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Q: severe pain after steroid injection
asked by: csmaller on November 23rd, 2008
New User
I am an active (well, was active) 38 year old man. I have a herniated L4 L5. It has been going on for a few months but was getting better with rest, ice, light exercise, meds, etc. Regardless of my slight improvements (hindsight is 20/20) that i was making I decided to get the steroid epi shot because I wanted to be able to ski . From my research it appeared to not have much of a risk associated with it. No pain, in and out of the hospital. I read and read about it and it appeared to be a great way to get back on my feet quicker. I could NOT have been more wrong.

The physiatrist who did the injection used the xray and dye to get the mark right. Right when he started the injection I experienced the worst pain shooting down my sciatic nerve into my left leg for the 30 seconds or so it took to inject the steroid. waves of pins and needles and pain. Then immediately afterwards they shoo'd me out of the office, more concerned with getting to the next patient and keeping the schedule than the obvious pain I was in. From what I have read and heard noone has had this problem or said it would go away after a few days. I was told that the site of the injection would be sore. What I experienced was immediately worse sciatic pain. much much worse than before. This was a week ago. Since that day of the injection i have been prescribed stronger meds and painkillers and have called in sick twice because of the pain. I am now at the point where I have to curl up on my side just to alleive the pain.

I cant do anything around the house, cant clean, cant stand up in a shower, and am using ski poles to walk around with. Getting into my car and into work is a big problem. I cant imagine people going through this who have to stand up all day or move around at work.
I have almost completely lost faith in the medical community. It seems like even with MRIs and Xrays they are still shooting in the dark with this crippling injury. i called the physiatrist and he wants me to talk to a surgeon. it seems the immediate response is surgery and more drugs. I have looked into yoga therapy and taking this into my own hands. I do NOT want to go through this pain any more and if I have to do months of yoga therapy, ice, and rest then so be it.

Has anyone else experienced this and if so, what did you do? i havent seen anything about sciatic pain getting 100x worse after an epi shot. I have done yoga on and off for years and am thinking that may help the most. At least the injury is in my control. My advice to all: make absolutely sure you can't rehab your injury on your own before you get this shot.
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zigemyster
replied on November 23rd, 2008
Moderator
An actual physiatrist gave you the injection?

This is not something that they should be doing at all. They might can watch it being done by professionals but not alone. Maybe they can?

~~~~~~~~~
Dr. #1: So an epidural steroid injection, for example, can be given in some places by a radiologist, an anesthesiologist/pain specialist, or a physiatrist. How do you choose there? Are there credentialing processes for that?

Dr. #2: There are. This is a little more complicated because the residency programs vary in the exposure that residents get in their training, Often physicians will do fellowships that further specialize in performing these injections. Radiology, anesthesiology, and physiatry are the three major specialties that perform these injections. At the Hospital for Special Surgery, we have doctors in all three of these specialties who are highly skilled in performing these spine injections.

Dr. #1: So a patient should just ask: “What is your experience, how many do you do, do you have good outcomes, etc.?”

Dr. #2: Yes. I would say in addition to that, one of the most important things is that these be image guided. There are many places where these injections are not image guided, and I think to get adequate localization of the medication and for safety reasons, they need to be done image guided. That is either fluoroscopically under x-ray guidance or CT guided.
~~~~~~~~~~

It sounds like your siatic nerve was hit.

With my second spinal tap I immediately felt pain shoot down into my leg from the lower back. For several weeks afterwards I could not stand up completely straight or walk a few feet without crying. I couldn't even bend into the tub without screaming.

Day after this injection I contacted my neurologist who ordered the spinal and the radiologist who did the spinal (he did the first one too which was OK) and they both played this game of 'well, that couldn't have happened, etc'....

It took a while for me to get better, maybe a month, and I haven't gone back.

It is unfortunate that your first epi went so wrong as it should not have.

I was told that there is always room for something to go wrong when dealing with the spine and it is a chance that is taken.

~Zig
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csmaller
replied on November 23rd, 2008
New User
going to er
i just tried to stand n it feels blown. i called a friend to take me to the er. it def is my sciatic nerve. worst pain everfelt\. let me ask u. did the pain go away after the month?
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zigemyster
replied on November 23rd, 2008
Moderator
I was back to my normal self after approx 1 month. Your pain sounds worst than what I had.

Did your other pain subside with the epi?

Don't quote me on this but I have heard of injections that were for the spine were missed and was actually injected into the surrounding tissue.

Get to the ER and I do hope you get relief and answers soon.

Update us if you can,

~Zig
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csmaller
replied on November 23rd, 2008
New User
i just got back from the ER. they put me on a morphine drip. i had to call 911 because my friend and I couldnt not get me off the couch. took 4 paramedics to get me into the ambulance. severe sharp pain in the back n glut. the Dr told me I didnt blow the back just the sciatic nerve is really inflammed. yesterday i thought i was getting better so i went to the gym to stretch and ride the bike (which after 2 mintues i couldnt do) and hit the jacuzzi. im thinking that may have made it worse. So, now I am back home on the couch with yet more drugs.
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littleonefb
replied on November 24th, 2008
Extremely eHealthy
Glad to here you went to the ER and got some pain meds to help ease your pain.

I have to agree with Zig and question as to whether a physiatrist actually gave you the ESI. Is the physiatrist also a pain management doctor as well?

If not, he had no business giving you the ESI and that may be the reason that you are having the problems your are having. In other words, x-ray, dye or no dye, a physiatrist is not qualified to to give the ESI.

A pain management doctor is a medical doctor, many times an anesthesiologist that has gone into the field of pain management, is the qualified doctor to administer spinal injections.

It sounds like the injection may not have been placed in the proper location and some of the steroid medication is in the muscle and or around the sciatic nerve and that is why the sciatic nerve is so inflamed.

Did your spine surgeon send you to the physiatrist for the ESI or did you select him on your own?
If you where sent to him/her by your spine surgeon, I would call the spine surgeon ASAP on Monday and report the problem to him/her.

Next I would find another spine surgeon to use as well, and sure wouldn't go near this so called physiatrist again for any kind of treatment or follow up care post this ESI.

ESI should not result in this kind of pain. Not only that, but you can be sedated so that you don't feel anything when they are being done, you are out cold like a light bulb and then awake within 5 minutes of the ESI being completed.

I have had 3 ESI done, before my spinal surgery 2 years ago and a selective nerve block as well. Was out cold for all 3 administrations of them, never felt a thing.
The ESI didn't do anything to ease the pain, but I do know they where administered by a well known, reputable pain management doctor. The selective nerve block he did was also done with sedation and it took about 2 days for the full affect to take hold and was quite successful in not only relieving the pain for several months, but also confirmed the diagnosis of what disc was the problem.

Hopefully you will get some pain relief with the new meds you got in the ER, and give you time to find some new spine surgeons and pain management doctor.

Fran
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