Did the dr say what he/she was injecting you with, I have had plenty of injections anywhere from steroids cortison to blocks, they did not help me but we are all different.
Good luck!
Let us know how you are doing with them.

Hi sandy

thanks for your reply.

Unfortunately, I don't really know exactly what he is going to use, only that it will be a steroid of some sort and an anesthetic.

What's the procedure itself like?

Thanks again.

Sarah

Hi sarah

from reading your post it sounds to me that they are going to do facet injections. Please check your pm (private message).

Imshirl :d

I'd be getting a lot more information and getting other opinions before I would let a doctor use me as a pin cushion to try and diagnose the problem. :shock:

From my experience, it sounds like what the doctor wants to do is to inject you with an anesthetic such as lidocaine, and a steroid to "cool" the nerves in the suspect area. If this works and provides you with relief, it tells the doctor that the suspect nerves were indeed the ones needing further treatment. When I had this done, it was for facet joints and sacroiliac joints. The doctor then asked me to keep a sort of "pain diary" to tell him how I felt over a period of a couple of weeks following.
The initial treatment itself is really not too bad. You basically just get a series of injections of local anesthetic in the area, then injections of the above stated mixture into the suspect joints. The same/next day you might be a little sore, but not too bad. If the doctor got the correct joint/nerve areas, your relief will be tremendous and well worth the treatment itself.
Unfortunately, this treatment is simply a preliminary test, and only will provide relief for a week of two. But if it does in fact provide you with relief, the doctor can then proceed with either futher injections, or radiofrequency neurotomies. These latter then provide more lasting (or even permanent relief in some cases).
In my opinion, you really just need to begin to ask more in depth questions of your doctor. What is he/she doing? Why? What is the goal? What is the overall gameplan? Will the procedure hurt? What can you expect afterwards? If it will hurt afterwards, then ask for a prescription for something to help with the short term pain.
It sounds like you are going through some procedures and steps I have already been through. If this is the case, then your doctor is actually taking a conservative and cuatious approach by performing this test rather than just doing a treatment.
Hang in there... It really is nothing to be so afraid of.
I understand your feelings of fear. But I think most of that stems from not understanding the "what" and "why" behind your doctor's actions.
I can't emphasize enough... Ask questions. Ask lots of them. Don't feel stupid or out of line asking things. Many doctors don't volunteer information unless asked. This I believe is because most patients either don't want to know, are afraid to know, or just assumes the doctor always knows best. When in doubt, seek a second opinion.
But to me it sounds like your doctor is not off track in this course of action.
I hope all this information helps!

Actually be very cautious indeed of injections.
They do more harm than good.
Especially in my case
i had si joint injections that didnt hurt when done or have any after affect however the facet joints are another matter...
Had these injected in my lower back and I have had endless pain since,
90%of my pain im getting now is from those blasted injections
neurosurgeons seem to differ in there opinion about these injections as of bone surgeons.
The steroid and needle seems to have an overall harmfull effect on surrounding nerves

Hi rank1 ~

wow it's good to see you. We have not seen you on spineand beyond in a long, long time. Have you forgot about us? :wink: we would love to see you back there again. We now have 145 members. :d love to hear how things are going for you.

Shirl

Hi. Yeah nice to see you on here again.
Ive just re-registerd on your site.
I will go onto the site(when I get password through) and tell you whats been happening with me.
Hope your okay
al

Please be careful of what these anesthesiologists do to you. Have you talked to a pain manaagement Dr. Or a neuro? Oh yes, I remember those well, they gave me medrol and something else, in both back and neck, I sure hope they help you, better than they did me!
Did you have them yet, did they help?
The best to you!

Dear all

firstly, many thanks for all of your comments, much appreciated!

I thought i'd update you all on what happened.

I went for the diagnostic joint injections. He injected local anesthetic and steriod (to reduce inflammation) to l3/4 s1, si joints and pubis symhysis.

Luckily for me I was sedated so the event itself wasn't too bad. However, the pain afterwards was quite something. I couldn't lay down so lack of sleep was on the menu. After 3 weeks however, I was almost pain free. I still am 4 weeks on. Or at least I was until I fell down some stairs on my butt the other day :roll: I am hoping that the pain from the fall will pass soon.

I am now scheduled for radio frequency denervation into the joints mentioned above.

Has anyone had this done? Again, I am scared of the procedure itself. Any pain I get from the aftermath I can deal with. It's just the procedure itself that unnerves me.

Any info welcomed!

Sarah :wink:

One thing to note about pain management doctors is, most are board certified anesthisiologists and have had extensive training in the art of pain management. It takes many years for these doctors to finish thier training and become specialists in pain management and as far as I am aware, none of them are pompous enough to say that they will always cure a patients ailments. Pain management is a difficult and almost impossible practice simply because pain is totally different to each patient.

