lumbar-epidural-steroid-injection

[rumak]

Has anyone had one of these injections to ease lower back pain ?

If someone in Chiangmai or Lamphun had one ,  please tell me where.

 

I will not be going to BKK to do one ...... but still if someone has experience with the  ESI  injection I would be interested to hear.

I have had lower back problem on and off for ten years....not that bad .   and have been to doctors and mri,  etc.

now looking into this option as things are getting a bit worse with age

[Lacessit]

I have found occasional use of kratom to be quite effective in eliminating lower back pain, about 2-3 times a week.

I had steroid injections for carpal tunnel syndrome, eventually they destroy nerve conduits.

Has the cause of your pain been identified? There is a big difference between osteoarthritis and a pinched nerve.

Apologies if not quite on topic.

[retarius]

Back pain is awful. Squirting anything including steroids into your lumbar vertebrae can be painful, especially after the op. My mother had one in the US, she had a good initial response but the results were temporary (3 or 4 months of moderate relief). Her doctor told her that only 50% of patients got good relief. I'd be inclined to go to Bangkok where the doctor is likely to be better trained. I don't know why you have ruled it out.

[save the frogs]

there are different causes of lower back pain.

 

but in some cases, walking more can alleviate the problem. 

 

https://www.physio-pedia.com/The_Effects_of_Walking_on_Low_Back_Pain

 

[Sheryl]

Have you had an MRI and has a spine specialist recommended this? It is not a simple "one size fits all" treatment for back pain. It will help only with pain from certain causes and the injection has to be targeted to the specific part of the spine responsible.  Which in turn means  an experienced spine specialist has reviewed an MRI and identified the likly source of the problem. 

 

I had it done. Twice actually --  once in lower spine once in cervical spine. The one in the lower spine worked for only a few weeks so I went on to have surgery (successful).  Though I  know people who have gotten relief for 6 months or more and do  this regularly as an alternative to surgery.

 

The one I had in the cervical spine on the other hand gave complete relief, over a year already (knock on wood!). That was not only an epidural but also a facet joint injection. I insisted on both to cover all bases as cause of the pain was a bit  uncertain.

 

[rumak]

4 hours ago, Sheryl said:

Have you had an MRI and has a spine specialist recommended this? It is not a simple "one size fits all" treatment for back pain. It will help only with pain from certain causes and the injection has to be targeted to the specific part of the spine responsible.  Which in turn means  an experienced spine specialist has reviewed an MRI and identified the likly source of the problem. 

 

I had it done. Twice actually --  once in lower spine once in cervical spine. The one in the lower spine worked for only a few weeks so I went on to have surgery (successful).  Though I  know people who have gotten relief for 6 months or more and do  this regularly as an alternative to surgery.

 

The one I had in the cervical spine on the other hand gave complete relief, over a year already (knock on wood!). That was not only an epidural but also a facet joint injection. I insisted on both to cover all vases as cause of the pain was a bit  uncertain.

 

I have had an MRI .... but a couple of years ago .  At that time my pain  (lower back) would come and go , and I did see a specialist here in CM .  He suggested to live with it ( being that it was not at a serious stage) ,  with occasional use of anti-inflamatories.  As time passes, and maybe you also know from personal experience,  there can come a time when the pain or discomfort becomes a problem that needs addressing.   Probably soon .

Of course if i were to get the ESI  it would be with a specialist ,  and I am seeking some personal cases such as yours to inform myself first .  The fact that you needed surgery on the lower back, but also injections in the cervical spine is informative .   My pain is mostly lower back,  but i am now getting more pain in upper regions at times ( and my neck ).  Reading about the facet joints also aroused my suspicions that I could be having problems associated with that . 

Surgery is something many people want to avoid (myself included) ..... as a surgery gone wrong is not unheard of .  That is why my first choice would be to try ESI (as you did) .   The second area you did which has worked sounds encouraging,   and thanks for the info about the facet joints . Gives me some good info for when i go to the specialist . 

