WHICH INJECTION IS IDEAL FOR BACK PAIN -EPIDURAL, STEROID, FACET JOINT OR TRIGGER POINTS?…

With so many different types of spinal injections available for back pain its difficult to decide which one to try. In a previous post I decided to do a bit of research on epidurals for back pain and other types of injections for back pain.

One I had (which was through the front of my neck ) was highly dangerous and not many pain consultants ( including mine) would perform this procedure. All the way through the procedure the consultant ( another one I had been referred to who specialised in this type of injection )kept saying I must not move one fraction of an inch but instead to shout stop whenever I started to feel it too uncomfortable.

I can honestly say it wasn’t the most pleasant or procedures but I’m always of the opinion of no pain no gain with these type as of procedures. Fortunately I had no after affects and after about three weeks ( I was told it could take that long) the pain relief kicked in and my neck and arm pain disappeared for the first time in years. Now 18 months later some of the pain and pins and needles are coming back but nothing like it was before. 

Spine Health wrote that while the effects of an epidural steroid injection tend to be temporary (lasting from a week to up to a year) an epidural steroid injection can deliver substantial benefits for many patients experiencing low back pain.

  • Recent research reports that lumbar epidural steroid injections are successful in patients with persistent sciatica from lumbar disc herniation, with more than 80% of the injected group with disc herniation experiencing relief (in contrast to 48% of the group that received a saline placebo injection).
  • Similarly, in a study focused on a group of patients with lumbar spinal stenosis and related sciatica symptoms, 75% of patients receiving injections had more than 50% of pain reduction one year following the injections. The majority also increased their walking duration and tolerance for standing.

So, I could see from this information that it seems to be ok for lumber pain but there is no mention of it for cervical pain.

An article in The Daily Mail said that tens of thousands of patients are being given a ‘useless’ back-pain injection, which costs the NHS nearly £40 million every year, an analysis suggests.

Patients that demand a ‘quick fix’ for their discomfort are being given the treatment, priced at £540 per procedure, despite doctors being told to recommend back-pain sufferers be more active or try psychological therapy.

According to an analysis of NHS data by The Times, 70,608 steroid injections into patients’ facet joints, which make spines flexible, occurred last year, compared to 62,570 five years ago.

Guidelines released in both 2009 and 2016 advise against the procedure. 

Figures also show 8,044 operations that fuse spinal bones together were carried out last year, up from 7,224 between 2012 and 2013. 

Spinal Healthcare point out that Epidural steroid injections are actually very safe, since they are simply an injection that contains both local anaesthetic and steroids. In effect these reduce the inflammation that is causing pain in the nerves and the disc in the spin and the local anaesthetic numbs the area, bringing short term numbness to the region. By the time the local anaesthetic wears off the steroid will be working to reduce inflammation.

However there are some risks with the procedure, but these need to be looked at in context. Almost every human activity carries some risk with it. For example, crossing the road, lifting heavy objects, even opening a tin of beans all carry risks. Yet we do them every day, simply because they are necessary to human function.

Reading through lots more posts on epidurals I have come to the conclusion that like anything in life one size does not fit all of us and for some this treatment gives great relief and for others none whatsoever. There is definitely a problem with the cost of this type of injection as you require x ray staff and others to proceed with it. My facet joint injections which were also done in X-ray were cut a couple of years ago due to funding.

After my move down south last June I managed to see a pain team in January of this year but they also said they do not cover facet joint injections which I have found to be the best for me. However, when I talked it through with my GP he said other hospitals offer it and if I got to the stage that I was desperate for them he could organise a referral.

I can quite understand the cuts as the NHS is under so much pressure but I think it would make sense to have a team of people who simply follow up your pain relief after the injection to monitor if it was worth doing or not. That way the ones who benefit could continue having them and and the ones that don’t could try something else.

As far as the safety of this type of injection, I guess any injection into your spine carries risks but that could apply to any type of procedure. However, having it for cervical pain is something I could not find so it makes me think that maybe the one I had was a one off that worked for a while but now it’s back to square one again.

The difference between the nerve block and the epidural is where they put the needle. The nerve block injection usually also contains a steroid to decrease inflammation and pain. The injection is similar to a transforaminal epidural steroid injection, but in a selective nerve root block, there is no attempt to have the medication enter the epidural space.

