Back pain injections

[rumak]

Has anyone had epidural or facet joint injections done here in Chiangmai  to relieve lower back pain ?    If so,  would like to know

if your results were good or not.   

[binjalin]

Yes I'd be interested too but I fear it does not tackle the actual problem.

[OneZero]

While you're waiting for an answer, In the meantime try the McKenzie exercises to see if they help. Help if any may not be immediate, so keep trying as long as pain isn't worse.

http://www.livestrong.com/article/313524-mckenzie-exercises-for-back-pain/

 

[FolkGuitar]

10 years ago I was in a full back brace taking Tramadol several times a day for pain while awaiting surgery that would both fuse the vertebra in my lower back and cut away some bone from inside the spinal nerve canal... The head of Orthopedic Surgery at Chiang Mai Ram said that would be the only way I 'might' be able to get free from the pain.

 

Then, quite by accident, I met a tourist here in Chiang Mai, Dr. Jolie Bookspan. (I knew her name from the book she wrote on Dive Physiology. The Sports Medicine community calls her 'The Saint Jude of Joints!') who said "Don't let them cut! I can help without surgery, without opiates, and do so quickly and easily!"  And she did...    Within a month or so I was out of the brace, had stopped taking the pain meds, and moving without discomfort. Within a few months I was back into competitive sports. I compete in International tournaments every year.

 

She's put ALL of her methodology on her web site with no cost. You can find what you need to be pain free right here.  http://www.drbookspan.com/BackPainArticleQuickStart.html

If you want a consultation with her, she does ask for a donation to help maintain the website.

Here is her CV... This is quite some woman!  http://www.scuba-doc.com/joliecv.html

[rumak]

Thanks for the previous responses.   All are correct !  Ultimately, though, one line from the McKenzie

report says :

Considerations

Although McKenzie's exercises can be very effective for relieving some causes of back pain; they are not a cure-all for all lumbar conditions. "Sarah Key's Back Sufferers' Bible" by Sarah Key suggests that some back problems may actually be made worse by McKenzie's exercises. Make sure you get your back pain diagnosed properly before trying the McKenzie series of exercises to ensure they are appropriate for your back condition.

I have been to Dr. Suthee and Dr. Chankarn over the years( they could not pinpoint the problem), as well as some others.

Unfortunately, though i have some issues with my back nobody can exactly say what causes the pain.

Since i am living with it,  I think I am the best person to "try" to see what will work best. I have done the

Mckenzie exercise but maybe not as diligently as i should have.  Will try again.

I am in fairly good shape, can bicycle and so some work....but am always a step away from a spasm.

My question about injections still stands....... they are not a solution but are touted as enabling the

body to heal better due to removal of pain,

 

[FolkGuitar]

It was Dr. Suthee who told me that I needed surgery, and that there was only a 75% chance that it would relieve my pain, and put me on Valium and Tramadol while waiting for surgery.

 

I was just very lucky to meet Dr. Bookspan before going into the hospital.

[MaeJoMTB]

Most lower back pain is caused by overweight and lack of exercise.

I cured my problems by eating less and exercising more ......... despite the doctors in the UK telling me it would only ever get worse. Yes, I've also had the spasms, but they reduced slowly over a period of 3 years from hiking up the Pilgrim's Trail 3x a week. Cycling isn't good exercise for your back, a lot of jolting and vibration of the spine, you need to build up your stomach muscles first. (took me 3 years before I could cycle easily with no back pains)

 

I've gone from unbelievable back pain in my 30s to zero back pain in my 60s through a healthier lifestyle.

[BuddyDean]

Yeah, if you are careful not to reinjured or strain it, it does seem to get a lot better.  If you have a herniated disk, it will hurt like Hell, even if you weight 46 Kg...but some studies say time can heal those and surgery may not be the best option.

 

As far as the shots.. and I assume you mean cortisone.  I shared a rot daeng with a Canadian couple, early sixties, last year.  He had just completed his appointment at RAM.  He had a few shots, but what was interesting was that they incorporated some type of scan that allowed them to very precisely pinpoint the injections for the best effect. He stated a bit over 2000 THB...seemed like a good value, and he was very positive about his experience.

[rumak]

BD,  thanks for your input.  The pain clinic at Ram is usually where the injections are done, with a computer screen to

pinpoint location.  A baseball player was just sent to Florida (according to the announcer) to get an epidural injection for his back problem.

Anyway, it is personal accounts that i am most interested in.  BTW....the cost is around 20,000 baht !!  not 2000.....

expensive ! 

I have never been overweight and have exercised my entire life.  I am not a fan or advocate of traditional medicine

(pills pills pills).... I thank all for their advice on proper ways to take care of the body.  The reason i am looking at these

injections i have told already.  I do NOT subscribe to taking opiates or strong pain killers.

