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Thread: Inter Costal nerve block injections

  1. #1
    Join Date
    Apr 2005
    Posts
    913

    Inter Costal nerve block injections

    I have pain in thoracic screws, at around T5-T6. I had talked to my ortho about it, and he surprised me yesterday by calling me and told me that there could be two reasons for it, as he had told me another time before.

    1) it could be that a nerve is irritated by the screws there, and he wants me to get an Inter Costal nerve block injection.

    2) he wants me to maybe get surgery if the injection doesn't work, to add more screws and fuse higher but he seems not optimistic at all about the outcome b/c I already had a screw/hook there and had it taken out back in '99, as it gave me a lot of pain 24/7 and so it is really ridiculous to get my spine fused higher. I don't like how he didn't tell me this before having this last surgery in Decmeber and I absolutley will not have surgery again this soon, especially since it would be putting something back that I couldn't endure. It makes me mad for him to talk about surgery non stop without considering my pain and emotional distress at this point, but that's another story

    Anyway, I had been waiting to get an appointment at a pain clinic but the wait could be a year, since last May. I have now a name of a private clinic, my only worry is if the doctor is knowledgeable in scoliosis but I have an appointment in a few weeks. I would like it if anybody has any info on Inter Costal nerve block injections, if it's painful, if it helped you(I know it varies on the patient and can be only short term or no relief only for some), if there are side effects, etc. I did a search and still would like any personal info, it would really be greatly appreciated
    35 y/old female from Montreal, Canada
    Diagnosed with scoliosis(double major) at age 12, wore Boston brace 4 years at least 23 hours a day-curve progressed
    Surgery age 26 for 60 degree curve in Oct. 1997 by Dr.Max Aebi-fused T5 to L2
    Surgery age 28 for a hook removal in Feb. 1999 by Dr.Max Aebi-pain free for 5 years
    Surgery age 34 in Dec.2005 for broken rod replacement, bigger screws and crosslinks added and pseudarthrosis(non union) by Dr. Jean Ouellet

  2. #2
    Join Date
    May 2004
    Location
    Houston, Texas now live in Colorado Springs, CO
    Posts
    543
    Hi Sweetness,

    I had trigger point injections done in the rib cage area where my anterior incision was done. The pain management doctor said I have intercoastal neuralgia (sp.?). The trigger point injections were done in the office, they didn't hurt that much, more of a sting. For me they only lasted a few days instead of weeks. The doctor said it was to dangerous to continue giving them to me in that area without getting longer pain relief. It is also in the area where my rib was removed, he said he was only centimeters away from the lung. We are now discusing a medial nerve block. That would be done with x-ray guidance and injecting a medicine near the spine into specific nerves to deaden them. I see the pain management doctor next week about this. Does it sound similar to what you are talking about?
    Theresa

    April 8 & 12, 2004 - Anterior/Posterior surgery 15 hours & 7 hours
    Thorasic - 79 degree down to 22
    Lumbar - 44 degree down to 18
    Fused T2 to sacrum
    June 2, 2005 - Pedicle subtraction osteotomy @L3 7 hours
    MAY 21, 2007 - Pedicle subtraction osteotomy @ L2, extended the fusion to S2 and added pelvic instrumentation 9 hours

    FUSED T2 - SACRUM 2

  3. #3
    Join Date
    Jan 2006
    Location
    Tasmania
    Posts
    259
    Hi Sweetness and Theresa. I had cortisone injected into the bottom part of my back near the discs where all the pain seemed to be coming from, but they did not do a thing, in fact they hurt more than helped.
    Sweetness all the best of luck when you go to the private pain clinic I would be interested as to what they suggest.
    Also I think that I have a nerve being irritated in exactly the same spot I think you had , and if in fact I could have one of those nerve blocking injection thingys at points down my back and it would guarantee numbness I would jump on a plane or swim to America, as there is not one doctor in Australia who is really and truly experienced in revision surgery.

    I really feel for you both, I honestly and truly do, and sweetness I know what you means by doctors seeming to be what I call scissor happy. Its all right isnt it for them to be saying yep, well I will cut here and fuse there but its your body getting all that done to it isnt it.

    Macky
    Operation 1966, Fused from T4 to L3, had Harrington rods inserted. Originally had an 85 degree Thoracic curve with lumbar scoliosis as well but had a good correction.
    Perfectly normal life till 1997 but now in a lot of pain daily. Consider myself very fortunate though.

  4. #4
    Join Date
    Apr 2005
    Posts
    913
    Thank you both for your replies

    I don't know much about the treatment, but from what I read about it online it's a bigger deal then getting a cortisone shot, and I think they put it in the same league as a medial branch-not sure if it's almost or the same, but will ask.