Out of curiosity ,  which hospital did you use in BKK .   Also,  doesn't that doctor , or you,  have a recommendation for CM ?   Thank you for your posting ...       rumak

[Sheryl]

For spine no, I cannot recommend anyone outside of Bangkok. And this is something that very much warrants having the best . 

 

Besides myself and various friends and board members, my sister also had 2 spinal surgeries (1 lumbar, 1 cervical) both successful here.   Many years later she had  an epIdural for pain that developed at a level of the lumbar spine above that of the prior surgery. It worked and so  far -- it's been at least 5 years -- she hasn't needed further treatment.

 

Not all back pain is due to the spine per se.  In fact most probably is not. Muscle strain and spasm are common causes and can be cased by both overuse (sports, work outs etc) and excessive sitting....and by poor posture. The muscles responsible may not even be in the back;  Issues with hip flexors and piriformis (a muscle deep in the buttocks) can both cause lower back pain.

 

If I were you I would try stretches and exercises  (maybe consult a physiotherapist initially  to identify clearly which muscles need work) and massage. Also heating pad. If  these work no need to look further.  If they don't then you need to see not just an ortho but specifically one specializing in spine.  The very best is Prof. Wicharn at the BNH hospital spine center. You'll need an Xray and MRI, can do these at an imaging center first to save money. Prof.  Wicharn will know quickly whether or not the pain is due to the spine and likely to respond to an epidural or need surgery.  Contrary to what some people expect, he does not recommend surgery to everyone and indeed will refuse people who want it if he thinks it is not indicated. Ditto other spine specialists  I have dealt with here and in the West. It is not at all the case that surgeons always want to operate and surgery is not the only tool in their repertoire. 

 

[mania]

Being a retired Gen Contractor I have had decades of back problems.

Like you as I got older they got worse to a point where a few times I was fully locked.

When that happened it would take 6-8 weeks to get better....slowly

 

But a few years ago I found in my case my work & single type of exercises were actually leaving areas even tighter so have found some great stretches that helped & also more full body exercises to help not being so one dimensional & causing tightness elsewhere

 

In my case I found the Quadratus Lumborum was a culprit

The stretches this lady shows in her Pilates video helps a lot

Quadratus Lumborum Pain and Tightness Program Fix!

 

Another one that really helped the most was the stretch shown on this video at 3:24

Although you should check the whole video & also search lower back pain in all his videos!

 Jeff Cavaliere is very knowledgeable

 

Good Luck!

Edited September 23, 2023 by mania

[scubascuba3]

I haven't needed an injection yet, last resort, i just recently started stretching, wow what a difference, i recommend trying.

 

https://youtu.be/0wAw1-1MHa4?si=ggt9Pi32A55hK2Xh

Edited September 23, 2023 by scubascuba3

[Sheryl]

8 hours ago, mania said:

Being a retired Gen Contractor I have had decades of back problems.

Like you as I got older they got worse to a point where a few times I was fully locked.

When that happened it would take 6-8 weeks to get better....slowly

 

But a few years ago I found in my case my work & single type of exercises were actually leaving areas even tighter so have found some great stretches that helped & also more full body exercises to help not being so one dimensional & causing tightness elsewhere

 

In my case I found the Quadratus Lumborum was a culprit

The stretches this lady shows in her Pilates video helps a lot

Quadratus Lumborum Pain and Tightness Program Fix!

 

Another one that really helped the most was the stretch shown on this video at 3:24

Although you should check the whole video & also search lower back pain in all his videos!

 Jeff Cavaliere is very knowledgeable

 

Good Luck!

Excellent video! Thanks for sharing. 

[pseudorabies]

I've had injections at L5-S1 2-3x per year for the last 8 years for disc herniation, stenosis and disc degeneration.  These were done in the US until 3 years ago when I moved to BK and began seeing a pain MD at BK Hospital's Spine Center.  Until recently injections would give me relief from lower back pain as well as nerve pain affecting my left leg and upper right leg. Relief would last for about 5 months and return to baseline at ~6 months. Along with the injections I also perform stretches and exercises.  If I was experiencing acute pain from walking, lifting heavy objects or just sleeping in the wrong position I would take prescribed opiates (thank God for those).  Last year I noticed that the benefit that I would get from the injections was less pronounced and would last for shorter periods of time.  Early this year I gave up on them completely as it was no longer worth the cost.