[BuddyDean]

20,000?  Sounds crazy high, for cortisone shots...what's a lower back MRI?  12K MAX?  Wouldn't be the first time that place produced a high bill.

[rumak]

From our friend Google : 

Back pain is one of the conditions for which steroid injections are commonly recommended. But these injections are not for everyone with back pain.

The injections, which typically cost $600 to $2,500   ( this is in U.S.)

 

the 2 common shots are called  facet joint injections ....and epidural injections        approx.10,000 baht per shot in Chiangmai

A lot cheaper than western countries but still way too expensive.

 

I did have a "cortisone" shot once ( actually a similar chemical is used).......which only cost 1200 baht.This shot was not for my back.  It actually worked in getting rid of a nagging  pain below my hip area !  I don't know why

these other shots cost so much more (other than the obvious overcharging of the medical industry)

[OneZero]

Before getting the shots you may want to ask your Dr to try oral methylprednisolone 4 mg 21 pack (spread over 6 days : 6-5-4-3-2-1 tabs/day).  Worked wonders for me to get rid of the extreme sciatica (I never did have pain in lower back despite pinched nerve there being the source of the sciatica).

Then the McKenzie exercises as daily preventive maintenance have prevented a re-occurance of problem. 

Also, If I don't do the McKenzies daily I can feel the stiffness returning to my lower back & I expect the sciatica would soon follow.

Methylprednisolone:

https://www.drugs.com/methylprednisolone.html

[khunyod]

On 10/3/2017 at 8:42 PM, OneZero said:

Before getting the shots you may want to ask your Dr to try oral methylprednisolone 4 mg 21 pack (spread over 6 days : 6-5-4-3-2-1 tabs/day).  Worked wonders for me to get rid of the extreme sciatica (I never did have pain in lower back despite pinched nerve there being the source of the sciatica).

 

 

Was this prescribed and/or dispensed in Chiang Mai? I'd like to try this approach, along with the Bookspan neutral spine. Pharmacies don't carry this, will need to see a doc and get it from a hospital pharmacy. Any reasonably priced/low cost options that folks know about, greatly appreciated.

[FolkGuitar]

3 hours ago, khunyod said:

Was this prescribed and/or dispensed in Chiang Mai? I'd like to try this approach, along with the Bookspan neutral spine. Pharmacies don't carry this, will need to see a doc and get it from a hospital pharmacy. Any reasonably priced/low cost options that folks know about, greatly appreciated.

 

Why not try it first without the medication? Dr. Bookspan is a firm believer that if the body is working/moving correctly, there shouldn't be any need for pain meds. Her back exercises and philosophy completely eliminated the need for my daily (actually three times daily) doses of Tramadol 100.

[khunyod]

Hello everyone,

 

I went to Lanna Hospital, which has a back pain clinic. Busy place, but wait times were no more than at Ram. I was once again impressed with this hospital (went there for one of the extensive checkups a few years ago, acceptable wait times, thorough work and good discussion with the English and Thai speaking doctors).

 

I was told they had walk in from 9am, but the afternoon was busier and with some appointments. I arrived about 10:30am, and saw Dr. Sirichai Luevitoonvechkij, a young, professional Thai doctor with fluent English, pleasant, and clear in his explanations and answers to my questions. First step after initial conversation was an X-ray which didn't take long. Maybe 30 minutes later I was back in his office looking at the X-ray on his computer screen. Compression of L5-S1 causing sciatica (as anticipated). Tramadol and a few other meds plus B12 were prescribed, along with 5 sessions of physical therapy (ultrasound/laser, heat, traction). Total cost 2,17500 THB for the doctor visit, X-Ray, meds, cash payment. Each physical therapy session is about an hour and costs 450 THB. Follow up appointment scheduled for two weeks hence.

 

After extensive investigation, I've come to the conclusion that whatever is useful inside the Bookspan website and books is much more clearly, comprehensively, and better discussed and presented in the earlier McKenzie books (his research started in the 1950s). The two volume "The Lumbar Spine: Mechanical Diagnosis & Therapy" is the key work of McKenzie, though simpler, smaller, popular volumes such as "Treat your own back" and others. From what I can tell, the Bookspan website and books essentially take up only 1/3rd of the diagnosis and treatment compendium of McKenzie (the postural component), but also provide very limited explanation and detail on actual stretches and exercises. The widespread use of McKenzie and the extensive literature and training programs in various countries far outweigh the lone self-promoter in breadth, depth, and sound foundation for treatment.

