My Mom is 63 and has just started a treatment of weekly Marcaine injections for pain in her left hip/lower back, diagnosed as damage to her sacroiliac joint from lifting an extremely heavy bag of cat litter about a year ago (of all things!) ... She has had a bone scan and x-rays that have not shown anything unusual (so she was told by her family doctor) but is still experiencing extreme pain every day now, usually aggravated by just a few minutes of standing.
Mom has about 5'6'', 220 lbs, and has adult onset diabetes (takes insulin), is deaf and visually impaired. She had been used to getting out for walks every day, even with her balance not being the greatest, but now after a year of dealing with this daily pain cannot even walk a block without excruciating pain in the left hip/lower back area (not radiating pain, but feels deep and sharp)...She has had 2 sets of Marcaine injections now, and has not felt much relief..just briefly after the session at the pain clinic.
Should I be worried? Is this safe? I'm afraid that it just might be masking the problem, and may cause more damage in the long run....What are some other options we should look into? All her family doctor would do over the past year is prescribe her Tylenol 3's, until we had to insist that her pain be investigated further....Because she has a cochlear implant above her ear (no longer works as she lost all her remaining hearing), she could not have an MRI....the doctor only sent her for an x-ray and then a bone scan....Then, referred her to a pain clinic, where she was diagnosed with the damage to the sacroiliac, just from the initial interview stage. Should my Mom be going to see a Neurologist or Orthopedic Surgeon? Is anyone familiar with the use of Marcaine injections for this type of pain treatment, and if it's the right solution? The Doctor said this was his first choice over Cortisone, because of her diabetes.
Marcaine is a local anesthetic and can be used just like novacaine or lidocaine for dental work, to numb the area for stitches to be put in and is used as a nerve block during labor and delivery and administering spinal epidural injections for spine pain.
It is a good idea not to use cortisone for your mother because of her diabetes. Cortisone can wreak havoc with blood sugar levels with those that have diabetes.
One question I do have is with the administration of the Marcaine injections itself, since you say that your mother has just had brief relief of pain at the pain clinic.
Are they using floroscopy when they administer the injection of marcaine? That is an x-ray of the area as it is being administered so that the doctor is sure that he is placing the needle in the correct location to relieve her pain?
If they are not doing this under floroscopy, then it is a "hit or miss" attempt at placing the needle in the correct location to place the marcaine.
I am surprised that your mother's doctor have not ordered a CT scan since she can not have an MRI done.
My hubby can not have an MRI done either because of metal that was placed during brain surgery 34 years ago.
He recently injured a tendon in his wrist and arm and it was important to see if there was any other damage going on and a CT scan was done.
Your mother should also be seen by a spinal surgeon and should have been, IMHO, before any pain management treatment was done. She needs a full evaluation as to what the cause of her pain is and where it is coming from.
She should have a CT scan done and be under the care and diagnosis of her orthopedic problem.
A pain management doctor should be consulted in conjunction with a spine surgeon and a family doctor should have referred your mother to a spine surgeon for diagnosis right away.
She should see either and orthopedic surgeon that specializes in spines only or a neurosurgeon that specializes in spines only.
If her marcaine administration is not being done under floroscopy, then she should not have any more done as it could be dangerous to play this game of "if i'm lucky I get the injection placed in the right place, if I'm not it is not going to help."
Only under floroscopy should it it be done.
If it is being done under floroscopy and she is not getting any pain relief, it would IMHO, she has not been diagnosed correctly and that is why she is not obtaining any pain relief.
Either way, she needs full evaluation by a spine specialist and not the family doctor and just a pain management doctor.
re: Marcaine injections for lower left back/hip pain ... Safe??
Thank you SO much for your caring and detailed reply! I really appreciate all of the opinions you put forth, and I must say, they are right in line with what I've been feeling all along...Was reassuring to know that my worries were quite reasonable, after all!....
