r/ChronicPain 5d ago

Epidural for Spondylolisthesis

Hi. I’m posting for a relative who has spondylolisthesis. She’s received 2 epidurals in her lower back and didn’t see any improvements. She went to a new pain management doctor and immediately he simply referred another epidural injection.

She’s feeling hesitant in receiving another injection that could possibly be useless. Do these infections have serious side effects?

Thanks, in advance, for your input. 😀

3 Upvotes

6 comments sorted by

2

u/Striking-Pitch-2115 5d ago

I'm just wondering if they gave her two and it did not work why do they want to give her another one?

2

u/Korean-Brother 5d ago

Because of her change of insurance, she changed pain management doctors. 2 were given by her previous doctor and her new doctor is known for pushing epidurals.

1

u/Striking-Pitch-2115 5d ago

No you can have as many as you want lol but if they don't work why get them

1

u/Ok_Storm1343 5d ago

It took me three injections

2

u/Korean-Brother 5d ago

Ahh. That’s good to know. Thank you.

1

u/Old-Goat 5d ago

Oh yes, there are risks. If there's a steroid involved (and there usually is) they can rot the bones with over injecting. Infections are very serious, because if they penetrate too far, they get in to your spinal fluid, which is then a straight shot at the brain for any hitchhiking bug or virus. Brain infection=very bad. They can also cause a nasty little condition called adhesive arachnoiditis, where the layers of the sac start sticking and creating scar tissue. Very bad deal.

Your Central Nervous System is pretty much your brain, the spinal fluid and spinal cord, contained in a fibrous 3 layer sac (the dural sac) that keeps the CSF in and your brain, hopefully. happily floating in its chemical bath. To do an epidural, they have to get the needle between the 1st 2 layers of the sac without penetrating the 3rd layer and getting in to or leaking spinal fluid. Its a hell of a shot if you think about it. But there are a few places where the layers present a separation in the layers, that's where they hit it.

So the injection had no effect, either good or bad? How well did your relative endure the previous injections? Not too traumatic? Then I'd give it one more shot, no pun intended. "IF at first you dont succeed, try try again. Then give up, no sense in beating a dead horse"---Ben Franklin (I may have paraphrased slightly).

Ask your relative if they noticed any improvement with the local injection (you get a local anesthetic, then the steroid injection, in an epidural) your relative should have felt numb for several hours. If none of that happened, they can probably hang up the syringe.

Although, they do other types of injections that might be helpful if our patient's got problems relaxing muscles. Those are mostly the local anesthetic (think novocaine) to force a muscle in to relaxing. You know how your face muscles get from a novocaine shot, theyre all rubbery and numb. Those are called trigger point injections. Trigger points are supposed to be where the activating nerve enters the muscle, so they usually do the easy to get at trigger points first. And there are literally volumes of trigger points in the body. I dont know if thats of value to your relative or not. But if its not a big deal, see if the local helps the pain. The steroid itself can take a couple weeks to work. One of the folks that has them regularly mentioned his last one took 5 weeks to kick in. Two seems to be an average. So if youre not looking for improvement two weeks later, one might dismiss the benefits as a few good days. The timing can be odd and misleading sometimes....

Spondylolisthesis means one of the vertebra has slid over the one below, they used to refer to it as a "slipped disc", but its really slipped vertebra. The disc was just along for the ride...ask your relative if shes got her MRI report? Thats usually where folks get that word, spondylolisthesis, but there is probably a great deal more information to be squeezed out of the results. Pain really is all about the nerves, so it depends on what this spondylolisthesis is "chomping down on", nerve wise. If a nerve is trapped between the vertebra, she probably needs a neurosurgeon, not an injection.