That being said, it sounds as though they have found the trick to your particular pain, if the anesthetic helped to take away the pain, then the next logical step (keep in mind pain managment and logic do not always co-exsist on an even playing field) is to do the nerve ablation procedure. There is a boat load of conflicting data as to the effectiveness of nerve ablation and you can ask the doctor if he/she is willing to simply do the maintainence procedure and only do the injections without doing the more invasive ablation procedure. It is your choice and if you decide that you do not want to risk having the second procedure done, they should be willing to at least do the injections and allow you to think about the bigger procedure for a while. If the injections worked, you will be able to live a fuller life and ever 3 to 6 months have the injections done to continue your relatively pain free life.

There are many resources on the internet for you to do research about "denervation/ nerve ablation", and in my opinion it is your responsibility to make sure you know as much as you can possibly know prior to making any decision that is as permanant as having the nerves destroyed. Once that is done, there is definatly no going back whereas if you do the injections, there is some reprieve because the steroids and anesthetic will wear off.

Good luck for the future and please take the time to find out as much as you can as to what you should do in the future, '

brian

Here is an article from spineuniverse with regard to facet injections/denervation:

is the facet syndrome a myth?

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lumbar facet syndrome is a very convenient diagnosis for mechanical low back pain (lbp). The signs (1,2) of a classic facet syndrome are: pain on lumbar hyperextension and decreased range of motion in any plane but especially in extension and rotation, local facet tenderness, absence of neurologic deficit or root tension signs; on lumbar flexion there may be relief, and straight-leg raising may or may not be normal. Pain is usually of a deep aching variety and may extend to the buttock, hip, and even below the knee but not into the foot. But most of these symptoms and signs may also refer to pain of discogenic origin. (2)



"the function of the lumbar apophysial joints is to allow limited movement between vertebrae and to protect the discs from shear forces, excessive flexion, and axial rotation. (3)

structures in the lumbar spine that receive a nerve supply are the zygapophysial joints, the ligaments of the posterior elements, the paravertebral muscles, the dura mater, the anterior and posterior longitudinal ligaments, and the intervertebral disks. (4) it becomes clear that functional tests cannot specifically stress the facet joints. Firmly holding the patient's hips and pelvis, and asking the patient to bend forward to determine if relief occurs, to help pinpoint a facet involvement or creating pain on lumbar extension versus flexion cannot specifically incriminate a facet since all of the tissues mentioned above will also be stressed. While the facet joints are part of the picture of mechanical lbp, and chiropractic adjustments move zygapophysial joints, there are, of course, many other factors to be considered as to the reason patients experience relief from adjustments.

Unfortunately, at our present state of knowledge, the diagnosis for lbp or for that matter any diagnosis incriminating a mechanical cause for lbp (as differentiated from, for example, a herniated disk compressing a specific nerve) is speculative. Nachemson states that "although today there is a better understanding of pain, the pathomechanism of low back pain is unknown. (5) he goes on to state that orthopedic surgeons who operate on patients with ill-defined back syndromes should realize that rarely are diagnoses scientifically valid, nor is the effectiveness of surgery proven by acceptable clinical trials.

While most authorities agree that the facet joint capsule has free nerve endings and is a probable source of pain, according to jackson (2) and others, (1,6) the "diagnostic capabilities for testing the presence of a facet syndrome have been proven invalid."

a common method for diagnosing lumbar pain are diagnostic blocks where an anesthetizing agent is injected to determine if pain is relieved. According to jackson, (2) who examined the literature and has performed three separate studies of his own regarding the injection of facet joints, the facet is not a common or clear source of significant pain and the facet syndrome is not a reliable clinical diagnosis.

While many studies involving facet injection have been favorable, jackson states that there are very few randomized controlled prospective studies. He states that the facet joint can only hold about 1-2 ml and many studies using more than that amount rupture the capsule and spreads the anesthetic to outlying areas. Jackson (2) in one study evaluated 390 patients with facet joint injections. He found that patients with more pain on lumbar extension and rotation did not get more pain relief after facet injection. He concluded that more than 90 percent of the patients with the signs of facet syndrome, did not respond better to facet injection.

Jackson (2) quotes a study by lorenz et al., (7) which demonstrates that the upper lumbar facets l2-l3 in the lumbar neutral and extension positions have higher compressive loads than the l4-l5 level. He uses this argument to prove that facets are not primary sources of pain since clinically most back pain occurs in the lower l4-l5 levels. Of course he does not mention the fact that due to greater disk degeneration at the l4-l5 level the pressure on the l4-l5 facets will increase accordingly. (8)

i suppose since no one at the present time can pinpoint the exact source of pain in the mechanical low back problem, it is easy to prove that no one location is the source of the pain. For years there has been an argument between the disk and the facets as the main source of pain. Until someone can definitely prove that the facet is not a principle cause, i, for one, will be using facet syndrome as a plausible diagnosis