The differences between epidurals and the nerve blocks and facet joint injections is that facet joint injections are used for both diagnostic and therapeutic reasons in the treatment of degenerative or arthritic conditions. Along with the numbing medication, a facet joint injection also includes injecting time-release steroid (cortisone) into the facet joint to reduce inflammation, which can sometimes provide longer-term pain relief.

A trigger point injection which I have recently been offered is an anesthetic such as lidocaine (Xylocaine) or bupivacaine (Marcaine), a mixture of anesthetics, or a corticosteroid (cortisone medication) alone or mixed with lidocaine and are used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin.

But, all seem to include some kind of steroid medication for the pain, they are all put into different areas and some involve using x-ray guidance but to me, the actual drug they are using is the same, but of course this is just what I have read online and is not something have discussed with my pain consultant.

 
Another treatment at the Regenerative Clinic in Harley Street London is stem cell therapy and PRP can help patients avoid spinal surgery and the side effects of epidural steroid injections. These procedures utilise the patient’s own natural growth factors or stem cells to treat bulging or herniated discs, degenerative conditions in the spine, and other back and neck conditions that cause pain.

According to Back Pain Expert Researchers at Manchester University’s Division of Regenerative Medicine are still currently running clinical trials in people with back pain to test a revolutionary treatment that could repair damaged intervertebral discs. The revolutionary new treatment based on stem cells, pioneered by Dr Stephen Richardson at Manchester University, may turn out to offer a permanent cure for back pain related to damaged intervertebral discs. For over five years, and backed with funding from the Arthritis Research Campaign, he and his colleagues at the Division of Regenerative Medicine have been developing a way of using cells from the body to regenerate the nucleus polposus in the damaged intervertebral discs.

However, I’m not holding my breath that this treatment will be available on the NHS anytime soon. I do feel that if you have only tried one type of injection and it’s not working as well then it is definitely worth trying another as you can see from this article there are a number of different options available. 

 

 

8 INTERESTING FACTS ABOUT BACK PAIN…

Here are eight really interesting facts about back pain.

1.Up to 7% of people with acute back pain will develop chronic back pain. These chronic patients have considerable discomfort and account for approximately 80% of the social and health care costs.

2. Severe intermittent back pain that goes down to your groin, could indicate that you have kidney stones.

3. Eighty to 90% of back pain resolves itself within a month to six weeks all on its own.

4. Back pain accounts for almost one fourth of all occupational injuries and illnesses.

5. A survey of back patients revealed that 75% of those who were told they needed surgery recovered successfully without it.

6. Most cases of back pain are mechanical or non-organic—meaning they are NOT caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer. But rather poor posture and poor use of the body.

7. The number of given people who have lumbar related pain increases with age.

8. Pain that is worse in the morning and improves with movement and stretching is often indicative of a muscle related issue or injury.

THE BEST HAND REFLEXOLOGY POINTS FOR LOWER BACK PAIN…

Most people know ‘reflexology’ as something that is done to your feet but hand reflexology is definitely another technique that is becoming just as popular.

Hand reflexology certainly provides some benefits compared to foot reflexology. The obvious example is that our hands are far more easily accessible compared to our feet, which makes hand reflexology the most usable self-help tool for both adults and children.

Hand and foot reflexology has actually been used as part of medical care since as far back as the ancient Egyptian and classic Chinese times. The basic assumption used by the reflexologist is that each organ, gland, and part of the body is reflected in both the hands and the feet. Stimulation of the so-called ‘reflex points’ promotes relaxation, improves circulation, and encourages the body to heal itself. This explains why hand reflexologists sometimes use the axiom: “Health is at your fingertips!”

Hand reflexology is also brilliant as a relief from the new stresses technology has placed on our hands.

For lower back pain press the point where the centre of your hand joins your wrist and stimulate it. Always take medical advice if you don’t know what the problem is. This is a perfect antidote to a backache caused by sitting at a computer for too long.

A great site Reflexology Map that explains in detail how to start a hand massage.

YOU CAN FOLLOW THESE STEPS TO START YOUR HAND MASSAGE:

Step 1:  Sit in a comfortable chair in a quiet room.

Step 2:  Enter a state of relaxation using a few of your favorite oil hands. Oils and creams are normally not used in professional reflexology sessions, but will not hurt to use them in an informal session.

hand reflexology

Step  3: Rub the cream on your hands for several minutes until completely absorbed. This will relax your hands and increase flexibility in preparation for applying reflexology. Be sure not to use a cream or oil greasy your hands are not slippery.

Step 4: Close your eyes and focus on any area of your body where you feel an uncomfortable pain. Sometimes you just feel as if some part of your body feels misaligned.

