Steroid Injection relieving Sciatica pain.

[tomx2]

Hi.

I have a question regarding having a Steroid Injection for relieving Sciatica pain in the leg.

I went to Pattaya Memorial Hospital recently. After having a MRI, it was recommended to have a Steroid Injection. Since my duration in Pattaya will be 5 months + my funds are limited, a Steroid Injection in my back would be the best solution to temporarily reduce Sciatica pain during my long stay.

Pattaya Memorial quoted me a price of 50,000 baht for a Steroid injection.

Questions:

Does this price (50,000 baht) sound reasonable for this procedure in Thailand?

Has anyone had the same procedure? What's your advice concerning this?

The procedure (from what I've read) is not always 100% successful. Is this correct?

I will also inquire at BPH, Pattaya International, and Banglamung Hospital to get a price quote for a Steroid Injection.

Thanks.

TC.

[hotwinter]

i suffer with back pain, i have never heard of a steroid injection for sciatica, sciatica is just the nerve being trapped. what was the diagnosis from the MRI?

[manfredtillmann]

my totally unprofessional advice:

sciatic pain originates from your lower spine, l5 or so. it usually disables people into a state of paralysis. but it is the totally wrong thing to do.

i have been on EVERYTHING (chemicals) for years after doing some mayor damage to my spine while fending off a guard dog..

my best advice: muscle training. ignore the pain. once you have got your 6-pack back there will be no more back pains.

[AlexRRR]

Firstly unless there not disclosing what the injection really is i would pass.....me i have both shoulder injuries, Rotor cuff, I've had about 6 steroid injections in total, at first they worked fine as i received more they worked less, a nurse told me 3 was the limit which means you need an operation...per shoulder, the cost and in one of the most expensive countries in the world Australia about $20 for 2 one in each shoulder, now i wouldn't like to say your being taken advantage because what they are quoting you on may very well be something else but if its a pure and simple steroid injection....yes i would be looking at them darkly.

[samuijimmy]

I had a steroid injection for same reason as OP, a few months back, at Samui Gov. Hospital, the cost was 10,000 baht....

That included X Ray and after care for several hours afterwards...

Yes, it has helped a lot, so does floating in water with a ring around chest and weights on the ankles.

[robblok]

I had a steroid injection for same reason as OP, a few months back, at Samui Gov. Hospital, the cost was 10,000 baht....

That included X Ray and after care for several hours afterwards...

Yes, it has helped a lot, so does floating in water with a ring around chest and weights on the ankles.

Just curious .. would hanging upside down help then too.

[Sheryl]

1. The cost is not reasonable IMO.\

2. Without knowing the diagnosis (sciatica is only a symptom, not a disease), can't say much about likelihood it will help.

3. There are down sides to steroid injections as they weaken the musculoskeletal system.

Depending on what the underlying problem is, you might do better to just get a course of physical therapy...or having a course of oral medications to reduce inflammation and relive the pain.

If I were you I'd get all the MRI films and Xray films, and take them into Bangkok and consult Dr. Wicharn at the BNH Hospital Spine Center to find out what, exactly, is the cause and what the treatment options - long and short-term - are.

[tomx2]

@Hotwinter This is my MRI findings(see Finding & Impression). Maybe a little to much to write for you and other members, but I'm not sure what paragraphs to snip.

The purpose of my original post.

Two Nurses at Pattaya Memorial quoted me a price of 15,000 Baht for a Steroid Injection in my back. The doctor informed me later they were incorrect and quoted 50,000 (Baht).

I got suspicious and told the doctor I need to think more about having this injection at this time. Just wanted to know if anyone on this forum thought this price (50,000) for Steroid Injection seems reasonable for Thailand. And if they ever had this procedure done.

I will eventually get this all sorted out when I get back to the U.S.(in 5 months) and visit my regular primary care physician.

You are also correct it's not an injection in the Sciatica but in the back, but it's purpose is to alleviate

the pain in my back which I assume will minimize the leg/calf pain that are causing the pain.

