Back in 2013 I moved wrong and it sent me into such pain that I couldn’t move to even pick up my phone. After five months of physical therapy, I was doing quite well again, but within just a couple of months of returning to “normal life” the pain was back; and, it continued to increase.
The orthopedic surgeon couldn’t find the issue and gave me a steroid shot and if that didn’t work the suggestion was exploratory surgery to see what they might find that hadn’t shown up on the MRI.
The shot didn’t help. Before I went back to see the DR about surgery I called to make sure they had the MRI from my neck, and asked the DR if he thought the shoulder pain might be from my neck. This was a debate that raged widely from doctor to doctor when the pain initially started. This time around he looked at both MRIs and at what I was describing pain-wise and declared “you’re a complicated case”.
The pain was definitely not indicative of being referred from the bulging/ herniated disks in my neck/back; that pain is definitely shoulder. I also have pain that is definitely NOT from the shoulder, but doesn’t perfectly fit the description of coming from my T2/T3 herniation (that every doctor focuses on). I also have bulges in the bottom three cervical discs.
We discussed two options; the first is to go into the shoulder and clean up what he can and see what else he can find, the second is to go to the pain management clinic and get an epidural in my spine. This second option was encouraged early on but I did my best to avoid it. However, it sounded like a better option than surgery, so I got the referral and went to the pain specialist.
What are Epidural Injections?
Epidural injections sound so menacing. A shot of what exactly in my spine? It sounds even more menacing when you find out that they often put you in “twilight” to do the shot, then again I’d prefer the twilight if I’m getting shot in the back. The idea of an epidural often conjures thoughts of childbirth. A shot to reduce the pain of giving birth; but, they are more than that.
What’s in a name? The dura is the protective tissue that surrounds the nerve. Epidural refers to the space surrounding the dura, which is where they inject the steroid/ pain medication. Most epidural injections use corticosteroid (and and anti-inflammatory); however, some use a combination of corticosteroid with an anesthetic.
While not always, many doctors perform these injections with their patients in a “twilight”, similar to what is used when you have a colonoscopy. As far as the patient is concerned they are not awake/ aware during the procedure. Some doctors provide only a local anesthetic to numb the area where the needle will go and perform the procedure with the patient awake. (If they told me they were doing this while I was awake I was running away).
When it comes to back pain, epidural steroid injections are commonly used to relieve pain from radiculopathy and spinal stenosis (narrowing of the spine); in my case, it’s for radiculopathy.
What is radiculopathy?
Radiculopathy is a fancy name for radiating pain, or referred pain. In this case, it’s when neck pain radiates down into your shoulders, arms, and hands. I’ve been told that the T2/3 herniation that I have often causes pain in the back around the shoulder blades and radiating pain to the front/chest. I’ve not had it radiate to the chest, but pain around the shoulder-blade and between the shoulder blades has been a pretty constant issue.
As with injections in other areas, often the pain increases shortly after the injection; however, this usually subsides within a couple of days, and you’ll know if the injection is working. From all that I’ve read and understand this really isn’t so different from the injections I’ve had in my shoulder (four in the last year); it’s just in a trickier place.
How Effective Are Epidural Injections?
Generally, epidural injections are effective about 50% of the time; not much different from injections elsewhere. There are a lot of factors including whether they hit exactly the right spot, and whether the assumed reason for your pain is the real reason for your pain. While the medicine reduces inflammation in the area it may not completely relieve the pressure on the nerve that is causing the pain, or there may be bigger issues that haven’t been identified.
Did the epidural shot work?
The short answer is no. I never met the pain specialist doctor prior to the shot. I saw his nurse several times when she happily handed over a prescription for opioid pain meds (which I rarely took). It felt like I was visiting an assembly line. Check in. Get a room. Nurse comes in. Hands me a script. Asks how I am. Leaves. Repeat in a month. It took several months before they were able to get me scheduled for the injection.
When I arrived for the injection I was rather annoyed that I’d never even met the doctor. He didn’t even come into my room to talk to me before they took me to the procedure room. I “met” him on the way to the procedure room. At that time, I tried to show him where the pain was to maybe help make sure he was going to give me the shot in the right place (since we’d never had any discussion). However, when I attempted to move to show him where it hurt he stopped me and basically told me to be quiet.
I wasn’t surprised when the shot didn’t work. It only had a 50/50 chance anyway, and after my experience with the doctor I felt my chances were even lower. They said I could try again in a few months, but by then I’d had enough of their assembly line and I’d found that by just not doing any of the things that aggravated the pain, I could keep it in check. So, that’s what I did. I stopped doing. It wasn’t until I started using the Oska Pulse (and used it for several months) that I finally got relief from that pain. That was three years later.