Hi All,
I have a pain mgmt doc I see monthly who is a doll and manages my pain well.
For big flares of pain,
About 5 yrs ago he sent me to another pain doc who did ESI's(epidural steroid injection) that worked well to control pain from a c4/5 herniated disc and helped with some neuropathy...I was very happy. He did this 2 or 3 times.

Well, another bad pain flare last week probably again from disc, an MRI result is pending, so back to the doc that my husband and I call Dr. Needles. However, this time he recommended first Facet Joint Injections, followed by RFA(radio frequency ablation). Now, this is without yet seeing my MRI or examining me as he has in the past, just very briefly talking to me. I asked him why the change in treatment when the previous ESI's worked so well. He got a bit testy and said treatments change and he thought my symptoms were different. I said no, they are the same. He then admitted the ESI now has to be done in the hospital, not in his office and "besides, the ESI is much riskier" than other treatment.

For those of you who have had a facet block and ablation, can you tell me if they helped your pain and what procedure and recovery is like. If anyone else has had ESI and the
facet Inj/ablation...can you offer advice or opinion.

I honestly think this doc is making a decision on what is best for him financially, not what is best for me. He refused to do the ESI he had done in the past.
Thanks, Diandra

Hi Diandra,

Actually, the doc is right. ESI's for the cervical spine are far more risky than facet injections. Facet injections are done in the joint and nowhere near the spinal cord. I was terrified of the one ESI I had for my cervical spine. It went well thank goodness but even my pain doc said they were far more risky. And in truth, the facet injections worked much better! I have never had the medial branch nerve(s) ablated in the cervical spine but have had them done in the lumbar. RF's work very, very well. At least for me. As for having this done in a hospital setting, it is not an "admission" so to say. It is a change in the law from what I understood. I am not sure if this was a new CMS rule or not. But I was told the same thing months and months ago. It is still somewhat confusing to me since my Mom had a lumber ESI in what I term the office setting. However, the group I go to also has a surgical suite so that may be the difference. Anyway, try the facet injections and if they work and ablation is next, you might find much longer relief.

Hi Kathi!
Thanks so much for the advice. I am always a chicken when I get an injection or procedure I have never had before. I am so glad the RF's worked well for you, you have given me just the encouragement I need. I was also very concerned before I had the first the ESI but it was so helpful, I was grateful for the relief. Take care, Diandra

Diandra,

You are welcome! Based on your first post my thinking is that your doctor is attempting to target (more specifically) your pain generators. So, that's a good thing! ESI's tend to just flood the area in hopes that it calms everything down. Now, I am just going to say this because facet joints are my problem in the cervical and lumbar..all the time. If they are inflamed, you will know it. The injections may be painful or maybe not. But since you are concerned you can always ask the doc for perhaps 10mg of Valium to get you through the procedure and to help you relax your neck muscles. Or perhaps an IV with Versed. I did that a few times. The nice thing is, these injections are usually pretty quick. And the best thing of all is that I normally had great relief right away from the numbing med! Which told the doc, yes, that was my pain generator. Having said that, you may find an increase in pain for about a week but give the steroid a chance. It takes a little time for it to kick in. And if they work, and the RF is next, rest assured it is actually easier than the injections themselves. I have had 3 in the lumbar over the years and never felt it.

Hi Diandra.

First, I will say: I hope you get some good pain relief from what procedure you and your physician decide to have done for you.

I*, my self, had 2 Epidural Steroid Injections for herniated C6-7 disc with left arm radiculopathy. This procedure was some years ago, and ir was done at an outpaitient surgical center. Thinking back, I am pretty sure it was done under brief general anesthesia.

I must also say, I do not know much about Facet Joint Injection, and have never had it done.

Last, but not least, I must say that the Epidural Steroid Injections did not help- me one bit. I used to say, that I think this procedure is wasteful, and overpriced.

Bur I have heard that this can be very individual. It can help for some, and not for others.
I think you are in your right to assess the situation, find out about the other procedure, and then you and your physician can make a choice.

I also agree with you regarding the doctors wanting to make the choice for the patients in order to suite their (often) financial benefits.
But this may not be the case here. As I said, this other procedure might be right for you.
But if you and the doctor wait for the MRI result, and then sit down to discuss it, then you might be better able to make the right disision.
Also take into concideration that it will give you some extra time to explain to the doctor that what procedure you hadf before, had helped you.

