tekoaMemberMarch 6, 2012 at 6:44 amPost count: 2
History – lifted improperly in 6/1999, resulting in bulging disc L5/S1. Had three EPI within a year, none were helpful.
Maintained weight and fitness levels to keep me relatively pain free until recently.
Aug ’10 – woke up to experience 8/10 pain. Unable to get out of bed unassisted, sit, or walk. Pain in lower back ONLY.
Between Aug ’10 and now there’ve been three or four episodes of this extreme zapping pain. (Localized to lower back)
Muscle relaxers and pain medication do not relieve it. (apparently the forum software does not like the names of the medications) But they only last two to three weeks. (only!?!) Two of the episodes came on while I was sitting perfectly still – felt like a cattle prod, really.
Had another MRI in Sep ’11 and no real deltas between that and the findings from 2000. Shopped the images to a couple of local (very conservative) surgeons and they said they could not help me.
Have had three facet injections from ~Sep ’11 to Dec ’11. They were quite helpful, and although they only lasted for a week or so each, I felt as if I were on top of the world for the short period that I was completely pain/opiate free.
I had an RFA in January ’12 and it was not at all helpful. I experience a 3/10 pain level at most times, unless I am flat on my back. PT since January ’11. Massage has helped the muscling higher on my back which is tight, apparently compensating for lower back.
1) Is there any chance that the facet injections were not conclusively diagnosing the facet joints as my pain generators?
2) If, in fact my facet joints ARE my pain generators, can the RFA be considered as a procedure that could possibly fail?
My PM doctor is not willing to do any more at this point. I am looking for a more permanent fix than, “Maybe you should see a chiropractor or use our DRX9000.”
I am shocked by how quickly my state of mind degenerates when my pain levels increase. I am not overweight, I have done PT for a year, and these ‘episodes’ are still recurring.Donald Corenman, MD, DCModeratorMarch 6, 2012 at 10:08 pmPost count: 8459
Facer injections are diagnostic if pain relief is noted in the first three hours only. This is when the anesthetic is working. If pain relief is noted after this period of time, this relief is a function of the steroid medication. Relief is not diagnostic if noted after this three hour window as steroid may not work locally at the injected facet but spread or become systemic and relieve inflammation at a distant site.
If you had good diagnostic relief (first three hours) and the injection was in the capsule of the facet (directly within the facet), the second confirmatory injection should be a medial branch block. This is the small nerve that gives the facet it’s innervation and there are two for each facet.
If you gain good relief from this second injection, you are a candidate for radio-rfrequency ablation (RFA) which uses a heated needle tip to destroy the small nerve roots that enter the facet. The success rate that I have seen is about 70% for relief of pain.
Why the success rate is not higher is suspected to be anatomic variations of the location of the nerve. The burn zone for the needle is about 3-4 mm. If the nerve is not where it is suppose to be, the burn will miss the nerve and pain will still be transmitted.
Voltaire made the best statement regarding the association of the back and mind. He stated: “The lower back is at the crossroads where the psyche meets the soma”.
Dr. CorenmantekoaMemberMarch 6, 2012 at 11:48 pmPost count: 2
Thank you, Dr. Corenman. I suppose my next step is to start over with the diagnostic process. I don’t think insurance will pay for the same tests again. Perhaps taking my medical records with me to another facility is the right answer. I was not unhappy with my current doctor, but if he is not going to keep looking for my pain generator (as I was under the assumption that we all decided it was the facets) then I should probably move on.
I was nervous about the last facet injection because I was not experiencing measurable pain on that day. I always felt more ‘sore’ than better upon leaving the surgical centre.
I wondered if there were standard deviations in the location of the nerve to be burned. I think I offended the PA when I asked about that. I have no idea at this point if I am indeed a candidate for RFA but I was curious if an endoscopic approach offered better success?
A medrol pack was the way that I ended the first, big, ‘episode’ that I had in Aug ’10. Often when I am especially painful, I notice a clunking noise/feeling in the lower back when I rise after sitting.Donald Corenman, MD, DCModeratorMarch 8, 2012 at 12:34 pmPost count: 8459
Clunking noises do not necessarily mean anything as long as the noises are not painful.
If you were not experiencing “measurable pain” prior to your facet blocks, it might be likely that the blocks were not diagnostic. You need to have appreciable pain prior to the blocks and/or be able to perform an activity that typically induces pain after the blocks for the three hour anesthetic window to gain knowledge enough to diagnose the facet as the pain generator.
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