    I had a cortisone shot also about a month before I had a part(hook) taken out, to see if it was the problem. It helped but just for a few days, as they told me it would if it worked and they mostly use it for a test, not long term relief.

    My original doctor has moved back to Europe, and opened his spine instituation, but this new one is very good, was trained by him for revision cases and I know how busy of a man he is, he's in charge of four hospitals. The system here is free healthcare and even if we do get the best techniques and hardware we don't get the bedside manners. My only beef is when they don't tell us all that we should do or not do after the surgery. The first time I knew not much, but now with having gotten a computer a year later after my first surgery and reading on this forum, it's really helping.
    35 y/old female from Montreal, Canada
    Diagnosed with scoliosis(double major) at age 12, wore Boston brace 4 years at least 23 hours a day-curve progressed
    Surgery age 26 for 60 degree curve in Oct. 1997 by Dr.Max Aebi-fused T5 to L2
    Surgery age 28 for a hook removal in Feb. 1999 by Dr.Max Aebi-pain free for 5 years
    Surgery age 34 in Dec.2005 for broken rod replacement, bigger screws and crosslinks added and pseudarthrosis(non union) by Dr. Jean Ouellet

  5. #5
    Join Date
    Aug 2006
    Location
    Lawrence, Kansas/ Overland Park, KS
    Posts
    195
    hey,
    i had trigger point injections (6 total) last fall on the right side up next to my thoracic spine, and they did not really help much more than a few days... I know it's different from the kind of injection you are looking at but I just wanted to warn you that when you are getting an injection on the side of your curve in your thoracic spine, you doctor should have a good idea of scoliosis and how it alters your anatomy. After having my lung collapse after one injection, i now refuse to get any more unless the dr. is guided under floroscopy (a fast x-ray). Just something to think about--- not something i was expecting when it happened to me but it wasn't pleasant and i wouldn't want it to happen to anyone else!

    good luck, and let me know if this new treatment works for you!

    -abbie
    aBbiE
    22 yr old F,KU college student
    Kyphoscoliosis...
    Scoliosis (25T, 23L) diagnosed @ 14 yrs old; curves June 08 were 45T, 32L with 18 degree rotation
    Kyphosis of 65 degrees...
    I am missing a lumbar vertebrae

    Surgery 6/30/2008 with Dr. Lawrence Lenke
    Fused T2-L2


    before/after pics
    all smiles!

  6. #6
    Join Date
    Jan 2006
    Location
    Tasmania
    Posts
    259
    I dont think the doctors over here would even know what a inter costal nerve injection is, because if they did I reckon I would have been given one.
    Amae, how scarey that must have been eh, as you said last thing you would have expected too.
    I have found as well Sweetness, that having this computor has helped me heaps in every way. I have learnt so much and it has made me feel like I wasnt going around the bend, when I found out that other people were having the same problems.
    Linda is really helpful and I feel really goes out of her way to give people references to look at, and also to help as far as she can from her own knowledge. You have also helped me heaps, thankyou. I really felt alone.


    Macky.
    Operation 1966, Fused from T4 to L3, had Harrington rods inserted. Originally had an 85 degree Thoracic curve with lumbar scoliosis as well but had a good correction.
    Perfectly normal life till 1997 but now in a lot of pain daily. Consider myself very fortunate though.

  7. #7
    Join Date
    Apr 2005
    Posts
    913
    Quote Originally Posted by amae28
    hey,
    i had trigger point injections (6 total) last fall on the right side up next to my thoracic spine, and they did not really help much more than a few days... I know it's different from the kind of injection you are looking at but I just wanted to warn you that when you are getting an injection on the side of your curve in your thoracic spine, you doctor should have a good idea of scoliosis and how it alters your anatomy. After having my lung collapse after one injection, i now refuse to get any more unless the dr. is guided under floroscopy (a fast x-ray). Just something to think about--- not something i was expecting when it happened to me but it wasn't pleasant and i wouldn't want it to happen to anyone else!

    good luck, and let me know if this new treatment works for you!

    -abbie
    Yikes, that sounds like a pain. Did your lung recover, and do you feel ok now?

