I threw out my back at work today… Got in to see the doctor, and he confirmed that it’s epidural time. tomorrow, I go in for a consultation at a pain management center, and schedule three shots. The thing is, I don’t just want the pain treated, I want the problem repaired… treating the pain will allow for the repair to take place more simply, however.
In addition to its widely known use for women during childbirth, the epidural injection is also associated with the treatment of neurological conditions involving the spine and its delicate nervous system. The name epidural describes the anatomical location of such an injection, epi meaning on or above, and dural, based on the Greek word for hard, and signifying the region of the spine know as the dura.
The disks of the spine are located between the vertebrae and are made up of a soft inner substance that is surrounded by a ring. As factors such as age or trauma cause a disk to wear, overexertion of the spine can cause the outer ring to rupture, exposing the soft inner part of the disk. This is known as a herniated disk. Other neurological conditions, such as radiculopathy, occur when bony osteophytes (abnormal bone growths) compress the nerve roots. This condition can affect any level of the spine, but tends to involve the lower lumbar and lower cervical spine more frequently. At any level, the nerve roots are impinged, and symptoms can include: weakness, numbness, and severe pain for some individuals. The pain may radiate into the limb that the nerve root normally supplies, as in the case of sciatica, in which patients describe a burning, piercing, throbbing, or aching pain in the leg.
After a full neurological evaluation and diagnostic studies, which often include imaging studies like the MRI (magnetic resonance imaging) examination, the treatment plan is decided upon.
Conservative treatment aimed at avoiding surgery is utilized initially. Treatment may include medications such as analgesics, muscle relaxers, and prophylactic treatments aimed at pain reduction. Physical therapy and other types of exercise are often prescribed to improve mobility and function, and are aimed at pain reduction. When these methods fail to relieve the symptoms of radiculopathy or sciatica, particularly when the pain is located in the lumbar spine, a physician may attempt a somewhat controversial treatment know as an epidural injection.
The aforementioned nerve roots enter and exit the spinal column, which is protected by a thick covering known as the dura. They pass through a layer known as the epidural space before reaching the intervertebral foramen (a passageway through the spine’s bony vertebrae). Epidural medications are injected directly into this epidural space, where they are retained until they are absorbed by tissue. Usually, an anesthetic agent such as Marcaine and a steroid such as methylprednisolone are given together in the injection. The injection is commonly called a cortisone shot, cortisone being perhaps the most well known of the synthetic adrenal-related compounds used to treat inflammation and pain.
The procedure is most often done on an outpatient basis. Although an anesthesiologist usually administers an epidural, some neurosurgeons, orthopedic surgeons, and neurologists also perform the procedure. In some cases, a mild sedative is given intravenously prior to the procedure. A local anesthetic is injected into the skin to numb the area prior to the actual injection into the epidural space.
Epidurals are controversial because they are painful and produce uncertain results. The injection is aimed at reducing the swelling, inflammation, and pain associated with an affected nerve root. Most physicians who suggest this form of treatment to their patients do so, hoping that its effects will alleviate back and limb pain, and prevent surgery. Some individuals notice improvement within hours of the injection, while others may find it takes days to feel a reduction in pain. Others, however, experience no improvement following the injection.
Although studies vary, they indicate that anywhere from 30 % to 70% of people who receive an epidural injection benefit from it. Some clinicians suggest that a series of two or three injections be performed over a number of weeks or months for maximum efficacy. To date, studies suggest the treatment may afford some benefit in short-term pain relief for certain individuals, but that in general this form of therapy should be reserved for specific cases that have not responded to conservative treatments. And, sometimes, the risk of nerve damage involved with most types of spinal dysfunction is significant enough to warrant surgery.
Complications surrounding an epidural injection are rare, but can include infection (such as epidural abscess) with the associated neurological aftereffects; hemorrhaging into the epidermal space; and headache resulting from a cerebrospinal fluid leak, which disrupts the necessary balance between the spine and the brain. Although the steroid given does not usually cause difficulties, approximately 2% of individuals may have mild fluid retention or other steroid-related side effects.
That’s my next step, before real surgery. I don’t like the success rate, but it’s worth rolling the dice for.
The walk-in wasn’t too bad; I had to wait about three hours before being seen, another 30 minutes in the private room… I told him what I wanted, and he agreed. That took all of five minutes.
I’m thinking about her, and those thoughts bring me more pleasure… I’m sending her warmth and good vibes. She’s an amazing woman, and a true touchstone for me.
I figured out why my paypal $$ info hasn’t updated.. It’s a bank holiday! Duh. Teach me to do my paypal registration on Friday, after hours.
hut’s back to 791. weird.