I've never looked into doctors in Chiang Mai however when I lived in Hua Hin for several months I would travel to BK for injections and consultations.  If I I had moved to Chiang Mai and was still getting injections I would definitely travel to BK to have the same MD perform them. If you're looking for a doctor in CM I think you want someone who is both competent with injections AND willing to prescribe "pain killers" as needed.  The last point can be tricky as pain tends to be under-treated in Thailand and if you ask up-front then the doctor probably will see you as a farang who is shopping for narcotics. Good luck.

[Sheryl]

2 hours ago, pseudorabies said:

I've had injections at L5-S1 2-3x per year for the last 8 years for disc herniation, stenosis and disc degeneration.  These were done in the US until 3 years ago when I moved to BK and began seeing a pain MD at BK Hospital's Spine Center.  Until recently injections would give me relief from lower back pain as well as nerve pain affecting my left leg and upper right leg. Relief would last for about 5 months and return to baseline at ~6 months. Along with the injections I also perform stretches and exercises.  If I was experiencing acute pain from walking, lifting heavy objects or just sleeping in the wrong position I would take prescribed opiates (thank God for those).  Last year I noticed that the benefit that I would get from the injections was less pronounced and would last for shorter periods of time.  Early this year I gave up on them completely as it was no longer worth the cost.

 

Sounds like you have reached the point where surgery may be indicated, provided you are a good surgical risk (i.e. not elevated risk from other underlying conditions).  Surgical approaches have advanced a lot in recent years and now include less invasive approaches e.g. minimally invasive decompression without fusion. Every case is different and some people may still be better off with a fusion but for a lot of people a minimally invasive decompression surgery will work wonders. Recovery is fast as muscles etc are not cut tin the process.

[rumak]

15 hours ago, mania said:

Being a retired Gen Contractor I have had decades of back problems.

Like you as I got older they got worse to a point where a few times I was fully locked.

When that happened it would take 6-8 weeks to get better....slowly

 

But a few years ago I found in my case my work & single type of exercises were actually leaving areas even tighter so have found some great stretches that helped & also more full body exercises to help not being so one dimensional & causing tightness elsewhere

 

In my case I found the Quadratus Lumborum was a culprit

The stretches this lady shows in her Pilates video helps a lot

Quadratus Lumborum Pain and Tightness Program Fix!

 

Another one that really helped the most was the stretch shown on this video at 3:24

Although you should check the whole video & also search lower back pain in all his videos!

 Jeff Cavaliere is very knowledgeable

 

Good Luck!

thank you .   literally hundreds of videos on youtube ( many contradicting what others say) ...

I have looked at the one you sent and will give it a try .   My one concern with the QL demonstrations are they do not take into account the flexibility of individuals.  I will let you know how i do  ????      I have always been fit and fairly strong...... but NOT flexible .   extremely tight hamstrings  .        Also, the problem with videos is again:   there are such an immense amount of variables/degrees/ causes/ and ages involved.   ( yes, that is why an "expert"  is needed ) 

But,,,,,,  there are a lot of problems when someone , like millions do,  gets the wrong diagnosis.

Ultimately < IMO ,  the patient must be capable of making the right "educated"  decisions .

 

[Sheryl]

35 minutes ago, rumak said:

thank you .   literally hundreds of videos on youtube ( many contradicting what others say) ...

I have looked at the one you sent and will give it a try .   My one concern with the QL demonstrations are they do not take into account the flexibility of individuals.  I will let you know how i do  ????      I have always been fit and fairly strong...... but NOT flexible .   extremely tight hamstrings  .        Also, the problem with videos is again:   there are such an immense amount of variables/degrees/ causes/ and ages involved.   ( yes, that is why an "expert"  is needed ) 

But,,,,,,  there are a lot of problems when someone , like millions do,  gets the wrong diagnosis.

Ultimately < IMO ,  the patient must be capable of making the right "educated"  decisions .