Step 5: Consult a hand reflexology map to identify the points of reflection in your hands that correspond to the parts of your body you want to work. For example, if you have pain in your left shoulder, you have to query the map and see that the points of reflection for your shoulder are located on the little finger of the left hand.

Step 6: Firmly press the reflex point. You can gradually increase the pressure to make sure you’re “activating” the reflex, but loose a little if you feel some pain.

Step 7: Hold the pressure for 30 seconds and release.

Step 8: Wait a few seconds and repeat. You can press either 30 seconds or you can press and release the point of a pulsed for 30 seconds.

Step 9: Use your thumb to apply light pressure technique pressure if you are uncomfortable. To do this, use a circular motion over the same point of reflection for about 5 seconds, then rotates in a circular in the opposite direction for 5 seconds. Repeated several times for each point of reflection.

Step 10: Reflexology applies to all areas in both hands, but lend him more attention on problem areas.

Step 11: When you’ve finished your reflexology session sit quietly for at least 10 minutes. If possible, lie down and rest well for half an hour.

Step 12: Drink several glasses of water after applying reflexology. Water will help to drain the toxins released from your organs and muscles during the session.

 

Hand Chart

Shine Holistic says that “Reflexology is known to be of use for both chronic and acute back pain, but it is also good for reducing stress, which can sometimes exacerbate people’s perception of pain. Reflexology reduces stress and increases emotional well-being. This is related to back pain because it can cause stress which leads to an increase in the pain level experienced. By working on both fronts reflexology can greatly decrease the symptoms of chronic back ache.

Conditions such as sciatica and arthritis are optimally treated by having twice monthly sessions. Other treatment plans, such as for osteoporosis and herniated discs, will vary depending on the level of pain experienced and the severity of the condition.”

WHY IDD THERAPY IS EXPANDING IN THE UK – A Physiotherapist’s View…

John Wood MCSP and Lewis Payne MCSP Sheffield Physiotherapy, explains…

Sheffield Physiotherapy has been using IDD Therapy spinal decompression for almost ten years now, to help patients with unresolved back and neck pain, especially those with disc-related problems. When we started, there were only a handful of clinics in the UK using IDD Therapy. However, the network has grown over the years as more clinics have come to understand how this treatment can help their patients’ suffering with more challenging spinal conditions.

When I came across IDD Therapy initially, I thought it was like traction. As we know, traction had faded out of clinical practice because at that time there were few trials that showed it to be effective. Though ask any older practitioner who used traction and they will tell you that for some patients it really helped them. IDD Therapy got our attention initially because unlike traction of old, it was specific and able to target particular levels of the spine.

Why IDD Therapy?

Developed in the late 1990s in North America, IDD Therapy was designed to address the failings of traction and the limitations of what we can achieve with standard hands-on treatments. The team that developed IDD Therapy initially spent a lot of time making sure that there was a tangible effect on the disc at the level of the spine being targeted.  

Whilst most back pain either resolves itself or very quickly resolves after a short course of physiotherapy, when it doesn’t it becomes a significant problem for both the patient and health service. Patients presenting again and again with unresolved back pain place an extra burden on GPs, pain clinics and primary care in general.   

We use IDD Therapy to help patients with disc problems especially bulging or herniated discs with referred pain.  It can also help patients with disc degeneration and spinal stenosis. 

How does it work?

IDD Therapy uses pulling forces or computer-controlled distraction. A patient lies on a table and is connected to the machine using ergonomic pelvic and chest harnesses. Measuring specific angles from 10 to 30 degrees, we are able to direct the distraction forces to the targeted spinal segment of the patients, most commonly the lower back segments L4/L5 or L5/S1.

The manner with which the forces are applied, means that we can use higher pulling forces of up to and over half a patient’s body weight comfortably, and this enables us to decompress the affected spinal segment. Of course, it is physically impossible to apply such forces to a patient with manual techniques, and to do so with control and consistency.

At the same time as we decompress the disc, taking principles of manual therapy, IDD Therapy uses an oscillation force to gently mobilise the spinal segment.  

Many spinal segments become stiff and immobile for a variety of reasons.  IDD Therapy decompresses the disc, but also mobilises the tissues surrounding the joint.  By improving mobility, the aim is to allow the body’s natural healing mechanisms to operate efficiently.

