Right buttock pain down the leg, need management advice

[MitchLevi]

Steroid injections do not work for facet arthritis.

They certainly do in the short term.

Inferior to an RFA, but facet CSI without Q work in facet mediated pain.

I don't do them BTW. It's RFA only with me, but I have done them and I've done a good bit of them in the past.

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[bedrock]

Steroid injections do not work for facet arthritis.

IA facet injections do work for mild or mild-moderate facet OA.

But I agree they don’t work for OA much worse than that

 

[Ducttape]

If it were inflammation, shouldn't the steroid cure the inflammation? Just like acute radics or true sacroilitiis...

Steroid for whiplash makes sense, but not for arthritic disease.

 

[SSdoc33]

If it were inflammation, shouldn't the steroid cure the inflammation? Just like acute radics or true sacroilitiis...

Steroid for whiplash makes sense, but not for arthritic disease.

so you dont do a ESIs for stenosis?

 

[Ducttape]

Severe stenosis is surgery or possibly MILD if they can't have surgery - I guess spacer for those inclined.

If the stenosis is not that severe, yes I will do ESi for pain with the presumption that the injection is safer than surgery or opioid, but the patient is under no delusion that the injection is curing their problem.

 

[clubdeac]

We all know steroids work in the short term for all these pathologies. Duct you also know that injectable steroids don’t last indefinitely so don’t ask ridiculous questions. You don't seem to understand the pathophysiology of spinal stenosis or an acute radic for that matter, or at least you're pretending to not understand for the sake of argument

 

[DrSpine]

I just saw those MRI images. That spine looks pretty good, both Sagittal and Axial. I probably wouldn't do Epidurals.

 

[clubdeac]

IA facet injections do work for mild or mild-moderate facet OA.

But I agree they don’t work for OA much worse than that

b/c you often can't get into a severely arthritic facet

 

[Dr. Ice]

Don’t we all tell these people that the injections are all about management anyway. That the pain will likely recur in a few months. That’s like the first thing I say.

 

[MitchLevi]

Don’t we all tell these people that the injections are all about management anyway. That the pain will likely recur in a few months. That’s like the first thing I say.

#metoo

"There's no such thing as a fix for the ageing process."

 

[Taus]

#metoo

"There's no such thing as a fix for the ageing process."

Duh…. Bmac/prp???…. Leaving money on the table dude.

 

[Dr. Ice]

To try to sell regen as a fix is also ****ed up. I do a bunch but none of my patients think it’s a miracle. One of the things I say is we are going to try to change the environment around where you are having pain, and there is nothing falsifying about that.

Not everything is solely about money dude.

Don’t knock it unless you’ve done it….

 

[Taus]

To try to sell regen as a fix is also ****ed up. I do a bunch but none of my patients think it’s a miracle. One of the things I say is we are going to try to change the environment around where you are having pain, and there is nothing falsifying about that.

Not everything is solely about money dude.

Don’t knock it unless you’ve done it….

I am referring to those who sell it as a cure for all the ails the patient. Desperate patients will cough up the cash. Sometimes the answer just doesn't lie in a procedure of any sort.

That said, Im not anti regen med. I refer for it intermittently. Like anything else we do, patient selection is key to success.

 

[MitchLevi]

Im very open about the limitations of everything I do. PRP, ablations, etc.

You'll be one day older when you get out of bed tomorrow. No one benefits from chronic pain, but we're all touched by it on some level.

Part of the human experience, but that negative is balanced out by so many positives that we take for granted.

 

[oneforfighting]

How exactly did you do that?

This discussion has come up repeatedly. I was always taught they don't hurt. Truthfully, I don't know why they would hurt either.

It's pain, not diabetes.

By ruling out all the other pain generators that have been discussed on this thread. And it is never the first, second, third, etc on my differential. But to rule it out entirely…I don’t.
I was taught they don’t hurt either. Truthfully, I don’t know why they wouldn’t hurt either.

 

[CarabinerSD]

I just saw those MRI images. That spine looks pretty good, both Sagittal and Axial. I probably wouldn't do Epidurals.

Update: So just another wrench into the treatment. Did a Right paracentral L5-S1 ILESI since the patient was begging for anything to help with the pain... got a 40% improvement. There's some radicular component that wasn't captured with the previous injections, but I'm going to hold out on more injections for now since she's doing a lot better.

 

[bedrock]

Glad the L5-S1 ILESI helped.

I expect the patient would have had even more than 40% improvement if you had a done a right S1 TFESI with depo as I suggested in March.