@AlexRRR I believe the proper term requested by the doctor is (ESI) Epidural Lumbar Steroid Injection for lower Back and Leg. Link: http://www.spine-health.com/video/epidural-steroid-injections-back-pain-and-leg-pain-video

TC.

Findings:

The study reveals S/P hemilaminectomy and loss of lumbar lordotic curve with slight retrolisthesis at L2 on L3. Homogeneous marrow signal intensity is seen. Schmorl's nodes and modic II representing subchondral fatty degreeration of bone marrow are detected at L2-3 apposing end-plants. Modic II is also detected at L5-S1. Marginal osteophytes along the lumbar spines are observed.

Loss of hyperS1 on Tw2 of all lumbar intervertebral discs represents degenerative discs and is describe in detail as follow:

L2-3 Mild diffuse bulging disc and disc protrusion with slight interior disc migration a central canal zone, causing moderate central spinal canal stenosis((collapsed the al sac with some separable nerve roots), narrowing of bilateral recesses suspicious impingement of bilateral L3 traversing roots.

L3-4: Mild diffuse bulging disc and annular fissure at central canal zone causing mild central spinal canal stenosis (collapsed thcal sac with separate nerve roots). No neural foraminal stenosis.

L4-5 Asymmetrical disc bulging and suspicious disc protrusion at right sub articular zone causing narrowing of left lateral recesses and suspicious impingement of bilateral L5 traversing roots.

L5-S1: Mild diffuse bulging disc and small disc protrusion at left sub articular zone causing narrowing of left lateral recess and suspicious impingement of left S1 traversing root.

No Intra/extramedullary cord lesion is seen.

The conus medullaris ends at L1 and appears normal.

The paraverterbral soft tissue is unremarkable.

Impression:

S/P left hemliaminectomy.

Lumbar spondylosis slight retrolisthesis at L2 on L3 and degenerate discs causing central spinal canal stenosis at L2-3 (moderate) L3-4 (mild) and L4-5 (moderate) and narrowing of bilateral L2-3, bilateral L4-5 and left L5-S1 lateral recesses.

Suspicious impingement of bilateral L3 bilateral L5 and left S1 traversing roots; This MRI study is performed only on supine position, hence the resulting image may or may not demonstrate lesion of interest. Correlation between radio-graphic findings and physical examination is advised.

• Disc protrusion with slight inferior disc migration at central canal zone of L2-3.

• Annular fissure at central canal zone of L3-4

• Asymmetrical disc bulging and suspicious disc protrusion at right sub articular zone of L4-5.

• Small disc protrusion at left sub articular zone of L5-S1.

[tomx2]

1. The cost is not reasonable IMO.\

2. Without knowing the diagnosis (sciatica is only a symptom, not a disease), can't say much about likelihood it will help.

3. There are down sides to steroid injections as they weaken the musculoskeletal system.

Depending on what the underlying problem is, you might do better to just get a course of physical therapy...or having a course of oral medications to reduce inflammation and relive the pain.

If I were you I'd get all the MRI films and Xray films, and take them into Bangkok and consult Dr. Wicharn at the BNH Hospital Spine Center to find out what, exactly, is the cause and what the treatment options - long and short-term - are.

@Sheryl Hi, I have tried many Oral(over-the-counter) medications from Tamadol to Cerebrex. None works.

I was prescribe by my Pattaya Memorial doctor Kapanol(20mg morphine) & Gabapentin 300mg. I took them as prescribe for 1 day and they do seen to reduce the pain but their were some side effects (I.E. sweating in the morning, dizziness).

Going to Bangkok is a little out of my way. So recommendation of a Physical Therapist would be helpful. I read on the net Pattaya International Hospital (soi 4) has a good PT.

Does anyone know a doctor at PI Hospital or should I ask for a Physical Therapist when I arrive? Should I bring the MRI to the Physical Therapist?

[Sheryl]

PT needs to be ordered first by a spinal specialist and afraid I can't recommend one in Pattaya. Though would likely include lumbar traction.

