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. 

 

 

THE DIFFERENCE BETWEEN OSTEOPENIA AND OSTEOPOROSIS…

If, like me you had never heard of osteopenia then I will explain what this condition is. Web MD write that you should think of it as a midpoint between having healthy bones and having osteoporosis.

Osteopenia is when your bones are weaker than normal but not so far gone that they break easily, which is the hallmark of osteoporosis. Your bones are usually at their densest when you’re about 30. Osteopenia, if it happens at all, usually occurs after age 50. The exact age depends how strong your bones are when you’re young. If they’re hardy, you may never get osteopenia. If your bones aren’t naturally dense, you may get it earlier.

Osteopenia — or seeing it turn into osteoporosis for that matter — is not inevitable. Dietexercise, and sometimes medication can help keep your bones dense and strong for decades.

Recently I was asked to go for a bone scan to look for osteoporosis due to ongoing pain in both my hips, or at least that was what I thought the scan was for. The results came back that I have osteopenia and I have now been put on some medication and they are arranging for me to see a Physiotherapist to start some core strength and weight bearing exercises to avoid it turning into osteoporosis.

When I asked the GP if this was causing my hip pain she said there is no pain associated with osteopenia unless you break a bone. My GP then started asking me a few questions about my hip pain and asked me to pop over and see her. She is now 99% sure that I am suffering from bursitis and is referring me to an Orthopedic Consultant. So, from the pain clinic sending me for a bone scan for hip pain which showed osteopenia I now also have another problem with bursitis which I will cover in another post.

Ortho Atlanta explains about osteopenia and osteoporosis that while these diseases do have some similarities, there are also distinct differences between them. Here’s what you need to know about the differences between osteoporosis and osteopenia.

Osteoporosis means “porous bones.” Bones that are porous, or less dense, are more likely to break. A person with osteoporosis may also walk with a stooped back. Osteopenia is considered a midway point to osteoporosis; the bone density is lower than normal but not as severe and treating it may slow the progression bone loss that leads to osteoporosis. Bone mineral density (BMD) measures the level of calcium in the bones. The lower this level is, the more likely a person is to sustain bone fractures. Osteoporosis and osteopenia are both diseases in which the bone density is low. 

Serious injuries can occur as a result of osteoporosis. Because persons diagnosed with osteoporosis have lost a lot of bone mass, their bones, more porous, and brittle, can fracture from something as simple as a sneeze or a minor fall. Fractures caused by osteoporosis most often occur in the spine. Known as vertebral compression fractures, fractures in the spine are almost twice as common as other fractures typically linked to osteoporosis, such as broken hips and wrists. Osteopenia isn’t quite as serious as osteoporosis because the bones aren’t as porous and measures can be taken to help prevent the onset of osteoporosis

Osteoporosis can’t be reversed; however, it can be managed using the same treatments recommended for osteopenia. In addition to diet and exercise, there are medications the doctor may recommend to help prevent further bone loss.

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.

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. 

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.”