 

Tight hamstrings will in themselves cause back ache. So will tightness in other muscles and tendons, and your lack of flexibilty suggests this is your problem. 

 

The way you describe your back issues sound much more like a problem due to issues with muscles than spine per se.

 

I suggest you see a good physiotherapust to develop a personalized program of stretches and exercises. 

[pseudorabies]

3 hours ago, Sheryl said:

Sounds like you have reached the point where surgery may be indicated, provided you are a good surgical risk (i.e. not elevated risk from other underlying conditions).  Surgical approaches have advanced a lot in recent years and now include less invasive approaches e.g. minimally invasive decompression without fusion. Every case is different and some people may still be better off with a fusion but for a lot of people a minimally invasive decompression surgery will work wonders. Recovery is fast as muscles etc are not cut tin the process.

Not to hijack the thread but maybe give the OP a sense of where it could go - I've consulted with a surgeon recommended by the pain MD who then ordered nerve conduction tests.  There was some impact but it wasn't too severe.  After reviewing the results we both felt that surgery wasn't indicated. Yet.  I appreciated his honesty and reticence to just get me on the operating table. By contrast I encountered a surgeon at Bumrungrad in 2018 who basically wanted to cut me open then and there.  

 

For the OP - One question I would ask any doctor performing the injection is where they get the steroid formulation from and how the hospital knows that it is really sterile.

[ericms]

Hi,

 

As a health care professional, I would highly recommend that you see an orthopedic MD. If neurological disorders are also present, then a neurologist should be consulted as well.

In your case, you should not rely on non-evidence-based approaches because they are very common in Thailand. The same goes for alternative or holistic (pseudoscience) approaches such as acupuncture, chiropractic, dry needling etc... because these have less evidence, and in some cases could make things even worse. Same for the content on YouTube! Stretching, strengthening or mobilisation of structure without knowledge, why and how etc. makes less sense as it can make things also worse!

Also, a physiotherapist would be a good choice, but as far as I know of some friends of mine and some clinics around bkk, they sell packages like a 30 minute diagnosis for some hundreds of baths, or they treat such issues with electro or ultrasound therapy, which can have a short time for a soft pain modulation but does not treat the main issue.

You need to get a proper physical examination and, as a consequence, a diagnostic which can lasts at least 3 to 4 sessions. I think you will hardly get such a physiotherapy quality here, as the education is not the same as outside of Thailand
Surgery should always be the last option, and do also keep in mind that many studies have already shown that spine degeneration is likely to be a part of normal aging and is NOT associated with pain (Disk bulge, protrusion, spondylosisthesis etc.)

You might consider going outside of Thailand to get a proper therapist, who is qualified to provide a professional physical examination, to understand if the conservative is the right way for you or not. A professional therapy takes a long time and is not easy, but showes in many long follow-ups the same and in some cases also the better results than surgery.

 

Ps. "He suggested to live with it", sorry but that shows everything about being professional!

 

Hope that helps you, wish you all the best.

Eric

[rumak]

3 hours ago, Sheryl said:

Tight hamstrings will in themselves cause back ache. So will tightness in other muscles and tendons, and your lack of flexibilty suggests this is your problem. 

 

The way you describe your back issues sound much more like a problem due to issues with muscles than spine per se.

 

I suggest you see a good physiotherapust to develop a personalized program of stretches and exercises. 

but......... before, for many years now,  when my back hurt I did not have pain or weakness in my

legs , hips, knees (  varies in location , and symptom)   Also slight numbness in toes at times. 

Seems like sciatica (which i did not have before) .     

I know i say this often ( and you have too) ....... its finding a GOOD one that is the secret.  I am starting some stretching and will give it a week to see what happens .  Dr, Chanagan about 3 years ago looked at my MRI and Xray and did not find anything drastic , just some age related narrowing.

Yes,  a new MRI  might be in order.  Pretty sure it is nerve related from lower back .

I also agree that tight muscles are a problem ..... very difficult for me to loosen those hamstrings. and bending over is also very limited.     I'll let y'all know what happens.  First a bit of rest and stretching 

 

 

[Sheryl]

You had not mentioned weakness/numbness. In that case it may be that the space where the nerve roor exits has further narrowed so a repeat  MRI would be prudent. 