    I will be having the injection in my back, and will for sure ask if the doctor knows about the spine but his secretary said he does, and he knows about people who have pain associated with screws. Will ask about all that has been posted here, and will keep everybody updated, as I know how the smallest things can be so helpful to all of us.
    35 y/old female from Montreal, Canada
    Diagnosed with scoliosis(double major) at age 12, wore Boston brace 4 years at least 23 hours a day-curve progressed
    Surgery age 26 for 60 degree curve in Oct. 1997 by Dr.Max Aebi-fused T5 to L2
    Surgery age 28 for a hook removal in Feb. 1999 by Dr.Max Aebi-pain free for 5 years
    Surgery age 34 in Dec.2005 for broken rod replacement, bigger screws and crosslinks added and pseudarthrosis(non union) by Dr. Jean Ouellet

  8. #8
    Join Date
    Aug 2006
    Location
    Lawrence, Kansas/ Overland Park, KS
    Posts
    195
    yeah i feel fine now, it wasn't bad enough that they had to put in a chest tube or anything, so it just was a matter of sitting in the hospital on oxygen waiting for it to fully inflate again. other than that, it feels just like it did before. good luck with everything!

    -abbie
    aBbiE
    22 yr old F,KU college student
    Kyphoscoliosis...
    Scoliosis (25T, 23L) diagnosed @ 14 yrs old; curves June 08 were 45T, 32L with 18 degree rotation
    Kyphosis of 65 degrees...
    I am missing a lumbar vertebrae

    Surgery 6/30/2008 with Dr. Lawrence Lenke
    Fused T2-L2


    before/after pics
    all smiles!

  9. #9
    Join Date
    Jan 2006
    Location
    Tasmania
    Posts
    259
    I am going to get my general practitioner to have a look at these posts so he can get an idea what exactly is going on. He is not a specialist but then there are no revision surgeons here anyway, but at least he will know that what I have told him and all the crying I have done in his office is real. Know what I mean?
    That is such a good idea sweetness to ask your doctor the questions, it will expecially help me, as it was only a few weeks ago my doctor was only counting down the discs in my thoracic spine to see which ones were the ones that were hurting me, and yep T5 and T6 and around that area, and he did not know why. As I said he is all I have to help me really. Thanks once again, your light shines. xx

    Macky
    Operation 1966, Fused from T4 to L3, had Harrington rods inserted. Originally had an 85 degree Thoracic curve with lumbar scoliosis as well but had a good correction.
    Perfectly normal life till 1997 but now in a lot of pain daily. Consider myself very fortunate though.

  10. #10
    Join Date
    Apr 2005
    Posts
    913
    Thanks for the kind words Macky, you don't know how uplifting they are

    I have a question for you, is the healthcare system free(public) down under? Here it's that way, and therefore the long waits. They are now making the private system more avalaible to everybody, but unfortunately there aren't any scoliosis surgeons in the private system, even after all these years scoliosis is still considered a "rare" disease and I don't know why, if 4% of the population is affected by it-on a different level.
    35 y/old female from Montreal, Canada
    Diagnosed with scoliosis(double major) at age 12, wore Boston brace 4 years at least 23 hours a day-curve progressed
    Surgery age 26 for 60 degree curve in Oct. 1997 by Dr.Max Aebi-fused T5 to L2
    Surgery age 28 for a hook removal in Feb. 1999 by Dr.Max Aebi-pain free for 5 years
    Surgery age 34 in Dec.2005 for broken rod replacement, bigger screws and crosslinks added and pseudarthrosis(non union) by Dr. Jean Ouellet

  11. #11
    Join Date
    May 2004
    Location
    Houston, Texas now live in Colorado Springs, CO
    Posts
    543
    Sweetness,

    My appointment is this Wednesday with the pain management doctor. We will be discussing the nerve block and I'll let you know what he says.
    Theresa

    April 8 & 12, 2004 - Anterior/Posterior surgery 15 hours & 7 hours
    Thorasic - 79 degree down to 22
    Lumbar - 44 degree down to 18
    Fused T2 to sacrum
    June 2, 2005 - Pedicle subtraction osteotomy @L3 7 hours
    MAY 21, 2007 - Pedicle subtraction osteotomy @ L2, extended the fusion to S2 and added pelvic instrumentation 9 hours

    FUSED T2 - SACRUM 2

  12. #12
    Join Date
    Jan 2006
    Location
    Tasmania
    Posts
    259
    Well Sweetness, yes, Australia is such a beautiful place. We do have a public health system and like yours it is free with a very long wait. We then go into a public Hospital. We also have private health cover which covers you for absolutely every type of illness. It costs quite a bit to pay it every month but it has the advantages of going into a private hospital without the wait.
    The public system covers scoliosis as well and all the doctors are included in it.

    I am on a pension which is called disability and is paid to me by the government every fortnight as I cannot work. Darn it!! Any tests that we have we dont have to pay for, so really we are lucky. People who are ill are put into sort of categories and the very sick dont have to wait long to get into Public hospitals but the people who arent urgent are the ones who have to wait.

