Nerve Block?
 

My doctor suggested a nerve block at L5-S1 to help rule in or out my lumbar spine as a cause of my neuropathy symptoms. I have never been a fan of steroids but I am considering it for 2 reasons:

1) It would be really great to know if this is the cause so I could make lifetime adjustments accordingly.
2) To give me some relief even though temporary

I would love to hear experiences from anyone who has had a nerve block or knows anything about them.

I do not plan to do this more than once. I'm sure if it takes away the symptoms and makes me feel normal again it will be hard to resist. Opinions on how slippery a slope this is would be great too.

Pinky, do you mean epidural injection(s). I've had scripts but never did them. My lower back is my achilles tendon for most of my life and worse with aging and hip job.

Some do these with no trepidations about doing them and others like myself think long and hard about these steroids in lower back.

Our PRP MD here would want to tighten up the ligaments around the joints. Insurance does not pay for these. And he does not guarantee but says lots get help from PRP injections. Some ortho docs in our area even do PRP now. Good wishes...

Pinky, I wish I could help but don't know anything about this. So the block the nerve using steroids? Interesting. Anyway, what I can say is that depending on the procedure, precise amount of steroids, etc., I would think (1) is immensely valuable for many reasons. I would just beware not to be seduced by (2). ;)

Epidural Steriod injection
 

My PN symptoms developed 2 nights after a lumbar epidural injection. I woke up in the middle of the night and thought someone came in and chopped off my big toe...symptoms quickly progressed up my feet and legs during the following days and weeks.( I think I gave my details in an earlier post.) This occurred October of 2013, unfortunately I am still struggling with PN. I would definitely find out what type of steroid they would be using. I received Kenolog which is not labeled for epidural use. It contains benzyl alcohol which is a neurotoxin. Many doctors still use it routinely. I have idiopathic SFN and large fibers also involved. Not sure if it was the trauma of the injection or an autoimmune response. No one on this forum at the time had any ideas or similar situation. I have been to many doctors since this began and only one neurologist would say that it was a direct result of the injection. She has since moved on as this was at the medical teaching hospital in my state.

That is awful results
 

from something that is designed to take pain away! Thank you for the information. I will definitely discuss this with my Dr. I do know there are differences between an epidural injection and a nerve block but there are also similarities.

I'm late to this conversation but info is info so here goes:
The nerve block is very different from a steroid shot. In general, the former is diagnostic and the latter is for treatment. I could rabbit trail and say that nerve blocks are treatment for several conditions such as migraines and complex regional pain syndrome, but I'll stay on course :)

The general course of action is to see if the nerve block (which is largely a numbing agent like Marcaine or Lidocaine) takes away the pain. The info then helps decide the next steps. If the onset of pain is recent, the doc could prescribe nerve-modulating drugs. The other extreme is nerve ablation, which injures the nerve in such a way that it temporarily stops firing. I've never had the ablation done because it wasn't indicated for my problem. I've heard some bad stories, but I also have a friend who goes every 6 months like clockwork. That's the thing about the ablation - it's temporary, and can cause its own side effects. So buyer beware, so to speak.

Nerve blocks can be done frequently and are often given in a series of 3. They're expensive (I live in the Midwest and the full-on cost including hospital time, surgeon, radiologist, etc. is ~$1,800.) but usually covered by insurance. I have one of those conditions for which nerve blocks (used to be) for treatment and I've lost count of how many I've had over the past 15 years. 30? 40?

As for risk, I won't say there's none. The risks are related to surgical error, so it pays to go to a place where they are rote. My issues are upper extremity, which is much less common than lower, so I had to do a pretty intensive search to find someone who had done a lot of stellate ganglion blocks. The injectable itself does have a small amount of steroid, but apparently not enough for anyone to get excited about.

Good luck with whatever you decide.

Funny story but not informational:
The only side effect I've experienced is a tattooing effect. I had so many done in one spot, right in the middle of my throat - and they always mark the location with a marker - that the ink has penetrated my skin. It's not noticeable when looking at me, as it looks like a freckle, but the moment I lie down on the table, the anesthesiologist breaks out into a big :D. X marks the spot, so to speak.

You're not late at all!
 

Thank you so much for this information. I've just begun reseaching this subject and it is most helpful especially with you having had so many rounds of treatment. Your tattoo story was quite amusing. :)

I've been lucky, I've had numerous epidurals, the injections in my hips and tried nerve blocks to see if a radiofrequency neurotomy was an option.

The nerve blocks did not work so I never had the radiofrequency neurotomy.

The epidurals and other injections bought me some relief for my back pain sometimes over six months. In my case it seemed when the back was screaming in pain it just added to the pain in my feet.

I was finally diagnosed with Degenerative Disc Disease and had a spinal fusion in L3-4-5. This is when I tried the nerve blocks to buy me some time before surgery.

I still have nueropathy in my feet but my back pain is gone.

Good Luck - in my opinion you need try to reduce the pain

Which type of doctor do you think
 

would be better for a nerve block? A Neurosurgeon or a Sports Medicine, Neuromusculoskeletal Medicine, Physical Medicine & Rehabilitation doctor? Both are good doctors.

Nerve block scheduled for 4/27/16
 

After having chronic burning for over a year (it is never gone except when I sleep and who knows since I'm asleep? :confused:) and having all types of tests to see if the cause is structural or other I have decided to go forward with this. My MRi's and flexion extension xray show that the area of L-4 L-5 S1 has issues that could be causing my symptoms. I am hoping that this may give me more data (and some relief) so that I will have a better idea how to proceed.

Thank you for your responses and concern. I will let you know how it goes and post the effects of this procedure. I am a little nervous, but the doctor who is doing the procedure is one of the few I trust. :)

Good luck!

