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Neurology (Expert Forum)
Epidural Steroid Injection of depo-medrol
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Epidural Steroid Injection of depo-medrol
by Gail-, Feb 08, 1998 12:00AM
Posted By CCF Neurosurgery MD on February 09, 1998 at 11:36:15:
In Reply to: Epidural Steroid Injection of depo-medrol posted by Gail on February 08, 1998 at 20:56:22:
: I was diagnosed with MS seven years ago based on symptoms and MRI
confirmation. I have had a great deal of pain in my neck, radiating down
through my shoulder, bicep, forearm and into my hand for the last four
years. Although I understand that pain is possible with MS, I have felt
that this pain was unrelated due to it's constancy and intensity. In 1994
they injected my shoulder with cortisone thinking I might have bursitis or
tendonitis, but the pain did not improve. It has continued to get worse
and finally I went back to my Internist in January.
Based on my description of the pain, he ordered a new MRI of my cervical
spine which showed bulges at C5-C6 and osteolytes(sp?). He sent me to an
orthopedic surgeon who confirmed that there was herniation of the disc. I
asked both physicians to analyze the MRI as though I did not have MS and
recommend treatment only based on the symptoms I currently have. Both sug-
gested that the first treatment should be an injection of steroids to try
to relieve inflammation and decrease pain followed by physical therapy.
The surgeon advised that he would recommend surgery if this course was not
successful in relieving my pain.
The surgeon sent me to a pain institute where I consulted with an
anesthesiologist who specializes in pain treatment. Without seeing the MRI
this physician immediately advised me that the pain I am experiencing is a
result of my multiple sclerosis, rather than the disc problem. He
suggested that instead of an epidural steroid injection right at the site
of the bulge as the orthopedic surgeon had told me would be done, he would
inject in the back of the spine to allow more therapeutic value for
general MS pain.
I had this procedure done on Wednesday of this past week. It is now Sunday
evening and I am still having pain from the injection down my spine. I
didn't have this pain prior to Wednesday and the original pain which I
went to the doctor for in the first place is still very much there.
My question is this...is it normal to have epidural steroid injection for
MS? Also, does it make sense to have the expected injection for the disc
problem at this point?
I am very interested in obtaining a second opinion on this. I am leaning
toward surgery to correct the disc problem and end the constant pain I am
having, but the pain specialist is very much against this option. I'm not
sure if his opinion is self-serving or appropriate for me. Can you offer
a second opinion based on the information I have provided?
In Reply to: Epidural Steroid Injection of depo-medrol posted by Gail on February 08, 1998 at 20:56:22:
: I was diagnosed with MS seven years ago based on symptoms and MRI
confirmation. I have had a great deal of pain in my neck, radiating down
through my shoulder, bicep, forearm and into my hand for the last four
years. Although I understand that pain is possible with MS, I have felt
that this pain was unrelated due to it's constancy and intensity. In 1994
they injected my shoulder with cortisone thinking I might have bursitis or
tendonitis, but the pain did not improve. It has continued to get worse
and finally I went back to my Internist in January.
Based on my description of the pain, he ordered a new MRI of my cervical
spine which showed bulges at C5-C6 and osteolytes(sp?). He sent me to an
orthopedic surgeon who confirmed that there was herniation of the disc. I
asked both physicians to analyze the MRI as though I did not have MS and
recommend treatment only based on the symptoms I currently have. Both sug-
gested that the first treatment should be an injection of steroids to try
to relieve inflammation and decrease pain followed by physical therapy.
The surgeon advised that he would recommend surgery if this course was not
successful in relieving my pain.
The surgeon sent me to a pain institute where I consulted with an
anesthesiologist who specializes in pain treatment. Without seeing the MRI
this physician immediately advised me that the pain I am experiencing is a
result of my multiple sclerosis, rather than the disc problem. He
suggested that instead of an epidural steroid injection right at the site
of the bulge as the orthopedic surgeon had told me would be done, he would
inject in the back of the spine to allow more therapeutic value for
general MS pain.
I had this procedure done on Wednesday of this past week. It is now Sunday
evening and I am still having pain from the injection down my spine. I
didn't have this pain prior to Wednesday and the original pain which I
went to the doctor for in the first place is still very much there.
My question is this...is it normal to have epidural steroid injection for
MS? Also, does it make sense to have the expected injection for the disc
problem at this point?
I am very interested in obtaining a second opinion on this. I am leaning
toward surgery to correct the disc problem and end the constant pain I am
having, but the pain specialist is very much against this option. I'm not
sure if his opinion is self-serving or appropriate for me. Can you offer
a second opinion based on the information I have provided?
Doctor's Answer
by CCF Neurosurgery MD, Feb 08, 1998 12:00AM
Dear Gail:
Your pain could certainly be related to MS, but may also be related to
your cervical degenerative disease. Although it may be difficult to tell
the difference, one should be able to review the MRI and see whether there
is correlation between the imaging and the neurological history and exam.
If your surgeons felt that your symptoms are based on fact that you have
disc bulges in the neck then the first mode of treatment is typically the
conservative type. This may include non-steroidal anti-inflammatory
medicine as well as physical therapy and/or nerve blocks.
Pain specialists tend to encourage nerve blocks because they feel that
symptoms can be helped and as such avoid surgery. This does not always
work and in some patients surgery is inevitable.
If you are interested in a second opinion you may contact the department of
Neurosurgery at the Cleveland Clinic. Both Drs. Kalfas and Bingaman
specialize in spinal disorders and would be able to provide you with
further help.
Good Luck!