    Just wish we had revision surgeons down here, which we dont. Thats why I find this forum so interesting and it is going to help my doctor to understand a bit more.
    Therese, I will be interested in what your pain clinic says as well.

    Thinking of you all, all the time and praying as well. xx

    Macky
    Operation 1966, Fused from T4 to L3, had Harrington rods inserted. Originally had an 85 degree Thoracic curve with lumbar scoliosis as well but had a good correction.
    Perfectly normal life till 1997 but now in a lot of pain daily. Consider myself very fortunate though.

  13. #13
    Join Date
    Apr 2005
    Posts
    913
    Quote Originally Posted by Theresa
    Sweetness,

    My appointment is this Wednesday with the pain management doctor. We will be discussing the nerve block and I'll let you know what he says.
    I had been thinking about you, and hoped your appointment went well and that your doctor had good news for you
    35 y/old female from Montreal, Canada
    Diagnosed with scoliosis(double major) at age 12, wore Boston brace 4 years at least 23 hours a day-curve progressed
    Surgery age 26 for 60 degree curve in Oct. 1997 by Dr.Max Aebi-fused T5 to L2
    Surgery age 28 for a hook removal in Feb. 1999 by Dr.Max Aebi-pain free for 5 years
    Surgery age 34 in Dec.2005 for broken rod replacement, bigger screws and crosslinks added and pseudarthrosis(non union) by Dr. Jean Ouellet

  14. #14
    Join Date
    May 2004
    Location
    Houston, Texas now live in Colorado Springs, CO
    Posts
    543
    Sweetness and Macky,

    Sorry it's taken a while to get back to you. At my appointment Wednesday the PA came in first and we talked all about the nerve block. They would have to do it at least twice. The first time they would inject the nerve at the facet joint with a numbing medicine. They would have to come at the nerve at an angle because of the rods. If the pain feels better then they know they have the right nerve. Once they are sure they have the right nerve, a laser that has a small needle tip is injected just barely into the skin and the nerve is destroyed. You can go back to work the next day if you want. Their success rate is pretty high. The nerves will grow back, sometimes as early as 6 months. Most of the time they don't grow back til about one year. Slowly the pain will return, if it gets bad again you can have this procedure repeated. I was already to set the date to have it done. When the pain management doctor came in (after reading my chart), he said he wants to wait at least 3 more months because my pain pattern has changed and he also wants to talk to my surgeon to see what he might be planning. I was very disappointed. He said this is usually a last resort thing to do because of the chance of infection. With rods that's the last thing that we want, an infection in the spinal area. He increased my nerve medicine for now. I take Lyrica, Hydrocodone, and Tizanidine. I will be going back to both doctors the Monday before Thanksgiving and I'll update then. Feel free to ask any questions.
    Theresa

    April 8 & 12, 2004 - Anterior/Posterior surgery 15 hours & 7 hours
    Thorasic - 79 degree down to 22
    Lumbar - 44 degree down to 18
    Fused T2 to sacrum
    June 2, 2005 - Pedicle subtraction osteotomy @L3 7 hours
    MAY 21, 2007 - Pedicle subtraction osteotomy @ L2, extended the fusion to S2 and added pelvic instrumentation 9 hours

    FUSED T2 - SACRUM 2

  15. #15
    Join Date
    Apr 2005
    Posts
    913
    Thank you for your reply Theresa,

    I can see that it's bittersweet as it has good chances to numb the pains but the risks of infections I did not know I will discuss this with my doctor when I go see him at this private clinic for sure, and my pain is also changing from week to week, so I don't know what to do also. I can have weeks where the pain is really bad and then a few days it gets better, but I still have to not do anything too brusk and basically lead a very easy type of lifestyle, and take it easy(even if I do walk and swim and do housework it's just not over doing it and doing movements in a certain way and not roughly).

    Will keep you posted on what I get as info. I'm curious if it's the same injections we're talking about.
    35 y/old female from Montreal, Canada
    Diagnosed with scoliosis(double major) at age 12, wore Boston brace 4 years at least 23 hours a day-curve progressed
    Surgery age 26 for 60 degree curve in Oct. 1997 by Dr.Max Aebi-fused T5 to L2
    Surgery age 28 for a hook removal in Feb. 1999 by Dr.Max Aebi-pain free for 5 years
    Surgery age 34 in Dec.2005 for broken rod replacement, bigger screws and crosslinks added and pseudarthrosis(non union) by Dr. Jean Ouellet

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