Becoming more widely accepted

For some practitioners looking at IDD Therapy the number of sessions has been controversial.  The standard protocol of treatment is based on twenty sessions over a six to eight week period, with patients lying on the IDD Therapy machine for 25 minutes, whereas the typical model of manual therapy is four to six sessions.  

However, what we, and all the IDD clinics, see is that for a certain category of patient, the short programme simply does not work. The forces used to decompress the spine are built up over the sessions, rather like a strengthening programme gradually conditions the body. Some patients can experience symptomatic relief very quickly whilst for others it takes longer.  

This shift in thinking is now much more widely accepted because of the growing experience of the outcomes. In fact, some insurance companies, such as AVIVA, are now paying for programmes of IDD Therapy because it can be more cost-effective and better for the patient when they avoid surgery.  

At a time when there is pressure to reduce the burden on primary care in the NHS, IDD Therapy is enabling patients to have a credible opportunity to resolve their problem, without resorting to surgery.

It is important to stress that IDD Therapy is not a stand-alone treatment. It is like the first stage of a journey and practitioners combine it with exercise and education which together give us the opportunity for long-term success.

Further improvements

There are over 1,000 clinics using IDD Therapy globally.  Here in the UK there are physiotherapists, osteopaths and chiropractors.  We get together for a conference and at the time of writing have agreed an expanded set of measures which clinics will use to track outcomes.  

In healthcare, change happens slowly, especially within physical therapy. Having used IDD Therapy for many years, both on its own and in combination with other modalities, we believe it provides the greatest opportunity for scalable improvement for patients with unresolved back and neck pain.

ABOUT THE AUTHOR

John Wood MCSP is from Sheffield Physiotherapy, a long-established physiotherapy clinic specialising in unresolved back and neck pain. http://iddtherapy.co.uk/

ABOUT IDD THERAPY

IDD Therapy is the fastest growing non-surgical spinal treatment for intervertebral discs with over 1,000 clinics worldwide and a network of clinics across the UK.

Facebook: IDD Therapy Europe

Twitter: https://twitter.com/IDDTherapyDisc

FAMILY SUPPORT FOR PATIENTS WITH FIBROMYALGIA OR CHRONIC PAIN…

The effect on family support for patients who are suffering from fibromyalgia or chronic pain is an essential factor in the care of these conditions, especially during this epidemic. While only one person in a family may suffer from fibromyalgia or chronic pain. the entire family is affected by it.

 

Everyday Health says “If a person has a chronic condition, it’s going to affect the people who care about him or her as well,” says Phyllis Talarico, former patient services coordinator of the National Fibromyalgia Association and founder of the North Orange County Fibromyalgia Support Group in Yorba Linda, Calif. “Education is vital for you to understand the symptoms and help them find the right treatment.”

Some good sources include NHS choices and Fibromyalgia Action UK.

Effective strategies for supporting someone in chronic pain has to start from the one closest to the patient.  Part of accepting the situation is managing their expectations. Once the family has identified what is likely to change, allow the patient to grieve for the things that have to fall by the wayside (at least for now) and let them go. Then focus on the areas where you foresee big problems and work toward realistic solutions. There are many undiagnosed patients at the moment due to COVID-19 but that doesn’t mean they don’t need help.

Recently, my own condition reared it’s ugly head and although my husband is right by my side to help me, my daughter really wanted to help more but it’s just not possible at the moment. Many Fibromyalgia sufferers who have help from Fibromyalgia and Pain clinics will be getting no help at all at the moment with the only support through online groups and websites.

With most GP appointments either via telephone or online it’s essential that you keep a diary or ask a family member to write one for you of how and where your pain is on a daily basis.I have written before that I was diagnosed after my spinal consultant asked me to write down all my pain symptoms for two weeks. When he read my diary he immediately said he thought I was also suffering from Fibromyalgia and sent me to see a Rheumatologist.

 

 

Of course, it’s not an ideal situation for the family members either, they are not immune to depression. It is frustrating to watch people who are sick and in pain, and yet to have little control over their illness.

Fibro Treatment Group points out that ‘The symptoms may be invisible put the pain is real. If you have fibromyalgia you’ve likely been told “but you don’t look sick.” A common misconception among those without the condition is that because the symptoms aren’t outwardly manifest or visible, they are not real. This is why we sometimes call fibromyalgia an “invisible illness”. While the symptoms may not be obvious and we may not look sick – the illness is very real.’

Finally, there are now thankfully a number of support groups set up around the UK and indeed the world. I guess one of the best places to look other than Google is the NHS website which has a list of support groups in the UK.