SUCCESS RATES OF AN EPIDURAL STEROID OR FACET JOINT INJECTIONS FOR BACK PAIN?…

With so many different types of spinal injections available for back pain I decided to do a bit of research on epidurals for back pain and what I had for my cervical pain back in March this year.

I was told at the time that the way I had this injection (which was through the front of my neck ) was highly dangerous and that 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.

Right from when start when the injection went in I instinctively moved slightly because of the discomfort and the consultant was quite strong in his words to remind me to say stop or he may have to stop the whole procedure.

Slowly but surely after numerous stops I was given a fair dose of the steroid to help with my pain. I then had strict instructions on how I might feel afterwards and if I felt differently to phone directly to speak to him.

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.

When I asked the consultant how many of this particular type of injection I could have in a year he said he would not recommend ever having another as it is so dangerous.

The pain relief lasted four amazing months !

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.

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.

 
 
 
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MY INTERVIEW ON UK HEALTH RADIO ON FUNDING FOR FACET JOINT INJECTIONS…

I have written in the past about facet joint injections for back pain. A cervical, thoracic or lumbar facet joint injection involves injecting a small amount of local anaesthetic (numbing agent) and/or steroid medication which can anaesthetize the facet joints and block pain. They are usually done under x-ray to guide the injections to the facet joints.

Recently funding for facet joint injections has been stopped in some post-codes but not in others. Unfortunately, mine has been stopped so my pain consultant has given me steroid injections into  my gluteal muscles in the hope this will give me some pain relief.

I can have them every four months just like I did with the facet joint injections and I am hoping they will last as well. I only had them done in December so it’s early days yet.

Mike Dilke from Relax back has a program on UK Health Radio and asked if we could have a chat about the funding problem and we also chatted about the two latest health apps, DRUGSTARS ‘ Giving by Taking and Talking MedicinesMedsmart app. 

A POSTCODE LOTTERY FOR FACET JOINT INJECTIONS IN THE UK…

 

As some of my readers will know I have regular facet joint injections for my low back pain which I find really beneficial. I have them every four months and it has been an important part of my pain management program for some time so I was really disappointed when I found out that due to the postcode I live it I could no longer have these injections.

My pain consultant was as frustrated as me but very sympathetic and encouraging that we would find something else that would help with the pain. He is also introducing me to another painkiller rather than Tramadol which will start in a small dose and then increase over a period of time until I feel the most benefit of it and also another injection with a steroid.

The differences in quality of a number of treatments on the NHS seems to be quite common now, but you tend to just read about it and hope it never happens to you.

My local area is basically saying that they will not fund chronic pain as facet joint injections are used mainly for this reason. Other postcodes in my County have said they will not fund facet joint injections but they are willing to look at specific cases if the consultant in charge feels you really need them. My pain consultant was hoping this would be the case for me but unfortunately, my County is not even willing to look at a specific case.

To say I am gutted is, to put it mildly, but I trust my consultant so much that I am not giving up hope that he will find some form of injection that will help with some of my chronic pain.

 

 

WHAT IS THE TRUE COST OF FACET JOINT INJECTIONS?…

Today I had my third lot of facet joint injections on the NHS at the Circle Nottingham Hospital. For me personally these injections (I have one in both sides of my spine) have been the most effective pain relief I have ever had.

For the first time in many years I have been back in control of my pain and I had reduced my Tramadol right down to taking it ‘only‘ on my bad days instead of taking it on slow release. While slowly cutting down on my Tramadol I started to feel quite different in myself without the awful side effects of the opioids.

Painkiller addiction is an increasing problem in our society, and it’s certainly receiving more media attention than ever before. There’s a lack of understanding about the dangers of prescription painkillers—opioid drugs that are both extremely powerful and addictive. Long-term addiction is usually preceded by tolerance to the drug, which means you feel as though you need a regular supply of them.

The reason I wanted to cut down on my Tramadol was to prepare myself for my Cubital Tunnel Operation. A few years ago I was unexpectedly faced with awful pain after foot surgery and was told I could not have any more pain relief due to what I was already taking. Tramadol is routinely prescribed after major surgeries so I told myself if I ever needed surgery again I would make sure I had cut down on my medication prior to the surgery.

I have struggled over the last few weeks as my facet joint injections were due but they were put on hold for six weeks due to my elbow surgery so today could not have come soon enough. I’ve had the same compassionate pain consultant who has looked after me for a number of years and who has tried everything available to help me with my chronic pain.

Before I signed the consent form he informed me that due to the cost of facet joint injections they were being cut right back and may not be available in the future.  He assured me I would still be having some today and that he would put me down for another set in four months but pointed out that he would have to put a case together in order to hopefully get the all clear to carry on giving me these injections.

I was bitterly disappointed that there was a possibility of these being stopped. When I told my husband about it on our way home he told me to try and find out how much these would cost if we went privately to have them done.

I was quite shocked at what I found out which in our area were roughly about £1,145 – £1,500 (each) and I have two of these. I then realised that it’s not just the injection that I would be paying for as I need the use of the Xray department for these and so a radiologist is required, plus two nurses and of course my consultant.

It’s not until you encounter something like this that you appreciate just how lucky we are to have the availability of the NHS in the UK. We just arrive, have the treatment and follow their advice and hopefully get the benefit but you can see why they are now having to question who should be the ones that can have this treatment and who are the ones that cannot. I guess I will just have to hope that my case is one they sympathize with and continue letting me have them otherwise I guess I will be back on the opioid route again.

FACET JOINT INJECTIONS FOR LOWER BACK #PAIN…

injection

Facet Joint injections for lower back pain are given under xray in the outpatients department at hospital. It is an injection into the small linking joints of your spine, the facet joints.

It’s not a cure for the cause of the pain but it is used to help reduce the level of your pain.

 The injection contains a mixture of local anaesthetic and steroid. It is thought to have the following beneficial effects:

  • Local anaesthetics numb the nerves for a period of hours giving short-term relief.
  • Local steroid has a long-term effect reducing inflammation in the joint and around the nerves.

There are only minimal effects on the rest of the body using local steroids by this route of administration. Any side effects, are more likely to occur if steroids are given orally over a short period of time, for example raised blood pressure and weight gain.Diabetics may experience short-term problems. Several joints may be injected in the same session. 

If the Facet Joint injection is helpful it may be repeated at intervals of a minimum of four months.

My first set of Facet Joint injections are booked for this Thursday after my MRI showed signs of arthritis in the facet joints. Hopefully this will help me cut down on my medication for a while.

anatomy-spine