As for the floroscopy, Mom says the doctor is not using it....The first session, she had 6 needles, in different sites including back and left buttocks around where she most feels the pain. Last Friday for the second session, she had 9 injections, all in different places, and was in incredible pain during the whole thing. She is now very concerned that the Doctor is not using the support of an x-ray during the treatment, and is willing to let me call her family doctor (who is also mine, too) tomorrow, to get in to see her for a referral to a specialist, and wants me to call the pain clinic to 'postpone' her upcoming injection this Friday, until she has further consultation from her doctor (and hopefully a good specialist, as soon as possible!) I was able to share the answer that you'd give me, word by word, and she was very grateful for your input, too...
Do you practice medicine at all, or are you speaking just from your own knowledge and experience? (if you don't mind me asking....Either way, you sure seem to know what you're talking about, with regards to this topic!)
It sounds like the bone scan that Mom did have was a CT scan, and the family doctor didn't 'find anything' from it (or the x-ray) .. I believe, though, that a specialist would probably be able to spot something that a GP may not realize is there, or would just have a more 'full' understanding of where to look for the cause of the problem, and what exactly needs to be done to try and 'fix it' ... including pain management, of course...but being able to dig deeper into the root of the problem.
I had first suspected (from my own humble research on the web, etc) that she may have experienced a herniated disc, after the traumatic event of lifting the heavy item and 'putting out' her back that day (and suffering ever since) ... So, I was pretty surprised when she told me that the tests she had did not show 'anything'.
Thanks, again, for your sharing your insight and experience....I will let you know how things progress, and would welcome any other input that you or anyone else may be willing to offer...
"Do you practice medicine at all, or are you speaking just from your own knowledge and experience? (if you don't mind me asking....Either way, you sure seem to know what you're talking about, with regards to this topic!) "
I don't practice medicine, I'm not a doctor. I'm just a too experienced "spiney" that has been through the ups and downs of spinal problems since 2006. Done lots of research, lots of tests, lots and lots of questions and 2 spinal surgeries exactly 2 years apart.
I've also spent many years working in hospitals in various positions and have a good understanding of medical terminology, access to various information and have had more dealings with orthopedic surgeons, broken bones, CT scans, MRI's and plain old x-rays than I really care to think of.
My siblings and myself where athletes from grade school through college, as where my 2 children and between all of us, there have been many, many trips to ERs, orthopedic surgeons, OR's etc over many, many years.
Having had to deal with spinal problems over the past 2 years myself, I've learned more information and fortunately have an excellent spinal surgeon that I obviously trust with my life and my spine and he's given me more information and answers to all kinds of questions.
When ever I can pass that knowledge that I've learned on to others, I try to do so.
What I do know from just general experience is that a family doctor, primary care physician etc. are qualified to do general care, routine physicals, sick calls etc., but when it comes to specialty care, they are way out of their league and far from qualified to take care of the patient.
Many of them try to do just that, and it's really poor medical care and dangerous to the patient.
It sounds like your mother's family physician is trying to take on more care than he/she is qualified to do and the result is not good care for your mother.
I have never heard of so many injections being given like your mother is getting and they are not helping here.
If you want to know if your mother had a CT Scan, ask her if she know if she was put inside a long type of tube for her x-ray. That would be a CT Scan, bone scans are not done with the same kind of machine, or she could have had a bone density scan.
None of these will show anything but joint and bone abnormalities. The will not show anything about the spine or discs, nor will they give enough information about what is going on with nerves or compression of nerves within the spine itself.
it is quite possible that she did herniate a disc while picking up a heavy object. That kind of pain would result in what is called nerve pain. It would be a burning, stinging, numbness type pain that is horribly painful. (believe me, I can vouch for that any day of the week).
If that is the case, she would need to have a CT scan to try and determine that and there are other tests that can be done to find that info out as well, without doing an MRI.
Many times with physical therapy and time, the herniation will heal on it's own. But the key is to get the diagnosis and get it correctly from a spine surgeon.
I, myself, have not had marcaine injections for anything. I have had epidural steroid injections under floroscopy, and have had them done with sedation. They use lidocaine and steroids and I was out cold while they where done.
I have had steroid injections directly to my hip and right knee. those are trigger point injections and they are just done in a doctors office. They do start out quite painful for about 10-15 seconds and then you feel nothing.
But if the pain doctor is injecting into the joints around the spine, then they should be done with floroscopy to be sure they are being placed correctly.