[rumak]

31 minutes ago, ericms said:

Hi,

 

As a health care professional, I would highly recommend that you see an orthopedic MD. If neurological disorders are also present, then a neurologist should be consulted as well.

In your case, you should not rely on non-evidence-based approaches because they are very common in Thailand. The same goes for alternative or holistic (pseudoscience) approaches such as acupuncture, chiropractic, dry needling etc... because these have less evidence, and in some cases could make things even worse. Same for the content on YouTube! Stretching, strengthening or mobilisation of structure without knowledge, why and how etc. makes less sense as it can make things also worse!

Also, a physiotherapist would be a good choice, but as far as I know of some friends of mine and some clinics around bkk, they sell packages like a 30 minute diagnosis for some hundreds of baths, or they treat such issues with electro or ultrasound therapy, which can have a short time for a soft pain modulation but does not treat the main issue.

You need to get a proper physical examination and, as a consequence, a diagnostic which can lasts at least 3 to 4 sessions. I think you will hardly get such a physiotherapy quality here, as the education is not the same as outside of Thailand
Surgery should always be the last option, and do also keep in mind that many studies have already shown that spine degeneration is likely to be a part of normal aging and is NOT associated with pain (Disk bulge, protrusion, spondylosisthesis etc.)

You might consider going outside of Thailand to get a proper therapist, who is qualified to provide a professional physical examination, to understand if the conservative is the right way for you or not. A professional therapy takes a long time and is not easy, but showes in many long follow-ups the same and in some cases also the better results than surgery.

 

Ps. "He suggested to live with it", sorry but that shows everything about being professional!

 

Hope that helps you, wish you all the best.

Eric

I agree with much of what you say .... and it has been my belief ( and i have read professional statements as well)  that the number of conditions affecting the back and lower extremities is tremendous.   As are the number of  "do this stretch.... do that stretch..... don't do this stretch  etc etc) .     

Having said that .... i think there are a very few skilled doctors/ surgeons available .  ( remember, even in US or elsewhere the quality of diagnosing and surgery varies greatly) .   I  had a successful "manipulation"  for a frozen shoulder here in Chiangmai by a renowned ( now retired) surgeon .

Impressive .    Also had a broken hip surgery , titanium rod ,  which has turned out well.  I was walking distance in about 6 months....  A recent xray shows that all is excellent , now 3 years later.

BUT.... I did pray a bit  haha  .  And i am not religious.   

This back thing is not simple,  though many have the usual go see a doctor answer.  I believe as you do that just any doctor will not help,  and could in fact make mistakes .   I have past experience with seeing 3 orthopedic doctors with only the last one making a correct diagnosis. (not the back issue)

Even the MRI i had done , which is not cheap,  was not interpreted well by 2 doctors.... but the 3rd one showed his expertise by comparison.

to be continued............ 

[rumak]

8 minutes ago, Sheryl said:

You had not mentioned weakness/numbness. In that case it may be that the space where the nerve roor exits has further narrowed so a repeat  MRI would be prudent. 

you're right.   just occurred to me to bring it up .   important

 

thanks Sheryl ...      ( i will still wait a bit to see how the rest and some light walking and stretching do )

 

Edited September 24, 2023 by rumak

[scubascuba3]

6 hours ago, rumak said:

I am starting some stretching and will give it a week to see what happens

Usually better to try one stretch at a time otherwise if you try multiple and have discomfort the next day you won't know which one caused it

[Sheryl]

11 hours ago, rumak said:

you're right.   just occurred to me to bring it up .   important

 

thanks Sheryl ...      ( i will still wait a bit to see how the rest and some light walking and stretching do )

 

If the MRI does not show an explanation then you'll need to look for other possible causes of the numbness/tingling. But start with the spine.

[Rumpelstilskin]

I had Platelet Enriched Plasma treatment at Zen Center Pattaya for a herniated disc tween L1 and L2 two weeks ago and have stopped taking pain medication. Also took 6 acupuncture treatments and physiotherapy. 2 more PEP treatments coming. Will add stretching too.