I guess I have used the wrong terminology in many of my postings so I want to apologize if they have mis-led anyone in the past, present, or future.

I guess I use the term "nerve block" incorrectly.

I have had injections with lidocaine or a similar agent and it was for "diagnostic" purpose. I have also had injections with steroids for "treatment" purposes. When having injections with a steroid, I have called them nerve blocks. If I was incorrect in doing so, I do apologize but the paperwork from my insurer says: surgical procedure - nerve block

I really did not mean to cause any confusion. I have also used the same term "nerve block" regardless of the site of the injection. I have used the term for spinal injections as well as injections for nerves AFTER they have left the spinal column.

The only reason I am making this post is to clarify that I may have been guilty of using improper terminology not only in the past, but will probably do so in the future. I just don't want anyone to be mis-led if I use the wrong terms.

It is confusing and it's not just us.
 

More than once this past year a Doctor has used the term "Nerve Block" when he really meant an Epidural Steroid Injection. I was told a nerve block was a diagnostic tool and then the procedure for an epidural was described. :confused: I did not realize the inaccuracy until I read the exchange of ideas on the subject here, between posters. I then knew I needed to research the topic more fully and if I do decide to get an epidural injection I will check to make sure Kenolog is not used as the steroid.

Most of us do not have a scientific or medical background and are just trying our best to be of service. I appreciate all of you guys more then you'll know.

I am editing because I just found this which adds to the confusion: http://apmspineandsports.com/diagnosis/epidurals/
"A selective nerve root block is a spinal procedure in which anesthetic is placed on a specific nerve root of the spine to help identify the exact source of leg or arm pain. The injection usually also contains steroid to decrease inflammation and pain. The injection is similar to a transforaminal epidural steroid injection, but in a selective nerve root block there is no attempt to have the medication enter the epidural space. Rather, the aim is strictly to cover the offending nerve root."

My husbands pain management doctor used the term "nerve block", no mention of steroids when he tried it in his feet. Totally painless according to my husband.

Did absolutely nothing in terms of pain relief, but certainly worth trying.

What works for some, doesn't for others.

Linda

Lidocaine part worked! Update and questions!
 

Last Wednesday I ended up having epidural steroid injections targeting L5. I believe it was the lidocaine in the injection that was responsible for about 2 1/2 hrs of complete bliss until it wore off. It was amazing to be free of my symptoms for the 1st time in 15 months.

The reason I attribute the relief to the Lidocaine is because the effect was temporary and the steroid takes some time (days to week) to kick in. What I question is how a local anesthetic applied to my back effect the nerves in my legs and feet? It wouldn't have lessened swelling or inflammation or any impingement.

I am so confused. If you have any ideas please give your input. My follow up appointment is in 2 weeks and I would love to understand this before I go.

Glad it helped the pain
Allmost all the peripheral innervations connects to the brain through the spinal cord.
The nerves that exits (motor) and enters (sensory) each segment of the spinal cord innervates a slice of the body, it is called dermatome, you can read about in Wiki -
https://en.wikipedia.org/wiki/Dermatome_(anatomy)
You can see in the image there that the nerve fibers that pass at L5 innervates the feet.

Thank you!
 

This is very helpful :)

Hi to all you lovely people! Update as promised!
 

1 month ago I had Epidural Steroid injection(s) targeted at L4-L5 to see if it is the cause of my symptoms and to give me some temporary relief. I kept a journal and here is the readers digest condensed version;)

The injection consisted of both lidocaine & corti-costeroid). Fluoroscopy (live x-ray) was used to monitor the placement of the liquid. It was not painful although I did feel a slight pressure in one area.

Within a short time after I got off the table I realized something was different. ALL my symptoms were gone completely. This included the burning in my hands which my neurologist insisted could not be from my lumbar. (Of course he has insisted other things that have not been my truth.) I felt a little tipsy which is why I guess you need someone to drive you after. The feeling of being whole again lasted about 2 1/2 hour and was glorious! As the Lidocaine wore off my symptoms started to come back and by early evening they were much more intense then usual. I could not get comfortable sitting, standing or lying down. They were horribly intense for the next 2 days and then started to die down. I used ice on my back and it helped some.

Over the next week my symptoms began to lessen. I was allowed to do a few exercises so I went to the gym and that turned out to be a huge mistake. Within hours my symptoms escalated and it took 1 1/2 days for them to start to calm down. It took a week to get back to where I had been before the gym.

My progress continues and symptoms are much improved but not gone. It seems when my burning is improved my night time twitches and flutters are more present still disrupting my sleep most nights.

I had a follow-up yesterday with the doctor who did the ESI (sports medicine, Physiatrist) and he feels my results confirm my lumbar being the cause. I have scheduled 2 appointments with university doctors to discuss the possibility of surgery and listen to their approach. I plan on getting a minimum of 3 opinions.

I'm still very reluctant to go this route but I know that besides (hopefully) being able to effect my symptoms, not being able to move my body is causing other areas to harm as they stiffen up due to osteo-arthritis. Besides, I'm not getting any younger! :Ponder:

You might explore some topical lidocaine in the same area, as the injection.

Lidoderm patches, or the OTC Aspercreme with Lidocaine.

Thanks MrsD. I do have the Aspercreme and will be doing some exploration!!

Hi Lukesmom,

Sorry to jump on the back of another thread but I read what you said about Kenolog being a neurotoxin. Is Kenolog a form of steroid? I have had intravenous hydrocortisone. I dont know what brand it was. When it entered my blood stream it immediately burnt my private area and the top of my head like someone had just set both ends on fire (excuse the visual). Is this why? Does this mean steroids are dodgy as well in terms of neuro toxicity.
:(

Should have added - intravenous steroids are considered an option in certain inflammatory neuropathies. This is something my neuro has discussed.