From your MRI report, your situation is complex and the MRI film really needs to be reviewed by a good spinal specialist along with a thorough physical exam. Radiologist MRI reports are often not that accurate and anyway what the film shows needs to be correlated with the clinical signs, which to a good spinal specilaist will help pinpoint which nerves are involved.

For pain due to disc impingement Dr. Wicharn prescribed me a brief (very brief) course of oral steroids (prednisolone) plus Lyrica and B12, which worked. But of course your case could be different - the point is, the meds you have tried do not represent the full range of treatment with oral medication. The dizziness & sweating are likely from the morphine.

I realize it is a long trip (it was for me as well) but coming into Bkk is the best advice I can give you.

Reverting back to the issue of a steroid injection, I am not sure it offers sufficient benefit over a short course of oral steroids to be worth the expense and risks. But again, need to get the opinion of a good spinal specialist.

[wcfoster]

BKK Hospital in Udon Thani. 40,000 baht

Public hospital Udon - 4,500 baht

Doctor clinic Udon 2,000

Same medicine, same doctor, all with fluoroscope.

It pays to shop around!

[samuijimmy]

I had a steroid injection for same reason as OP, a few months back, at Samui Gov. Hospital, the cost was 10,000 baht....

That included X Ray and after care for several hours afterwards...

Yes, it has helped a lot, so does floating in water with a ring around chest and weights on the ankles.

Just curious .. would hanging upside down help then too.

Can't comment as I have not tried, but I hear that can help too...

[islandguy]

Traction can help various disc related problems. Physical therapy clinics may have an apparatus that allows you to lie on a table while traction is applied horizontally. Hanging upside down is usually too strenuous for someone with an acute condition, and getting back up to the bar can be quite hard if you are not fit or if your blood pressure is not good. Lying on a slant board is probably the easiest kind of traction to do in a home setting. Head down

[dddave]

+1 on Dr. Wicharn with whom I consulted on Sheryl's recommendation for a nerve problem in my leg. He is proficient, an excellent communicator in English and a good listener as well...sometimes a rare quality in Thailand. I saw him at BNH, Bangkok.

[digital]

I had an epidural steroid mixure injected in to my lower back a long time ago (almost 15 Years now) in the UK. My symptoms were lower back pain but mainly sciatica which was painfull in my right leg down to my ankle, for a long time I could not put my right foot to the ground, I was walking on tip toes. My musles locked up in the lower back and I was very crooked looking.

I was taking medications and 3 times a week osteopathy and there was no improvement at all. As it had been going on so long my GP referred me to BUPA to try to speed things up, they did the epidural at a cost of around 600GBP. This for me did not help me, some minor short lived pain reduction only, but may for you. Paying privately did mean I was fast tracked with the same doctor in the NHS system, he admitted me as he said this was the fastest way to get the MRI scan. After the MRI scan a specialist neurosurgeon came from another hospital and it was decided I need a discectomy (L4 L5 I think it was), I had to go to a further away hospital that had the neurology specialists.

After the surgery it was expected I would leave in 2-3 days, but ended up nearer to 10 days. I dont remember the exact details but as well as the discetomy there was some fusion, I never understood if he meant he had to fuse the bones together or if the bones were fused (later I tried to find out but my GP said the records were only basic and I needed to get from the hospital, which I never did). The surgery fixed the immediate problem, but still have back pain from time to time and I have mild scoliosis and spondylosis of the lumbar spine (which may be a part of my current problem in my other post).

I think how well the injection works depends on the severity, but its an easy procedure so worth doing it if medications, rest, physical therapy etc have all failed.

[tomx2]

This is the OP.

On Saturday, I went to Pattaya International Hospital Soi 4(on a friend's recommendation) to see his Orthopedist. He stated after reviewing my MRI and taking an additional back Xray (350 Baht), my problem is in the L4-L5 area. Although his English was good, but not excellent, it appears to him my Lumbar was not showing any signs of damage, bent or twisted when lying straight down..