 

 

[khunyod]

On 9/29/2017 at 10:18 PM, OneZero said:

While you're waiting for an answer, In the meantime try the McKenzie exercises to see if they help. Help if any may not be immediate, so keep trying as long as pain isn't worse.

http://www.livestrong.com/article/313524-mckenzie-exercises-for-back-pain/

 

Note that the Livestrong article, while useful, is very brief and in no way accounts for all the various McKenzie exercises. Also, it leaves out the diagnostic to know which exercises to start with, and which to try next. The various popular McKenzie books are a much greater help, either the "Treat your own back" or "7 steps to a pain-free live" are good starter texts. See: https://www.amazon.com/Robin-McKenzie/e/B001H6N148

[khunyod]

2 hours ago, khunyod said:

...Total cost 2,17500 THB for the doctor visit, X-Ray, meds, cash payment. Each physical therapy session is about an hour and costs 450 THB. Follow up appointment scheduled for two weeks hence.

 

Note, that was 2,175 THB (sorry for typo, I don't think I can edit the post now). Also, the reason why I went to Lanna, and also discussed this with the doctor, pertains to the OP request about injections. They do steroid injections if needed, but only after not only an x-ray but also an MRI. In my case the Doctor thinks my back does not need such treatment, and physical therapy along with pain medication can help resolve the issue.

[orang37]

Quote

I am in fairly good shape, can bicycle and so some work....but am always a step away from a spasm.

Hi, Khun Rumak,

 

You've gotten lots of good suggestions here, but I wonder what the "context" of your pain/spasm is: occurs what time of day, or night; occurs during what type of activities, or movements, or during/after what types of exercise ? And, the pain is: dull; acute/sharp; shooting; wide-area; specific foci ?

 

Prednisolone: a powerful drug that can affect blood-sugar, lower immune system protection, and, can have mental-state impact, etc. I hope you will only use this with medical supervision.

 

I'm not any kind of back-pain expert, just another person who went through an episode of sciatica: what "saved" me from surgery was ... ice-packs 4x per day 15 minutes per pack.

 

to your health, ~o:37;

[rumak]

Thanks to all who have offered advice and their experiences.  I quote from an article from Spine Health:

"As you may already know through personal experience, back pain can be uniquely complex and difficult to diagnose and treat. There are myriad causes and contributing factors, and a wide range of treatments that may or may not work for the same condition."

Well, that is not very comforting.   I have been trying to "diagnose" the cause of my pain (along with an x-ray, MRI, and some doctors' opinions).   I could list all the "healthy" things I do and eat, but that gets boring fast.  Over time I have tried :   suggested back stretches, the McKenzie method ,  anti-inflamatories (a few!),

rest,  activity,, hot, cold, etc etc.   The protocol i follow now allows me to get by fairly well, without (hardly) using any drugs.  I walk, ride a bike, and do light yard work that does not require bending or excessive strength. ....................................... My main problem is that my lower back/ waist area is so stiff that I can only bend at about 70% of normal.    attempting more than that can cause painful spasms.

I would love to do stretches but they not only do not help...they usually cause me pain later.  

and that is why..... i am wondering if it might be worth trying an injection .   

[agg211]

May I suggest you try acupuncture first? You could visit Dr. Wang near Warorot market .

[khunyod]

2 hours ago, rumak said:

I have been trying to "diagnose" the cause of my pain (along with an x-ray, MRI, and some doctors' opinions)..... i am wondering if it might be worth trying an injection .   

 

You aren't going to get an injection without a doctor who can give one thinking it is a good idea, so go to the various doctors/clinics that do have injections as an option, and see what they have to say.

[Konini]

I think it has been already mentioned, but the injection gives only temporary relief.  It's more than 17 years since I had a vertibrea removed; I refused to have surgery until the time that I actually couldn't lift right my leg to climb stairs - I had to go to the toilet in the cafe next door to my office because ours was on the first floor.  Orthopaedic surgeon was amazing, he understood that I didn't want surgery and we went through exercises then the cortisone injection about 6 months after the first consultation.  It worked for about 3 months with the pain, but my leg was still dragging, I was walking a bit like Quazimodo for months before accepting the inevitable. We also had a very long discussion about fusion, I just didn't want it so the disc and bone was removed and I was stitched up.  When you run you finger down my back its bone, bone, bone, hole. My problem now is the nerve damage, probably because I left it so long before addressing the problem.  I have electric shocks constantly running down my thighs, hundreds of tiny nerves tormenting me, constantly buzzing, predominantly on the right leg where the sciatic nerve is damaged and have no sensation on the skin from buttock to little toe and the one next to it.  Fortunately there is now medication to stop the nerve pain, I can still feel it but it's kind of dull and more annoying than painful.

 

The motto of my tale of woe is address the problem.  Try the exercises mentioned above; really try them, not halfheartedly, and of course you have to give them time to see if they are helping - if I'd known about this 18 years ago I might have a complete back.  Being sat on a computer for up to 18 hours at a stretch was the cause of my problem, I even knew at the time that I should get up and move but it was always 'just after I've got this right' and I stayed put (it gave me excellent bladder control). Maybe it wouldn't have worked for me, but maybe it would. 

 

If the exercises truly don't help, address the problem.