I had an MRI of my lumbar spine recently at one of the top private hospitals and it identified a variety of potential sources of my lower back pain - from sacroiliitis to narrowed lateral recesses that could be compressing root nerves, enlarged facet joints among others.

I've looked up the efficacy rates of various injections used for 'pain management' as they like to call it. Not very impressive. Most are around the 50-70% efficacy ranges, and they take minimum 1-2 weeks to feel any improvement (if you get any improvement at all)

The various injections are known as:

Transforaminal Epidural Steroid Injection (TFESI),

Bilateral Lumbar Facet Joint Injections, and

Sacroiliac (SI) Joint Injections

These injections are supposed to be done by a skilled anaesthesiologist, guided by x-ray (fluoroscopy) to ensure the needle enters the right spots.

Anyone have any experience with any of these? Recommendations, etc? I know @Sheryl has recommended an ortho/spine doctor at BNH but he's a surgeon, not an anaesthesiologist, and so the experience of these procedures could vary expert to expert.

Prof. Wicharn, the doctor you refer to, has 2 anesthesiologists who work with him and provide these injections. He also works with physical therapists. The fact that someone is a surgeon does not mean they only do surgery. I can assure you from first hand experience that Prof. Wicharn does not recommend or perform surgery on all patients. Probably not even most.

One does not go straight to an anesthesiolgist for this as the cause of the pain must first be identified. Which takes an expert ortho specializing in spine to do, reviewing scans and Xrays in the context of the clinical picture. Not only can such a speciallist usually identify the source of the pain, he can also assess the likelihood steroid injections will help. Sometimes, if there is doubt about cause of the pain, nerve conduction studies may also be done.

Abnormal findings on MRI are common and not necessarily the cause of the pain. This is why it is so important to be assessed by s very experienced spinal specialist.

The various injections you list are the same thing just injected in diffrent parts of the spine according to the source of the pain.

I have had these injections 3 times, twice in lumbar spine and once in cervical spine. . One helped only for 2 weeks (I then had surgery) and 2 gave what is so far permanent relief. My sister had it once with so far (15 years later) permanent relief.

With all treatments -- injections, physical theraoy, surgery, medications --the likelihood of success is highest if the cause of the pain has been correctly identified.

Even when the injections don't help, they can be useful in confirming the diagnosis because in addition to steroid they contain shorter acting local anesthetic (hence my injection that worked for only 2 weeks -- the diagnosis was correct but there was nerve compressed by bone to an extent only surgery could relieve)

Go see Prof. Wicharn bringing the MRI on DVD with you.

5 minutes ago, Sheryl said:

Go see Prof. Wicharn bringing thr MRI on DVD with you.

Okay thanks @Sheryl for your comprehensive reply and advice. I'll take the DVD to see Prof. Wicharn. Should I take the radiologist report too, or just the DVD and let Wicharn come up with his own review and diagnosis?

Best

R.

I am having problems with my back , since I was young. For 24 years now, I am suffering from Adhesive Arachnoiditis.

In 1999, I had a successful back surgery at Phramongkutklao Hospital in Bangkok.

In the following link, you will find a lot of information, regarding your query. I hope you find answers.

https://arachnoiditishope.com/protocols/

Edited July 1Jul 1 by Beat666
Additional Info

3 minutes ago, Beat666 said:

I am having problems with my back , since I was young. For 24 years now, I am suffering from Adhesive Arachnoiditis.

In the following link, you will find a lot of information, regarding your query. I hope you find anders.

https://arachnoiditishope.com/protocols/

Wow. Sorry to learn about that. I hope you have found some coping mechanisms...

3 minutes ago, ronnie50 said:

Wow. Sorry to learn about that. I hope you have found some coping mechanisms...

Yes, actually I am doing pretty well.

15 years ago, I was having severe back pain. I went to Chiang Mai Ram, and was advised to have my spinal cord 'enlarged' and three vertebrae fused. I was in a full back brace, taking tramadol 4-5 times a day for the pain.
While I was deciding, I happened to meet Dr. Jolie Bookspan while she was vacationing here. She said, "Don't let them cut! I can fix you!
And she did, with just a few simple exercises.
I stopped taking the Tramadol after two weeks, and was out of the back brace after about a month! I was back, active in sports in less than two months!
She offers her skills for free on her web page. Everything she told me to do can be found here! http://www.drbookspan.com/clinical.html

Scroll down the page for links to the exercises.
Your condition may be different from mine, but perhaps you can get the same relief. Dr. Bookspan comes to Chiang Mai every year for the Flower Show. We get together every year for a few days now. She's helped a lot of people over the years.

Edited July 2Jul 2 by FolkGuitar

21 hours ago, ronnie50 said:

Wow. Sorry to learn about that. I hope you have found some coping mechanisms...