The fact that they are so painful to your mother, is disturbing to say the least. I would be concerned that if your mother is experiencing that much pain during the injections that the pain doctor is not giving her something to relax her, at the very least and better yet, sedating her to have them done. She should not have to undergo that much pain to have them done.
I agree that she should hold off on having any more of them, especially if the end result is they are not helping her and get a proper diagnosis from a spine surgeon.
You may need to be prepared to argue with your mother's doctor to get the referral and if her family doctor refuses to seek medical care elsewhere for her.
Good luck and let us know how she is doing.
You can PM me any time if you want to or just post here.
I've had the same medical condition.. What I would suggest is too see your family doc. again.. Get referred to a orthopedic surgeon also ask fam. doc for a medicine called Lyrica which is a pain blocker for nerve pain 150mg twice per day also naproxen 500mg twice per day, also she needs a better pain medication than T3 I would suggest one of the long lasting types that are available, I don't want to suggest any on here but Pain Doctor would know quite well what I'm talking about... This should help and go a long way with pain management until a surgeon wants to do next... But that pain needs to be managed properly right away... remember LYRICA (pain blocker) Naproxen (Anti-Inflammatory and New Pain Meds.. Hope this helps
Marcaine Inject.-migraines, whiplash injury & lower back pai
I received marcaine injections about 3 years after a rear end collision in which I suffered whiplash and lower back injuries. About 3 days after the MVA, I started getting debilitating migraine headaches. I suffered for the 3 years (1996-1999) until I read, in a magazine in my doctor's waiting room, about a woman who was suffering almost the exact symptoms that I was. I asked to be referred for the treatments and found that I good results after about the first 4 treatments and sustained relief for about 18 months. Once back to work I was unable to travel the 4 hours one way to get the treatments and managed as well as possible with acupuncture and massage as well as strong (not Tylenol 3's) pain medication and naproxen.
I have been involved in 2 additional rear end collisions (May 2001 & June 2006) a roll over MVA (Dec 2005) and a motorcycle accident (July 2006) and could really use something better that just the pain medication I am taking now. It is quite strong but doesn't allow me to do much activity before the pain - mostly in my lower back- comes back. I also suffered another whiplash injury in the June 2006 MVA and am receiving physiotherapy and using a tens machine. But I think that I have done so much soft tissue damage over the years that it is going to take a lot more time for things to heal - if they ever do.
To summarize, after 5 MVA's and many treatment plans, I feel that the marcaine injections were one of the best. If I had easier access to the treatment I would certainly start again.
I'm from Toronto too, and had marcaine injections done at a Pain Clinic. They're nothing to be afraid of but they did not work at all for me. They don't go deep enough. They're just basically injecting anaesthetic into the skin and muscle. It hurts, and it's totally unnecessary when there are much better alternatives like ESI's. I recommend the St. Michael's Hospital Pain Clinic. You'll need a referral but their phone number is 416-864-5561 if you have any questions.
I am a pain specialist in the states. Marcaine injections are very effective even done "blindly". A pain specialist has good knowledge of the anatomy that can be done without image guidance. In fact a majority of studies support marcaine injections as more effective without u/s or fluoroscopy.
It can be done withOUT imaging to a) diagnose b) as a form of therapy. It can take anywhere from 4-8 sessions to truly know if it works for you.
I wanted to add that "littleonefb" is offering medical advice as a non-physician. This is dangerous. Her diagnoses are inaccurate. She may have the experience as a patient - but it's just that, her own experience.
Pain is dividided into neuropathic and nociceptive. Back pain can have burning features or dull or achy features. A herniated or slip disc need not have neuropathic (shooting/burning features). It can be a dull ache. In fact, many people walk around without pain who have herniated discs.
Pain is multifactorial - not just nerves, bones, neuro transmitters, muscles etc.
I am not offering medical advise as a non-physician. I am stating the accurate information and from experience.
You may be a pain specialist in the states, but every pain specialist I have dealt with, both as a patient and working in hospitals use floroscopy when doing injections into the sacroiliac joint and the into the back.
Nor have I heard of, as stated in my post, that many marcaine injections done at once.
I have also not found any pain management doctors who would use that many at once or use them without floroscopy. Nor have they heard or read of and studies that claim the, as you stated, that "marcaine injections are more effective without the use of floroscoopy.
