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. 

 

 

JOINT PAIN AND HOW TO OVERCOME IT…

As we get older we all suffer from joint pain. It can become quite a problem for many of us. For a number of years, herbalists have sworn by the effectiveness of rose hips for arthritic conditions. Eight out of ten osteoarthritis sufferers experienced less pain and stiffness after they took a wild rose hip preparation rich in compound called GOPO which is available from Superdrug, Amazon, Pharmacies and Health Food Stores.

Rose-hip is not only full of Vitamin C, but it’s also bursting with antioxidants, which are good for reducing inflammation in the body which is often the root cause of joint and arthritic pain. Studies have also shown that Vitamin C may be helpful in managing inflammation in the body.

Hot or cold therapy can help with joint pain as can acupuncture and regular massage. According to the Arthritis Foundation, regular massaging of arthritic joints can help reduce pain and stiffness and improve your range of motion.

Hydrotherapy is one of the oldest types of health treatments today and still occupies a major place in medicine throughout China, Japan and Europe. It is believed to have healing properties. It is particularly effective for reducing muscle pain, improving sleep disorders, increasing your mobility and reducing stiffness. Hydrotherapy UK says the only side effects are with any water-based activity, caution should be exercised to remain safe from drowning. Almost all hydrotherapy is carried out in pools more shallow than the height of the person using it. Hydrotherapy is a type of physical therapy which utilises water to create a therapeutic environment. It is used all around the world and is considered a valuable part of mainstream healthcare.

Another point is to become aware of your body positions. It’s good to avoid being in one position for a long time, or any posture that makes you feel stiff. It can help to avoid activities that need a tight grip or put too much pressure on your fingers. Try using equipment that helps to reduce stress on joints, such as easy-turn taps, a pick-up reacher and raised seats.

Try to maintain a healthy weight, as this helps to reduce stress on weight-bearing joints. It can lessen joint pain, and helps to avoid joint damage.

One activity which can cause significant arthritic pain, especially if the condition affects weight-bearing joints in your hips, knees or ankles, is going up and down the stairs in your home. So, take it easy if you are suffering from pain in your weight-bearing joints.

Turmeric is increasingly being used in formulas for back and arthritic problems. Many people report that turmeric can help, but it’s important to choose a high potency turmeric product. And recent studies have shown that turmeric may also help people with bloating and digestive discomfort.

Tumeric is safe to take long term and Nature’s Best have the High Potency capsules at 10,000 mg. We often see and read about different herbs that can help with pain and arthritis but not all of them come up to scratch. However my twin sister who suffers from severe inflammatory arthritis was in so much pain she felt it was worth a try.

After only 10 days of taking the Nature’s Best High Potency capsules she felt the benefits. Taking a sweater over her head was very painful and uncomfortable and yet she could easily take her sweater off after such a short period of being on Tumeric. She was so impressed that she rang me to tell me to try them.  Although some of my spinal problems are mechanical I do have arthritis in my facet joints.

SUPPORTIVE RESOURCES FOR MANAGING CHRONIC PAIN…

If you’ve recently been diagnosed with a health condition that causes chronic pain, you might be wondering where to turn for health and advice. After all, managing chronic pain can be quite challenging, and it can be tough to find practical solutions. The following resources are packed with information on understanding your diagnosis, getting relief from your symptoms, and learning to relax on rough days.

Accepting your diagnosis…

You finally have a diagnosis – but now, you’re confused about what to do next. These resources can guide you along the way.● It’s normal to feel shocked. Give yourself time to grieve and process your new diagnosis.● If your diagnosis has made you feel isolated, check out Back Pain Blog UK to read accounts from other chronic pain patients.● Consult expert tips to turn your home into a comfortable wellness haven.

Safe Symptom Management…

Your symptoms can range from mild to debilitating. Here’s how to find some relief with safe methods. ● Stock your pantry with tasty, anti-inflammatory foods. ● Focus on cooking nutritious meals at home with whole, unprocessed ingredients.● Take supplements that have been proven to help relieve chronic pain. ● Ask your healthcare provider about using CBD products to alleviate your symptoms.

Relaxation Techniques…

Chronic pain can raise your stress levels. Turn to these breathing and relaxation tactics to calm down.● Try these mindfulness techniques specifically geared towards people with chronic pain. ● This soothing yoga sequence can help you get your body moving without exacerbating aches and pains.● These sleep positions will allow you to get the rest you need every night.  

Living with chronic pain can be difficult, but if you’ve just received a chronic pain diagnosis of some kind, you will quickly find that knowledge is power. The more you learn about your condition and potential treatment options, the better you’ll feel. By referencing these resources, you’ll be able to research the best ways to manage your pain.

Guest post from Jackie Waters

IT’S SLEEP SUNDAY – 5 REASONS YOU MAY NOT BE FALLING ASLEEP STRAIGHT AWAY…

1. Not taking enough time. One of the most common mistakes people make about sleep is thinking there’s this switch that gets triggered as soon as you jump into bed that cues sleep. However, that is not how sleep works. Taking everything in it’s stride but in a routine will help your brain to start slowing down.

2. Bringing cell phones to bed with you. Cell phones bring the world to your fingertips wherever you go, which is great — except when you’re trying to signal to your body to shut down and power off. And the same goes for laptops, TVs, tablets and other electronics. I honestly cannot sleep without my phone on next to me but I now always turn the sound off and place it face down so the light doesn’t disturb my sleep. I think knowing it’s next to me helps me to relax.

3. Too much caffeine during the day. It’s not just before you go to sleep that caffeine can affect your sleep it’s how much of it you have consumed in a whole day be it tea, coffee or chocolate which are the worst culprits. Think about what you are consuming after 12 Noon onwards.

4. Sleeping too hot. Part of the body’s process of falling asleep is decreasing its temperature. (Physiologically, that’s part of what happens during sleep!) So keeping your bedroom temperature cool just helps this happen faster. Ideally keep your thermostat between 60 and 67 degrees Fahrenheit, according to the National Sleep Foundation. If that feels chilly, cover with a light blanket (or keep one nearby) that you can shove aside as needed.

5. Too much light. Light is one of the most important external factors that can affect sleep. It does so both directly, by making it difficult for people to fall asleep, and indirectly, by influencing the timing of our internal clock and thereby affecting our preferred time to sleep, says Harvard Healthy Sleep.

MASSAGE HANDS AND FEET FOR TIGHT MUSCLES…

The DAILY Mail Health section wrote about Brendan Smith (pictured), founder of the Sydney-based clinic Village Remedies, who uses Chinese medicine practices to stimulate the body’s natural healing process and maintain optimal health.

Brendan also said a number of upper and lower body pain can often be eased by rubbing your hands and feet – a process known as reflexology.

‘Reflexology is a general practice part of Chinese medicine,’ Brandan said.

‘For example, if you have a sore neck or back you can use reflexology simply by massaging your hands to help relax the upper body.’

The same method can also be applied to assist lower back strains by massaging pressure points in the feet or giving your feet a relaxing foot bath. 

According to research, reflexology may also reduce other pain and psychological symptoms including stress and anxiety.  

If you massage in the correct areas, this can ultimately stimulate a reaction from the nervous system to generate a healing response. 

To assist clients and customers with further, Village Remedies has published a simple, practical E-book to self-care acupressure that’s free to order off Kindle.