I know, you probably are not suffering from AA (Adhesive Arachnoiditis), but it can develop, if you face too many invasive procedures for your back problems.

Therefore, it is of great importance always to seek out for non-invasive procedures first, likely with help from a pain management doctor, before having any invasions, lumbar punctures, injections, etc. done at your back.

The reason I sent you the link to Prof. Dr. Tennant`s website is, that many of his expertise also works with other back problems, besides AA.

From an orthopaedic perspective, you might consider Phramongkutklao Hospital in Bangkok to get yourself examined.

From a neurological perspective, you might consider Prasat Neurological Hospital in Bangkok for examination.

With both hospitals, I have had great success and I am still thankful to the doctors, that I am able to walk, with the help of a walker on wheels.

I hope you will find the best possible way to be able to fight your back problems and your back pain.🤞🍀🙏

On 7/1/2026 at 4:56 PM, ronnie50 said:

I had an MRI of my lumbar spine recently at one of the top private hospitals and it identified a variety of potential sources of my lower back pain - from sacroiliitis to narrowed lateral recesses that could be compressing root nerves, enlarged facet joints among others.

I've looked up the efficacy rates of various injections used for 'pain management' as they like to call it. Not very impressive. Most are around the 50-70% efficacy ranges, and they take minimum 1-2 weeks to feel any improvement (if you get any improvement at all)

The various injections are known as:

Transforaminal Epidural Steroid Injection (TFESI),

Bilateral Lumbar Facet Joint Injections, and

Sacroiliac (SI) Joint Injections

These injections are supposed to be done by a skilled anaesthesiologist, guided by x-ray (fluoroscopy) to ensure the needle enters the right spots.

Anyone have any experience with any of these? Recommendations, etc? I know @Sheryl has recommended an ortho/spine doctor at BNH but he's a surgeon, not an anaesthesiologist, and so the experience of these procedures could vary expert to expert.

Before you think even to get any injections, please go this way first:

Stay active

Apply heat

use Ice

Try the 90-90 position

Physical therapy

Manual therapy

Do you have:

? Numbness in your groins, buttocks?

? Sudden weakness, tingling, loss of control in your legs?

? Difficulties in urinating?

? Unexplained fevor, chills , sudden weight loss?

If injections:

Approval rate ESIS over 70%

Trigger point injections more than 75% and temporary relief

However, injections ate NOT a PERMANENT cure, but can give relief for 6 months sometimes.

On 7/1/2026 at 5:30 PM, ronnie50 said:

Okay thanks @Sheryl for your comprehensive reply and advice. I'll take the DVD to see Prof. Wicharn. Should I take the radiologist report too, or just the DVD and let Wicharn come up with his own review and diagnosis?

Best

R.

He will read the MRI himself, no need for radiologist report. He will also have you do Xrays at the hospital, he has his own protocol for that. When you arrive tell the nurses you have MRI already (and give them the DVD to upload) but not Xray, they will usually send you to do that before you see him.

1998 ruptured L5 S1Surgery offered only. Second opinion w SF 49 Dr.

He offerend me an alternative. Stating mankind has effectively dealt thruout time healing naturally. Two injections at the root. Gradually found a way to manipulate pain relief.

Eventually nature fused the disc.

Major problems for years, degeneration in 3 discs and stenosis.

I have an active lifestyle and all managed by physical therapy, manual therapy, visits the to the sauna (hot bath, ice bath) and exercise. It’s worth if if you put the effort in.

Before L4/L5 decompression, I had three rounds of steroid injections that provided some relief but didn't solve the problem. Steroids work better for injuries that have the potential to heal than for degenerative back issues.

As I've learned is typical, the first steroid injection worked great for a few months. The second injection was harder for the doctor to get the needle in the right spot, so quite an unpleasant procedure and didn't give as much relief. The third injection required a general anesthetic to get the needle placed and provided very little relief at all. I understand that this declining effectiveness is to be expected.

I had nagging problems starting in my 20's and worked on the problem with stretching, weight loss, acupuncture, chiropractic, orthotics and various meds my entire life before steroids and surgery at 60. My advice in retrospect is not to go for more than one round of steroids, figure out if surgery is the only path, and get it done as early in life as possible if that's what's needed to be comfortable.

On 7/1/2026 at 4:56 PM, ronnie50 said:

I had an MRI of my lumbar spine recently at one of the top private hospitals and it identified a variety of potential sources of my lower back pain - from sacroiliitis to narrowed lateral recesses that could be compressing root nerves, enlarged facet joints among others.

