Starting steroid injections in spine/lower back. What should I know.

Speed King

Speed King

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I have three degenerative disks in lower back. Part of treatment is a methyl prednisone injection. The doctor says its way stronger then a steroid dose pack. Does anyone have any idea how this works and what I can expect from this?
 
Speed King said:
I have three degenerative disks in lower back. Part of treatment is a methyl prednisolone injection. The doctor says its way stronger then a steroid dose pack. Does anyone have any idea how this works and what I can expect from this?
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Its a synthetic glucocorticoid for patients with discogenic low back pain due to inflammation, either from direct chemical irritation or secondary to an autoimmune response, regarded as being of short-term value...
 
Thanks. I'm new to the whole bulging disks thing. I will remain optimistic about it. Needles and spine don't mix with me. May ask for sedation ;)
 
Do you do any exercises for lower back? It's been shown repeatedly to help inhibit the sometimes excessive chemical inflammation in degenerative discs (ie the non-physical causes of inflammation/pain).
 
The injections aren't worth a damn if they are not put in exactly the right place. pain from a bulging an herniated discs are much more complex than just squirt the prednisone onto the disc and can be very hard for doctors to pinpoint.

I have had injections work )benefits lasted about 2 weeks or less) and had injections make the pain 10x worse because they increase pressure in the area.

If I were you I'd quit all sports forever (even when you feel better) and do low impact exercise. Dont overdo it or you will be in horrible pain for months straight, even permanently. I have one herniaated disc that was repaired via discectomy and have a level 4-7 pain all the time for over a year now and have had intermittent pain for a decade. I would give anything to go back to how I was a year ago where I didn't have pain 24/7 and spend all of my paycheck on painkillers and doctor visits.

I have had to restructure my entire life, job, social life, furniture, even switch homes. I have been suicidal from the pain in the last year and overdosed on opiates also. Bulging discs are no joke and can easily destroy your life if you let them get too bad
 
LucidSDreamr said:
The injections aren't worth a damn if they are not put in exactly the right place. pain from a bulging an herniated discs are much more complex than just squirt the prednisone onto the disc and can be very hard for doctors to pinpoint.

I have had injections work )benefits lasted about 2 weeks or less) and had injections make the pain 10x worse because they increase pressure in the area.

If I were you I'd quit all sports forever (even when you feel better) and do low impact exercise. Dont overdo it or you will be in horrible pain for months straight, even permanently. I have one herniaated disc that was repaired via discectomy and have a level 4-7 pain all the time for over a year now and have had intermittent pain for a decade. I would give anything to go back to how I was a year ago where I didn't have pain 24/7 and spend all of my paycheck on painkillers and doctor visits.

I have had to restructure my entire life, job, social life, furniture, even switch homes. I have been suicidal from the pain in the last year and overdosed on opiates also. Bulging discs are no joke and can easily destroy your life if you let them get too bad
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I'm sorry to hear about your troubles LucidSDreamr. However often mild physical activity and strengthening exercises (even relatively impactful stuff) is highly effective for the management of degenerating or herniated discs.

Strengthening the spinal erectors and surrounding muscles tends to be protective and reduce the load and shearing forces experienced in the spine and by the discs. Such activity can also override the run-away inflammatory cycle through the stimulation of growth promoting chemicals and hormones in and surrounding the joint. By reducing inflammation, oftentimes much of the pain (from the pressure exerted on nerves) is alleviated.

Certainly overdoing it can be harmful though, and activity is dependent on each individual and the degree of damage. I wouldn't abandon forever the idea of doing some light strengthening exercises for your spine, even just starting with a few assisted bodyweight back extensions. In the long term failure to strengthen the muscles in that area will ultimately reduce stability and increase the load upon the discs, which could make things worse.
 
My thoughts exactly. I believe I mentioned that I see a great physical therapist. Well before I had a MRI and just had pain, this guy started me off very delicately and as I became more comfortable, we lightly increased the excercise. As far as the main source of pain/ lower back was concerned, we did very minimal, easy excercise. Stretching mainly, including light back arching and laying on stomach and propping up self on elbows. Very light.
I feel that, as was said, strengthening the core and working those muscles that are all supportive of the spine is a major part of the answer. I will follow everything everything you said CFC. Thanks for all the detailed information. I will use all of it.
 