If an microdiscectomy procedure was not possible to do at this time, I could get a Steroid Injection in the hospital for 30,000 Baht.

I stated the price was to high. He then mentioned a Govt Hospital would be apply the same Injection for a cheaper price if his prescribe medication (see below) does not help.

He prescribe the following Meds for a short term use: Lyrica, Norgesic, Douzabox(Vit B1-6-12), Fenac, and Pred Tab.

2nd I will begin going to Pattaya International Hospital Physical Therapy facility (1000 Baht per visit) beginning Tuesday July 12^th.

Will give Meds/Physical Therapy two weeks to see if there is any significant improvements in reducing my pain.

If not, I will (upon his suggestion) visit the Govt Hospital for a Steroid Injection at a reduce price.

Thanks all for the Feedback.

TC.

[Sheryl]

Sounds like a solid plan. A combo of prednisone, lyrica + B vits is standard management for pain due to pressure from a bulging or prolapsed disc (the addition of muscle relaxant and NSAID being typical polypharmacy popular here) as is PT.

[KhunFred]

I've been suffering with spinal stenosis and apparent sciatica for a number of years now. The information I've read on

TV , regarding epidural injections  is kind of depressing. I am seeing quotes of up to fifty thousand baht from a low of 10 thousand. I had my last epidural injection over three years ago in the United States. Of course my insurance took care of most of the cost and I was only responsible for a 30 dollar copay. I've been taking Tramadol on a regular basis for about five years, but I would rather resort to some type of physical therapy or acupuncture (if that's a sane alternative). I'm sure that a hospital like Pattaya City Hospital would not be as expensive for the epidural treatment, but that's mostly conjecture  based on what I've heard. At 68 years old, decent medical insurance at a fair price is simply not available to me. Does anyone have any suggestions for treatment or therapy at a SANE price?? Thailand has a great reputation in terms of medical tourism and that apparently is driving up prices. Insurance would also be problematic because of a history of prostate cancer (now in remission) and brain surgery for a benign cyst, some years back. I've gotten quotes as high as 800 USD a month, which is basically impossible. Any advice might be helpful at this stage. Thanks.

[Sheryl]

Before embarking on PT (which might help but might also do harm) you need to get an assessment by a good spinal specialist and detailed orders for type of exercises.

 

I very much doubt accupuncture will help, it doesn't usually with spinal stenosis.

 

Where you not considered a surgical candidate in the US? Stenosis bad enough to require multiple epidurals would usually warrant it.

 

If you are open to possible surgical correction or if you want to pursue possible repeat epidural then your best option is a government hospital but needs to be a tertiary level one, preferrably a teaching hospital.

 

I suggest Chulalongkorn or Siriraj, both in Bangkok but Chula more convenient location. Be prepared for very long waits and many repeat visits to accomplish what could be done in a single visit privately. Mondays, Fridays or ant day following a holiday are the worst so aim to come on say a Tuesday. Bring a Thai speaker with you if at all possible. Arrive very early morning (e.g. 7 AM) to get a queue number, tell them spine clinic. (I'm not sure if they will let you go there without first running a successive gauntlet of medical students, interns etc in the general medical section, but no harm in trying, maybe they will. Stress that you were diagnosed already with spinal condition in your home country).

 

You need to be registered wit a patient number first, that can be done anytime 9-5 so suggest doing it the day before to save time in the morning. Bring tons of reading matter and lots of patience. Plan on staying at least 2-3 nights - Chula is in the Silom area, lots of inexpensive hotels.

 

Before embarking on this I suggest you get some quotes from:

 

1. https://www.s-spinehospital.com/en/about-us/

It is private but very new so prices may not yet be too high (maybe), they are still jockeying for market share

 

2. Phyathai Sri Racha, email [email protected]  or call him at 089 – 7500293 (he's an expat). while private it tends to be more moderately priced than others.