I've looked up the efficacy rates of various injections used for 'pain management' as they like to call it. Not very impressive. Most are around the 50-70% efficacy ranges, and they take minimum 1-2 weeks to feel any improvement (if you get any improvement at all)

The various injections are known as:

Transforaminal Epidural Steroid Injection (TFESI),

Bilateral Lumbar Facet Joint Injections, and

Sacroiliac (SI) Joint Injections

These injections are supposed to be done by a skilled anaesthesiologist, guided by x-ray (fluoroscopy) to ensure the needle enters the right spots.

Anyone have any experience with any of these? Recommendations, etc? I know @Sheryl has recommended an ortho/spine doctor at BNH but he's a surgeon, not an anaesthesiologist, and so the experience of these procedures could vary expert to expert.

Ronnie I have had Physical Therapy at BNH and presently at a private clinic J Clinic. Both are good, but I have to say after 40 years of messed-up back to laminectomies and therapy, J Clinic has done more than any therapists in Thailand or Canada.

I would suggest seeing the surgeons at BNH. I have been seeing them for 16 years, both for surgeries and any issue with my back. They are the best. For therapy, I would recommend J Clinic. I go to the one across from EMsphere in Phrom Pong. They will also want to see the DVD

I got the injections in Canada and had to travel 2 hours by bus to get it, then 2 hours back home. By the time I got back home the effect had worn off.

Edited July 3Jul 3 by kingstonkid

I have had lower back pain for about 10 years. It's been diagnosed as a torn muscle, but no slipped disc or other spine problem.

I go in every week for an RF (radio-frequency) back massage. That helps me a lot, as well as putting a hot-pack on it every evening before I go to bed.

About 45 years ago I injured my back at work lifting something far too heavy. It was bad, not walking for weeks before I could get surgery. I have a few things done on L3,4 and 5. I saw a neurosurgeon for all treatments.

15 years later, more serious constant pain. I had a TFESI. I felt better within days. It worked great for maybe 10 years. Ten years after that, I had another. I am 70 now. I am not overweight by any means. I exercise daily, and do many exercises for my back and stomach. My spine is such if I fart wrong, I could be back in bad shape. But I would highly recommend the TFESI.

On 7/2/2026 at 9:12 AM, FolkGuitar said:

15 years ago, I was having severe back pain. I went to Chiang Mai Ram, and was advised to have my spinal cord 'enlarged' and three vertebrae fused. I was in a full back brace, taking tramadol 4-5 times a day for the pain.
While I was deciding, I happened to meet Dr. Jolie Bookspan while she was vacationing here. She said, "Don't let them cut! I can fix you!
And she did, with just a few simple exercises.
I stopped taking the Tramadol after two weeks, and was out of the back brace after about a month! I was back, active in sports in less than two months!
She offers her skills for free on her web page. Everything she told me to do can be found here! http://www.drbookspan.com/clinical.html

Scroll down the page for links to the exercises.
Your condition may be different from mine, but perhaps you can get the same relief. Dr. Bookspan comes to Chiang Mai every year for the Flower Show. We get together every year for a few days now. She's helped a lot of people over the years.

Excellent advise. I just loved her opening gambit, "Don't let them cut! I can fix you!' Certainly visit her website and get the lowdown, but I would also recommend another option. Go and take a look at this website as well: https://flowingzen.com/why-your-back-really-hurts/

I've been practicing Qigong for 15 years and under this guy's tutorage for 3 or 4 years. I used to get regular bouts of backpain before I found Qigong, but not any more. I've hit 80 years now I'm still active and pain free.

What 'flows your boat' I hope it works out for you.

After my backs disc fusing I experience a new ailment . Several years later. I recall when diagnosed he said, you learned from the back repair and just appy the same techniques.

This was degenerative disc disease this time in my neck.

Since I have came up with a routines that realign and recover each day

manipulation 101

Edited July 3Jul 3 by earlinclaifornia

For years prior to moving to Thailand I had the injections you mentioned. In my experience they were temporary at best. Usually, 3 months or less. Prof. Wicharn at BNH is a highly regarded and well-respected surgeon Not for my back but I have been an in-patient at BNH 3 times and could not find a thing in the care provided to complain about. I live in Ban Chang and even with the 2-3 hour drive to BNH that is and always will be my go-to hospital.

On 7/1/2026 at 5:35 PM, Beat666 said:

I am having problems with my back , since I was young. For 24 years now, I am suffering from Adhesive Arachnoiditis.

In 1999, I had a successful back surgery at Phramongkutklao Hospital in Bangkok.

In the following link, you will find a lot of information, regarding your query. I hope you find answers.

https://arachnoiditishope.com/protocols/

I see this is the Army hospital. I've had good luck with the Navy hospital, Somdej Phra Pinklao. (Not back pain, hyperbaric chamber.)