I did not diagnose this members mother, nor did I attempt to. I clearly stated that she could have herniated a disc, since her pain developed after lifting a heavy object and indicated what type of pain she would have.
This memeber's mother is clearly in pain, may very well have a disc problem, maybe not.
A family physician is not qualified to treat spinal and joint issues. They need to be diagnosed by a spine specialist as I clearly stated.
This patient can't have an MRI and needs a CT scan for a spine specialist to aid in diagnosis.
The patient is getting no relief from a mass number of injections, but rather, only getting worse.
It may be that it takes several attempts to know if it will work, but clearly, if this patient is getting much worse with the treatment, it obviously is not going to help her, but rather make her situation worse.
It could very well be that the pain doctor is not getting the injections where they should be going, because there is a lack of floroscope assistance being used.
Well is true and well known that many, many people walk around with slipped/herniated discs and have no pain or suffer any problems with it, we are discussing a patient who is in extreme pain after lifting a heavy object.
The very likely cause would be a problem with a disc pressing on nerves.
And, another key issue to this patient is diabetes. Diabetics have varied responses to pain including difficulty perceiving pain. This patient may not be feeling the nerve compression that may or may not exist.
Asking questons, offering personal opinions and advise,based on experience and personal knowledge is far from what you describe what I am doing.
This patient's mother asked for opinions and advise and that is exactly what I gave her.
I stand by exactly what I said, differ with your opinions and the medical doctors, family physicians, pain management doctors, orthopedic spine specialist I know personally as my own physicians as well as those I have worked with for many, many years as associates in hospitals, all agree with exactly what I have stated.
one year ago, I had hernia operation under the stomach left side but missfortunately there was nerve damage after operation which caused big pain.
Doctor performed different examins to me and he said there was nothing with me!!
Now doctor gives me marcaine 2,5 mg. injection every week, but I still feel pain in my left thigh efter 4 hours and I spew and difficult to move.
Is this treatment is OK to me?
Are there side effects?
I'm not familiar with marcaine injections for the type of pain you are having.
It seems to me that if you are in need of having these injections once a week and you are not obtaining any relief or enough relief, then the best thing to do would see another doctor for a second opinion or even get a third opinion as to what is going on and the best way to treat it.
What type of examinations did the doctor do.
How was it determined that you have nerve damage done from the surgery?
I have suffered dibilitating back pain since 2000 after a severe car accident. I have been through every type of medication and therapy (physio, chiro, accupunture etc) to try to deal with my ruined back. In 2007, I had 2 back surgeries, 6 months apart, to try to fix the problem. These were not unsuccessful at all but unfortunately, I will be plagued by back and leg pain for the rest of my life (I am 35).
I live in the Toronto area and have just recently started marcaine injections - blind. Before starting this type of therapy I contacted my physician, neurologist, neurosurgeon, a friend who is a cardiologist and several other friends that work either as nurses or in the medical field. I always spend the time researching before I committ to a new therapy. I have now had 3 therapy injections. At first it did not seem to help but I was told they build on each other and after the last injection, I am actually starting to feel a difference - positively. I started out with 5 injections (1 major, 4 tiny) and am up to 7. Not sure what it will be next time.
For anyone who is interested. Try to keep an open mind about the injections and here in Ontario it is not at all unusual for the injections to be administered 'blind'. Oh - and St. Mikes's rocks!
Marcaine injection with another drug, not sure on what it was
I have a quick question, or a plea for help....
Yesterday I went into my Doc's office for a review of the meds for my lower back injury. I explained to him they work on some days and others (depending on weather and my activity) they do not work at all. He gave me 2 injections, one on each side of the lower spine at the SI Joints...They told me it was a mixture of Marcaine and Ducharon <----the last one I think they spelled it wrong to me...I can not find any thing on it to see what it is. I am VERY sore today at the injection site, I have had pain down the back side of my right leg ever since the injection along with a headache too. I called them this morning and they said it would all go away soon (the sorness from the injection site, pain down the leg and headache). My main concern right now is trying to find out what that second drug is that was mixted with the Marcaine....Please help!!