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Thread: Caudel Epidural, S1 injections, Facet injections, Medial Branch blocks/Radio Ablation

  1. #1
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    Caudel Epidural, S1 injections, Facet injections, Medial Branch blocks/Radio Ablation

    I know many of us that have had surgery are now with pain management practices and have day-surgery epidural procedures done. I have had a caudel epidural, and the first part of "medial branch block" portion of a radio Ablation treatment - am waiting for the actual ablation part to be done. Unfortunately, my physiatrist insisted on doing it in two parts and my insurance ran out after the diagnostic part was done. Some doctors do ablations with only one procedure; my bad luck that the guy MediCaid assigns me to does it in two.

    Anyway, I am still confused as to what the actual procedural difference is between say, a caudal epidural and a S1 joint injection? Or a facet injection? Of course I know they are all different parts of the spine, but I guess what I'm asking is what does each specifically target? For instance, I have nerve pain shooting down the front of my left leg. I also sometimes have it shooting down the middle of my buttock and back of my leg. Which procedures should I ask for? I have very limited medical care, so I have to be aggressive and ask, otherwise I won't get it.

    Next week, after waiting ten months, I have an epidural appointment. I know the guy will only do one procedure at a time, so I'll go for the caudel epidural again. What else should I ask for next time? How many weeks apart do procedures have to be? Can you have an epidural one week and a S1 epidural the next? Also, how do others deal with getting up an down on stomach on a narrow table? It is hard with a fused spine because the table is so narrow and nowhere to roll to side?

    Also, the pain with the epidural was tolerable, but the medial branch block was hideously painful, and I was crying/screaming in the OR. The needle was going through scar tissue, so the doctor said, and the nerve pain went right to my brain. The IV Fentanyl and Versed did nothing. Suggestions? I would like to complete the Ablation treatment, but am terrified of that kind of tortuous pain.

  2. #2
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    I am fused from C2- sacrum and I managed to get on and lay down on the narrow table.

    I had SI injections and had some relief from them

    Good luck

    Melissa
    Melissa

    Fused from C2 - sacrum 7/2011

    December 8, 2014 - Another Broken Rod Surgery

  3. #3
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    You can sometimes tell what part of the spine is causing pain by checking out the deramtomes:

    http://en.wikipedia.org/wiki/Dermato...t_1962_663.png
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  4. #4
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    Quote Originally Posted by Tableone View Post
    I know many of us that have had surgery are now with pain management practices and have day-surgery epidural procedures done. I have had a caudel epidural, and the first part of "medial branch block" portion of a radio Ablation treatment - am waiting for the actual ablation part to be done. Unfortunately, my physiatrist insisted on doing it in two parts and my insurance ran out after the diagnostic part was done. Some doctors do ablations with only one procedure; my bad luck that the guy MediCaid assigns me to does it in two.

    Anyway, I am still confused as to what the actual procedural difference is between say, a caudal epidural and a S1 joint injection? Or a facet injection? Of course I know they are all different parts of the spine, but I guess what I'm asking is what does each specifically target? For instance, I have nerve pain shooting down the front of my left leg. I also sometimes have it shooting down the middle of my buttock and back of my leg. Which procedures should I ask for? I have very limited medical care, so I have to be aggressive and ask, otherwise I won't get it.

    Next week, after waiting ten months, I have an epidural appointment. I know the guy will only do one procedure at a time, so I'll go for the caudel epidural again. What else should I ask for next time? How many weeks apart do procedures have to be? Can you have an epidural one week and a S1 epidural the next? Also, how do others deal with getting up an down on stomach on a narrow table? It is hard with a fused spine because the table is so narrow and nowhere to roll to side?

    Also, the pain with the epidural was tolerable, but the medial branch block was hideously painful, and I was crying/screaming in the OR. The needle was going through scar tissue, so the doctor said, and the nerve pain went right to my brain. The IV Fentanyl and Versed did nothing. Suggestions? I would like to complete the Ablation treatment, but am terrified of that kind of tortuous pain.
    Tableone,

    Re: ablation: Medicare requires that a person has 2 trials before the actual procedure.

    Re: getting on and off the table....that's a challenge! The last time, I got on the narrow table on my hands and knees, and then slowly lowered my knees and and body while doing a sort of "push up" position with my arms, but it was a gradual lowering of my upper body. OHSU asks that you walk into the procedure room, so I have a small elevated platform to help me step onto the table. Needless to say, it is a challenge. I ask the nurse to "spot" for me, so that if I go to fall off the table, she can help me. Getting off the table isn't a problem, because I just log roll onto a guerney.

    Re: meds, ask for more. Explain that whatever they used the last time did not work, so they needed to give you more or different meds. Also, have the pain MD ask you about pain during the procedure. You have an IV in, so they can add more when you need it....but obviously, they did not listen to you since you were screaming and you think that they would figure it out.

    Good luck, Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  5. #5
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    Thank you, Susan, for the suggestions about getting on and off the narrow table. I asked for another gurney so I could log roll off the table and they said they didn't have one. No matter how much I explain to medical professionals that I have a completely fused spine, they just don't get what that means. I guess next time I'll just log roll myself onto the floor and then sue them. Just kidding! Anyway, thanks. Yes, I will ask for more fentanyl and versed although neither really do anything. They should do this procedure under a general, but that would be too expensive and epidurals are the new cash cow. Medicare is not hard and fast on everything, and it depends what plan you're on, so I have not been told the same thing about the two tries of the nerve block first, although I have been denied just about everything else because I am also on MediCal/Medicaid, which truly sucks. Thanks again.