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Degenerative disc disease is a complicated entity. It is also a specialty of mine, as most of the papers I have authored have been on the subject (especially with 3 or more discs involved, as surgery becomes contra-indicated when more than 2 discs are involved). In systematic reviews and meta-analyses from the last 10 years, data has shown surgery and conservative care (like structured exercise plans) to be nearly equal in efficacy. ESIs will sometimes help short term if the inflammatory component is significant, however, repeated use dulls the effects and corticosteroids./glucocorticoids cause tissue to become brittle and can increase degeneration long-term... (I don't like to push my research, but bone marrow concentrate injections and/or cultured mesenchymal stem cell injections have the effect of a setroid injection plus regenerative capacity, and have similar or better results than surgery, but cultured cells are only available in clinical trials as of now). If you can find a trial enrolling near you it would be free.

As an absolute recommendation I would take it easy on the ESIs, and make sure they also use a local anesthetic as in some trials the local alon is nearly as effective...

There is also constantly improving research on percutaneous (through the skin/injection) therapies, and new co-cultured disc regeneration treatments are not far off so be patient and avoid surgery if at all possible...
 
Hey SK,

I empathize, my brotha. I suffer with C4 thru T1 and L4/L5, with annular tears @ S1 and hematomas all along my spine into sciatic. The pain is a bitch. I resorted to spinal injections through a neuro in 2005-06, with little to no success. Results differ, so hopefully you will have better results.

As PINK says...avoid surgical intervention with hollow promises of relief. I consulted a sports neuro and ortho in late 2013 out of total desperation. The neuro was honest enough to tell me that although my neck/back is fucked, "corrective" surgery would require hardware that would fail within 5 years. I guess it's the ole "gonna live...gotta live with it" conundrum.

I swim laps daily, not for fun but for non-weight bearing exercise. My knees/hips are fucked too, due to chemotherapy in the 90s. I use a TENS unit, warm moist heat (can't stand ice) and Toradol eases some degree of inflammation. Voltaren has been helpful too, but we all know both can be tough on the tummy.

I am enrolled in PM after consulting 8 or 9 specialists across 3 states for not only skeletal degeneration, but also stage 4 endometriosis. I am 22 years post multiple surgeries and Lupron, with no hope in sight. The pain meds have exacerbated GI issues, with bowels/bladder already choked by adhesions.

:\ Sorry I got off into my own ditch...I've read your recent posts of med changes and increased pain and stress. STRESS, as you know, can manifest itself physically, making our pain feel even more intense. It's good that you're working with a PT. At one point (for many years) it helped me to see a psychologist.

I, too, am looking for answers that elude me. Sending healing hope your way!
 
You're welcome. I have some less serious back issues myself from sports injuries. I also routinely have to give that same speech to patients, so it has been sculpted to include as much info as possible without overloading a patient who may not recognize every medical term.

I have to make one more recommendation too, please try your best to avoid increasing narcotic doasages (i would stay below a morphine equivalent dose of 60 per day) as anything above that can cause tachyphylaxis, severe dependence and something resembling opioid-induced hyperalgaesia. In my experience, those who stick to a few percs or vicodin a day or as needed only have the best outcomes when it comes to interventional treatments like ESIs, BMC, etc. I know it will be hard, but high-dose narcotics will make sure you never get the same relief from them again if you really need it down the line (for something like cancer, or other severe pain causing illnesses).

Good Luck.
 
Panther, the wealth of information will help me greatly.. I have a doctor who is okay with small talk, but anything drug related or injury related has to be basically on his level.This information has given me the ammunition educationally. I'll be able to talk to talk on his level and I'll sound smart.
My physical therapist already is aware of my condition.. I am going to concentrate on building my core and on the physicial therapy excercizes.'thank you again.

Question Panther on medicine.Right now I am on IR Oxycodonen 5/325. It is great for breakthrough pain. I want to either go to a higher dose like 7,5 or 10/325 or an ER pill . I have a tolerance.
 
At such a low dose of 5 mg of oxycodone, I would think you would be safe moving up. For me (I have used opioids extensively) the best bet would be something like a 20 mg extended release formulation orally of oxycodone, maybe twice a day. Or something like 3-4 IR oxycodones (7.5 or 10mg, ideally without apap) a day. You should try and stay at or below that level, and even try and not take it when you really don't need it, that way your pain management goals will stay within reach for an extended period. Maybe even take days off when you have no responsibilities and can handle a little w/d. If you can, with a condtion like DDD, you may be better off getting pills without APAP and taking NSAIDS as needed with your opioids, because you get the anti-inflammatory effects too. I went through several major surgeries after being on suboxone with just a few tramadol, but primarily NSAIDS. You may be able to keep your dose lower for longer that way. If you are sensitive to the GI effects of NSAIDS like me, try and take a dose with each meal when you need it, as this greatly diminishes the side-effects by helping it move into your intestines first before dissolving and being absorbed.