[thaisabai]

Hello

Sheryl seems to have very good answers to this topic!

My case: I had an epidural injection in the lower back in the Pattaya international hospital (Dr. Danai, Orthopedist) years ago and my backpain was completely gone for about 6 years.

Now backpain is back (some days not so bad, some days painkillers needed)

Also, I can no longer walk more than 50 meters, then need to sit and rest for 2 minutes.

 

went back to see the doctor recently and he did a scan. He then said, "no epidural needed" and gave me some painkillers.

 

getting worried that I might soon no longer be able to walk.

may be Sheryl has some advice, where to see a doctor (preferably in Pattaya)

 

thaisabai

[PeterA]

I had 2  epidurals long ago, maybe 30 years ago after a back injury and surgery. It gave me over a year pain-free after each injection. I would do it again in a heart beat. Just make sure it is a Neurologist that does it.

This was done in the US, so I can't recommend anyone here. Best of luck!

[Dirk Z]

I am a retired neurosurgeon having done thousands of spinal operations and treatments. Around 40 years of practice have taught me that - unless there is clear-cut pathology, like a herniated disc, a tumor, cyst etc. - a lot of treatments are trial and error with very little evidence to support the effectiveness of one treatment over another. We also know that many conditions have spontaneous remission without specific treatment as my own experience in occasional back pain shows. That means that the last therapist always has the best result because the patient is getting better by himself. We having the saying that "nature takes care of the disease while the doctor/therapist entertains the patient".

As for lumbar epidural: I have seen the best results in acute lumbar pain and varying results in the more chronic forms. But as far as I know there is still no solid evidence for it's effectiveness. It is not easy to set up a study with matching patient groups over a longer period of time.

[Sheryl]

1 hour ago, thaisabai said:

Hello

Sheryl seems to have very good answers to this topic!

My case: I had an epidural injection in the lower back in the Pattaya international hospital (Dr. Danai, Orthopedist) years ago and my backpain was completely gone for about 6 years.

Now backpain is back (some days not so bad, some days painkillers needed)

Also, I can no longer walk more than 50 meters, then need to sit and rest for 2 minutes.

 

went back to see the doctor recently and he did a scan. He then said, "no epidural needed" and gave me some painkillers.

 

getting worried that I might soon no longer be able to walk.

may be Sheryl has some advice, where to see a doctor (preferably in Pattaya)

 

thaisabai

I do have advice but it means going to Bangkok.

 

Get your xray and scans (actual films in disc not just radiology report) and consult Pof. Wicharn in Bangkok at BNH hospital spine center.

 

When you say you have to rest after walking 50 meters -- is that due to back pain or other issue like shortness of breath?

[thaisabai]

HI SHERYL

re your question:

the walking problem seems to be due to my legs getting tired and painful

 

thanks

 

thaisabai

[Sheryl]

4 minutes ago, thaisabai said:

HI SHERYL

re your question:

the walking problem seems to be due to my legs getting tired and painful

 

thanks

 

thaisabai

Consult spinal specialist as above.

 

If he feels not due to spine then next stop would be assessment by a vascular specialist to rule out   peripheral vascular disease. 

[rumak]

2 hours ago, thaisabai said:

Hello

Sheryl seems to have very good answers to this topic!

My case: I had an epidural injection in the lower back in the Pattaya international hospital (Dr. Danai, Orthopedist) years ago and my backpain was completely gone for about 6 years.

Now backpain is back (some days not so bad, some days painkillers needed)

Also, I can no longer walk more than 50 meters, then need to sit and rest for 2 minutes.

 

went back to see the doctor recently and he did a scan. He then said, "no epidural needed" and gave me some painkillers.

 

getting worried that I might soon no longer be able to walk.

may be Sheryl has some advice, where to see a doctor (preferably in Pattaya)

 

thaisabai

If i knew my pain was going to be gone for even 3 years i would be in the hospital tomorrow !

btw :  Nobody has said whether the actual shot was VERY painful or not too bad .  

Good luck going forward ..... maybe surgery time .    but gotta see a specialist