health.com/treatment/injections/cervical-thoracic-and-lumbar-facet-joint-injections

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