Keep up the PT and exercise, and push through the rough days, maintaining your dose at a consistent level and your doctors won't question you because you'll do alright. The temptation to increase will be there, but remember, in the long run it can do more harm than good. A low dose ER with adjuvant low dose IR can really work miracles if you're dedicated to a non-narcotic solution in the long run.

Are you anywhere near Colorado? If so I may be able to help more than just suggestions... PM me if you want. You can get IV/IM ketorlac (Torradol sp?) probably if you maintain a low dose of the narcotics, which can be "stronger" than over the counter NSAIDS (even though you probably trade more side effects over a traditional over the counter NSAID)

A muscle relaxer every now and then could help too, on a trial and error basis, but always remember, less medications = better. You will have to try a few things before you really hit the sweet spot likely, but it will be worth it.
 
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https://www.ncbi.nlm.nih.gov/pubmed/26156727

I wrote this paper. We have beyond the 3 year mark follow up for these patients now, and a full paper with stats and everything on 147 mulit-level degeneration patients (3+ levels of degeneration). If you can't access it, I could provide some PDFs for you. It is the new-ish method we have used, and in the in progress 3 year paper, we have data showing significant reductions in narcotic requirements among the patients in the 1 and 2 level study that the link is to. The one year version with biochemical analysis is available too, if you would like, from the journal Stem Cells circa 2015 (early).
 
Panther, I read the pub med article. I found it interesting. I'll have to read it again, that's how much it has to say. My doctor was out of town for a couple days. I end up in emergency room and since I'm signed up with pain mansgement, the ER doctor gave me one petcocet and a shot of toradol. Within an hour, I felt excellent.
Unfortunately, I am not very close to Colorado. Honestly, I'd much rather ingest cannabis for pain control, I am not allowed to with my current pain contract. When I first switched to this doctor, I was on oxymorphone er 10 mg , twice a day and 90 Percocet 5/325 a month. That equals roughly 55 mg Oxycodonen a day.
This guy cuts me cold turkey off of the total 20mg oxymorphone ER I now get 120, 5/325 Percocet and I'm already almost out. That's the pain I've been in. Why doctor had to change a near perfect dosage of medicine to 120, 5/325 Percocet is beyond me. I mean the Percocet works but it is on the weaker side. I would like to tell the doctor that an increase is in order. 7,5, 10/325 would work. Should I just go for it? I'm afraid/ concerned about telling him that I have gone thru almost all of my 5/325. Percocet. I filled script on 3/2 (120,5/325),
Today 3/18 , I have 8 left. I'm afraid to say two weeks short.
 
Speed King said:
Panther, I read the pub med article. I found it interesting. I'll have to read it again, that's how much it has to say. My doctor was out of town for a couple days. I end up in emergency room and since I'm signed up with pain mansgement, the ER doctor gave me one petcocet and a shot of toradol. Within an hour, I felt excellent.
Unfortunately, I am not very close to Colorado. Honestly, I'd much rather ingest cannabis for pain control, I am not allowed to with my current pain contract. When I first switched to this doctor, I was on oxymorphone er 10 mg , twice a day and 90 Percocet 5/325 a month. That equals roughly 55 mg Oxycodonen a day.
This guy cuts me cold turkey off of the total 20mg oxymorphone ER I now get 120, 5/325 Percocet and I'm already almost out. That's the pain I've been in. Why doctor had to change a near perfect dosage of medicine to 120, 5/325 Percocet is beyond me. I mean the Percocet works but it is on the weaker side. I would like to tell the doctor that an increase is in order. 7,5, 10/325 would work. Should I just go for it? I'm afraid/ concerned about telling him that I have gone thru almost all of my 5/325. Percocet. I filled script on 3/2 (120,5/325),
Today 3/18 , I have 8 left. I'm afraid to say two weeks short.
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cannabis doesn't make your pain worse? Cannabis always makes my back pain much worse for the day when I smoke it.

just had my 3 of 3 injection a few dys ago and it actually worked great. this was the first time I have had one work so well....it really depends on if the doc puts it in exactly the right spot.
 
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