  6. #6
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    Quote Originally Posted by Tableone View Post
    Thank you, Susan, for the suggestions about getting on and off the narrow table. I asked for another gurney so I could log roll off the table and they said they didn't have one. No matter how much I explain to medical professionals that I have a completely fused spine, they just don't get what that means. I guess next time I'll just log roll myself onto the floor and then sue them. Just kidding! Anyway, thanks. Yes, I will ask for more fentanyl and versed although neither really do anything. They should do this procedure under a general, but that would be too expensive and epidurals are the new cash cow. Medicare is not hard and fast on everything, and it depends what plan you're on, so I have not been told the same thing about the two tries of the nerve block first, although I have been denied just about everything else because I am also on MediCal/Medicaid, which truly sucks. Thanks again.
    The two trials of the procedure are for us old people on Medicare. I think that the stuff that they tell you is Fentenyl and Versed are really placebo if they let you walk out of the procedure room. I totally agree with you about the ignorance of many people in the medical community about the ability of people w/ fusion to move. My primary still gets really nervous when I move to the side to try to push myself up....that is after she has offered me her hand to help me sit up like someone would do who did not have a spinal fusion. Talk about narrow, the CT scan bed is really narrow!

    It must really suck to need to fight for everything that you need from the medical community. I spent 6 months trying to convince one pain Mangement doctor that a Rhizotomy would be helpful. Finally, he scored a research job and passed me on to another doctor. I asked her what she thought about it and she said, "sure". Message to Self: you should have dumped the PMD long before he got his research job.

    Best of luck and I hope that you find some pain relief soon.

    Susan
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  7. #7
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    hi tableone
    i had fentenyl patches for a while...they did nothing for me.. maybe they were low dose, i don't know...i do know morphine makes me throw up, even when it
    was given to me in nasal spray form years ago (not for spinal pain, for something else)....i know fentenyl is supposed to be dangerous in high doses

    what i discovered about injections was that all that mattered, in my case, was WHERE the injection was put....i had all kinds of different injections, facet block, tried nerve ablation etc....the only thing that helped me was sacroiliac joint injections...
    injections elsewhere did not give me any pain relief at all.

    jess...and Sparky

  8. #8
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    Jan 2012
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    55
    When the pain from being put in a cam walking boot first began, I was sent for injections.

    I believe I had in excess of one dozen and can be precise if any one is interested. Some where along the line, I did have about an hour or two of pain relief.

    However, I lost 27% of my bone density. Although I was still "normal", this was SO upsetting b/c I had protected my BD. I have never had to take medication to build up my bones but STILL!!!

    The good and strange news is: I have been taking four 600 mg Calcium and in excess of 1200 mg of VD3. I can go back for the beginning date. This caused an INCREASE in my BD of .4% per year since taking those vitamins. This is not supposed to happen--one ortho was in a flap--a complete state of disbelief...

    It was not worth it!!!

  9. #9
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    S1 joint injetion today

    I had a S1 joint injection today on right and left side No IV pain meds were offered, so I did it with lidocaine only. It actually was not as painful as the caudel epidural I had two weeks ago, and that was done with 50 mg of Fentanyl and 1 mg of Versed. It was a different doctor, an older guy, so maybe he had a better technique or maybe I had less scar tissue down there. The scar on my right hip from that wonderful bone graph they did for my Harrington Rod surgery 30 years ago didn't feel too good when he was doing the right side. And, at one point, the needle caused the muscle in my thoracic area to seize up in a charlie horse cramp. Doc said I would need to give it 24 hours to see if it worked.

  10. #10
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    May 2009
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    i hope you get relief...that was the only spot on me that
    they ever injected that actually DID give me relief, as i wrote...the relief would kick in within 24 hours....and usually lasted...for me anyway....about 3 months...the relief diminished as time wore on...
    it made me so happy when it kicked in...i could walk again without pain...
    just be careful...
    the other thing too much steroid does is CRASH the adrenal system...surprised it didn't happen to anyone who had a dozen shots! it took my cortisol level down to almost zero...feels like MONO....
    zero energy....thank goodness my cortisol level came back after 6 long months...

    please be careful of how many shots you get...
    and enjoy the pain relief i hope comes for you....

    jess...and Sparky

  11. #11
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    Mar 2010
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    Tableone,
    I am also one who gets injections. My Botox injections in the neck and upper shoulders can be excruciating. My doctor gave me 2mg of Ativan to take one hour before the procedure and 2mg to take one half hour before the procedure. It did make a difference in calming me down and the injections weren't as painful.

    As for lumbar area injections. There are personnel on both sides of me on the table. They always put pillows under my hips because lying flat hurts so much. If they are hitting a nerve to cause head pain like you described I would insist that the procedure be stopped until the pain was controlled! Fentanyl via IV is not a placebo. It is a very strong narcotic. You must have been in a tremendous amount of pain for that not to work.

    My suggestion is that from here on out, you discuss these concerns with your doctor and get a prescription to take BEFORE the procedure and make sure there are measures in place ahead of time just in case you need more pain control.

    I'm glad your last injection wasn't too bad. The SI injection that I had was the worst lower back injection I've ever had. I'm having an injection next Tuesday. We'll see how it goes.

    Best wishes to you.
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

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