There is another point to remember that I think is important: It is always good to know that when one has a invasive risky procedure, it is done in a safe hospital invironment.

Good luck with your procedure.

Synnove

Have any of you ever considered going to a chiropractor for pain relief without drugs?

My recent MRI had revealed that I have several disc herniations and spinal cord impingement with C6 and C7 being the worse.

And that for years my C1 (Atlas) and C2 (Axis) never stays in place. Getting worse as years have gone by.

I have gone to a chiropractor since 1999 for my lumbar L4, L5 and S1 issues.

I now have had a Thoracic MRI and Cervical MRI and they showed T4 is herniated and again C1, C2, C3, C4, C6 and C7 are really messed up. To say the least.

My current chiropractor had suggested that I try cervical decompression. Where they decompress the cervical spine with slow mechanical movements. It is painless and actually I go to sleep for the 5 to 7 minutes that I am having it done, lol. It has helped me tremendously. My migraines are eased and I can sleep better than I have in a long while.

Mind you that I have been dx with RRMS too.

I have recently been talking with my old chiropractor from where I used to live and she has been a Godsend to say the least.

She suggested that I would benefit from seeing a Upper Cervical Chiropractor (they xray you standing upright) They are able to see problems of the cervical spine differently as opposed to lying down the conventional way.

I recently was able to buy a great read on this very subject. "The Downside of Upright Posture" by Michael Flannagan, D.C. ($24.95)

It is so informative and is an easy read. I can't put it down. It was talking to me to a T!!! Best money I ever spent.

Mind you, I have had no success with neuro's and my reg PCP on why my face was going numb and how I lost partial vision in my right eye. They still think it is from the MS as the optic neuritis keeps recurring.

While I have lesions on my spine (reason for RRMS dx) ... I wonder how much my neck has played a role in this and could it actually be from not enough blood supply going to my brain.

I never believed in chiropractic until about 1999 when a good friend from work had found relief from his painful back.

I exercise as much as I can and I stretch ALOT. Recently I have changed my diet. Gluten free, a little at a time, to see if I see any changes in how I feel.

Can't hurt ... and wouldn't it be LOVELY ... if just this simple change can take some or all of our pain away .. without the use of drugs? Drugs are toxic to the rest of the body. Mmmm something to ponder on.

Praying for pain free days ahead
God Bless
Str*

yup....tried 6 or 7 over the yrs along with DO's and acupuncture, massage, phys therapy. no luck way before I went the drug route. I recently had been very deconditioned and my high blood pressure was problem. I did not want to add more drugs i tried swimming slowly and aqua therapy and hanging upside down from gym equipment....apparently I did more harm than good. honestly, cranial sacral therapy and these various injections are the only things that have helped my cerv disc issues. diandr

Pain relief without medication is always the primary goal of pain mangement.

Studies have shown that physical therapy is as effective as surgery in the long term for some conditions.

study: surgery vs. physical therapy

Myofascial Trigger Point Therapy (MTPT) is very effective for soft tissue and some musculoskeletal issues.

TENS, Biofeedback, Mindfullness Meditation, diet (avoiding triggers and feeding the body with nutrients), supplements (Do you consider supplements to be medications?), distraction, acupressure/acupuncture, lifestyle changes, and other techniques can all be effective for some. Medications generally are—and should be—the last resort before surgical intervention.

I accomplished cervical decompression (as much as possible) with gentle traction.

Chiropractic can be a polarizing topic around here. Ask IllPn (there are others as well, but I'd have to search for posts/threads) about chiropractors for cervical issues.

Lumbar... maybe, if you buy into that stuff.
I'd be extremely wary, particularly with the kinds of spinal issues of members here.
emphasis mine

I don't expect to change any minds of chiropractic converts/followers, but for any on the fence or wondering, I advocate diligent research and coming to one's own conclusions rather than anecdotal evidence.

Doc

Hi Doc,
You said, "I accomplished cervical decompression (as much as possible) with gentle traction."

How did you do it, with a physical therapist or your own home traction device, etc?
Thanks, Diandra

Both. It began with PT, at which time it was suggested I might get a home unit. After asking a lot of questions of PTs, my doctors (my ortho uses one) and reading online, I chose an over-the-door unit and made some slight modifications so it would work better for me.

Doc