6 hours ago, WDSmart said:

I have had lower back pain for about 10 years. It's been diagnosed as a torn muscle, but no slipped disc or other spine problem.

I go in every week for an RF (radio-frequency) back massage. That helps me a lot, as well as putting a hot-pack on it every evening before I go to bed.

Interesting sorry to hear though. Did you get an MRI to confirm torn muscle? I was told the same - back sprain - I wasn't convinced. So I finally got up enough nerve to do the 2 hour MRI. Two recently compression fractured vertebrae in thoracic spine, and a whole range of things in lumbar that is causing me a lot of pain. Both doctors from same hospital too - one of the 'top' ones.

I have my procedures done in the US during my annual visits, because I have Medicare insurance there. I have SI joint injections, and Radio Frequency Ablation on my lower back done every year. The SI injections are helpful, but I get the greatest relief from the RF Ablation. It lasts about 8-10 months for me, but it varies from person to person. I've never had the other 2 injections you mentioned so I can't comment on them. I recently purchased a TENS unit for home use. It provides some degree of relief and is very inexpensive.

9 hours ago, Wuvu2 said:

Before L4/L5 decompression, I had three rounds of steroid injections that provided some relief but didn't solve the problem. Steroids work better for injuries that have the potential to heal than for degenerative back issues.

As I've learned is typical, the first steroid injection worked great for a few months. The second injection was harder for the doctor to get the needle in the right spot, so quite an unpleasant procedure and didn't give as much relief. The third injection required a general anesthetic to get the needle placed and provided very little relief at all. I understand that this declining effectiveness is to be expected.

I had nagging problems starting in my 20's and worked on the problem with stretching, weight loss, acupuncture, chiropractic, orthotics and various meds my entire life before steroids and surgery at 60. My advice in retrospect is not to go for more than one round of steroids, figure out if surgery is the only path, and get it done as early in life as possible if that's what's needed to be comfortable.

Thanks for sharing your experience. It's useful to know. Interesting what you say about the declining usefulness of steroid shots/injections. I wonder about that too. I had bursitis in my knee (apparently confirmed by ultrasound at the same hospital earlier this year) and eventually had an ultrasound-guided cortisone injection - but 2 weeks later the nagging pain was still there. So I went back, and they sent me to a knee specialist who gave me more cortisone injections. Eventually, after a couple of more weeks, it worked, but it shouldn't have taken that long. So it makes me wonder if the shots are worth it given the 50-70% efficacy in the broader population. For my back, I've already tried 'trigger point injections' and they did little to nothing for pain. Also, if you have high BP (I do) the steroid will shoot the BP through the roof and has to be carefully monitored and thought out in advance.

16 hours ago, ronnie50 said:

Interesting sorry to hear though. Did you get an MRI to confirm torn muscle? I was told the same - back sprain - I wasn't convinced. So I finally got up enough nerve to do the 2 hour MRI. Two recently compression fractured vertebrae in thoracic spine, and a whole range of things in lumbar that is causing me a lot of pain. Both doctors from same hospital too - one of the 'top' ones.

No, I've gotten an MRI, but never on my back. However, when the incident occurred about 20 years ago, I was given a back X-ray, and it showed no fractures or slipped disk. I injured my back one day when standing up after sitting on the toilet. I remember it well because I could hardly walk for a couple of days.

On 7/3/2026 at 7:22 AM, ronnie50 said:

Thanks for sharing your experience. It's useful to know. Interesting what you say about the declining usefulness of steroid shots/injections. I wonder about that too. I had bursitis in my knee (apparently confirmed by ultrasound at the same hospital earlier this year) and eventually had an ultrasound-guided cortisone injection - but 2 weeks later the nagging pain was still there. So I went back, and they sent me to a knee specialist who gave me more cortisone injections. Eventually, after a couple of more weeks, it worked, but it shouldn't have taken that long. So it makes me wonder if the shots are worth it given the 50-70% efficacy in the broader population. For my back, I've already tried 'trigger point injections' and they did little to nothing for pain. Also, if you have high BP (I do) the steroid will shoot the BP through the roof and has to be carefully monitored and thought out in advance.

Again, the efficacy of the shots depends very much on the underlying cause of the pain. Which in your case still needs to be ascertained.

As you mention the MRI showed some compression fractures, a thorough investigation is warranted. Not to alarm you but these can be due to serious bone disease including from cancer metastasis.

Get a proper evaluation and do not waste time at this point debating the pros and cons of treatments that might not even be recommended for your specific case.

12 hours ago, Sheryl said:

Get a proper evaluation and do not waste time at this point debating the pros and cons of treatments that might not even be recommended for your specific case.

Thanks. I will. Just waiting for the DVD of MRI to arrive.