 

If you are not willing to consider surgery or another epidural and want only PT and perhaps meds, I suggest you get a lumbar MRI and a spinal Xray here (any branch; Bang Na probably closest coming from Pattaya)

 

http://www.mrithailand.com/index.php?lang=en

 

and take it (the actual CDs/film) to this doctor (make appointment beforehand)

 

https://www.bnhhospital.com/find-doctor/search-result/?dname=wicharn

https://www.bch.in.th/en/doctor-th-4/surgery/item/696-doc31.html

same doctor, different hospitals, the second is cheaper but his hours there are less frequent.

 

Get a thorough evaluation from him including, if he thinks it will help, detailed PT recommendations. Then take that to the PT dept at Pattaya Intermational Hospital

 

http://www.pih-inter.com/contact.php

 

Bear in mind that the spine is not static. However thorough the evaluations you have had in the past they are not a substitute for an evaluation now. Stenosis is progressive with age, and other issues may have developed as well.

 

The MRi & Xray will cost you about 9,000 baht if done at the place I listed. Doctor consultation not including medications, about 2,000 baht. If meds are advised get at a pharmacy not the hospital unless one of the meds is prednisolone, that one has to come from the hospital.

 

 

 

 

 

[KhunFred]

17 hours ago, Sheryl said:

 

Where you not considered a surgical candidate in the US? Stenosis bad enough to require multiple epidurals would usually warrant it.

 

 

I consulted the same neurosurgeon who excised my brain cyst and he basically told me that he would rather not take a chance on spinal surgery. He said operating may help or make it worse. He was very direct and put me on Tramadol. It works pretty well but causes other problems. Sheryl, thank you so much for the information. I know a Thai woman in Bangkok who is fluent in English and Spanish (if you can believe that). I could pay this woman to help me with translation problems, since that's basically what she does for a living.

 

 

 

 

 

 

Edited June 27, 2018 by KhunFred
additional info

[faraday]

I had a Spinal Injection as I have a disc protusion at l5/S1.

Prior to the injection, the Sciatic pain was awful.

 

I had it performed by Dr Warin, who is an excellent Orthopaedic surgeon at Fort Prajak Hospital in Udon.

 

It took about 20 minutes to do, a bit uncomfortable, & now I am pain free. Feels great.

 

Cost was 4000 baht. Yep 4000.

 

And don't have to take any meds at all.

 

Dr Warin speaks good English.

 

 

 

 

 

[Sheryl]

If it cost 4000 in upcountry govt hospital will likely be around 5-6,000 in Bangkok.

OP a neurosurgeon does not IMO have the same degree of expertise in spinal surgery as an ortho surgeon specialuzing in spine. For this reason and because there may have been significant changes in your spine since then I think you would be well advised to get re-evaluated.



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[KhunFred]

On 6/27/2018 at 2:53 PM, faraday said:

I had a Spinal Injection as I have a disc protusion at l5/S1.

Prior to the injection, the Sciatic pain was awful.

 

I had it performed by Dr Warin, who is an excellent Orthopaedic surgeon at Fort Prajak Hospital in Udon.

 

It took about 20 minutes to do, a bit uncomfortable, & now I am pain free. Feels great.

 

Cost was 4000 baht. Yep 4000.

 

And don't have to take any meds at all.

 

Dr Warin speaks good English.

 

 

 

 

 

Where did you have your MRI done?? Costs are a major concern. I draw a decent enough income for a retiree, but I'm still not "wealthy", though the Thais disagree. The variance in prices for these procedures is puzzling. The information provided so far is very valuable.

[faraday]

59 minutes ago, KhunFred said:

Where did you have your MRI done?? Costs are a major concern. I draw a decent enough income for a retiree, but I'm still not "wealthy", though the Thais disagree. The variance in prices for these procedures is puzzling. The information provided so far is very valuable.

Fort Prajak Hospital here in Udon, it cost 8000 baht.

[Sheryl]

MRI costs at govt hospitals and imaging centers are about the same but tbere is a wait list at many govt hospitsls. Pvt hospitals cost much mote.

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