Trigger Point Needle Injections???

[thirdeye33]

Ok, gave in and got 4 this afternoon. Hurt like hell!!! I'm sore as hell!! What input can people give me on them? Did they work? How long was the relief? How long will my soreness last...how bad am I going to feel in the morning? Any bad side effects? I need info please...anxiety!!

I went in for a follow up w/ my PM doc and he said, once again I want you to have an steroid epidural( scared and don't want one) I suggested trigger needles and he said,"I'll do it but, with your bad MRI and neck/back, it is like filling a crumbling wall with spackle" I said, I wanna try this first.

**Several Disc Herniations/Buldges C 5-6, C 6-7  L 2-3, L3-4, L4-5 ,L5-S1 w. anular tear w/ osteophtes and stenosis.
Mild sclerosis at C7-T1 and
severe neck sprain from MVA 2/2011 to list a few :(

[Suziespeculates]

Sorry, did not notice that your posting was in Nov. of 2011.....Hopefully you have had relief from your pain in the interim.

[Suziespeculates]

Hi....An epidural will not be given just one time and be a cure all.  Usually these are given in a three injection series over a period of a few months. I have had these and the small amount of pain associated with them is mild compared to the pain you are having from your other conditions and the relief they should provide.  Any pain associated will only be for a few minutes or less.  Normally they WILL work, but it takes a few days to start feeling relief.  An ice pack on the painful area helps me while waiting for the steroid to take effect. Patience is the key and I know how hard this is when you are hurting...It's like having a bad toothache that doesn't quit. DO NOT BE AFRAID TO HAVE AN EPIDURAL!!!!!!! The relief it should provide will be worth it.  Anxiety just makes your pain worse as it causes stress.....Doubt you need a phychiatrist, unless you just need to talk with someone.  

[thirdeye33]

Just to be clear, I don't feel like lying about saying ,I'm in pain and not being in pain. My pain is off the scale! I wanna tell my PM doctor it's not as bad as it is because I'm so afraid of epidurals and also nobody has anything good to say about epidural steroids. I have extreme anxiety over this and I'm running out of options. He did give me the refill, he just doesn't want to see me have to be on strong meds and constant pain all the time. I'm only 33 and he said you're falling into the chronic pain category. I refuse to accept this, I was so active!!! I am so severely depressed and add in the flashbacks ptsd...I just can't get to a calm point. My PM wants me to see a Psychiatrist about my ptsd. I already went to see a social worker/psychologist, cause I thought that was he wanted me to see for my TBI/ post concussion syndrome and that was horrible. He apologized and made it clear it should be a Doctor. The thought of having to explain my car accident story all over again, keeps me from making another appt. and starting the search for a good Psychiatrist....how do you even find a good one? It's not like I'm gonna ask a friend about recommendation..ya know? I just hate everything lately, but my two sweet boys. I love them so so much!! They keep me living. Just really upset, I wish there was a switch to turn all this off.

PS Hi Femmy29 :) Thanks for the input, again I'm not getting a steroid epidural....I'd need to hear a story of someone who just had only one and was cured of pain and never had to go again. Hope you're doing well. Talk to ya soon, honestly, my cervical radiculopathy has been causing so much pain in my arm that I don't like typing anymore. *****!

[Tuckamore]

Please Thirdeye whatever you do, Don't Lie!! I know we can be tempted in an effort to get our physicians to understand our pain or disabilities but it's never a good choice. I think your heart knows that is true.

I don't know the reason your PMP does not want you to remain on opiates, if they are needed. It may be your age or your diagnosis but most PMP are willing to do whatever it takes (within reason) to manage our pain.

Have a heart to heart with him. Tell him how you are feeling...  that you fear not having pain control. He'll respect you in the end and you'll build a better relationship with him.

It's my understanding that whatever level of pain relief you have now is what you can expect from the Trigger Point Injections. That was true for me but may not be true for everyone. If these injections took you from a pain level of 8 to a 7 that doesn't mean you still don't need pain control. So again discuss your pain and it's management with your physician.

Please keep in touch.

Best of Luck,
~Tuck

[femmy29]

I have lumbar degenerative disc disease with lumbar radiculopathy along with other issues in my mid to upper back.  I have a ruptured disc that's nucleus is spilling and indenting the thecal sac and a bulging disc that is impinging on the S1 nerve root.  I have found that epidurals really help for my pain.  I have had 5 so far and I am going in for the 6th in Dec.

I disagree with your PM doctor's thoughts that trigger point injections or epidural injections are the long term solution.  In fact, I have been told just the opposite!  My doctors are concerned about my bones as the steroid medication wrecks havoc on your bones over the long term such that it could develop into arthritis of the hip.  So I am not sure how much longer I am going to be able to get these injections.

I agree with Tuck that their effectiveness highly depends on the skill of the anesthesiologist.  I have had good ones and bad ones.  They typically use an X-ray to guide the epidural needle to its proper place and this helps ensure the medication is delivered where needed but for some reason I have had a couple of bad injections that resulted in minimal pain relief but the majority of them have helped.  

The epidural injection takes about 5 mins to do once you are prepped and the anesthesiologist is ready to go.  I didn't find them that painful.  I have not tried the trigger point injections.

Many doctors that practice pain management have a fear of the DEA prosecuting them for prescribing strong opiates such that they need a diagnosis (which you have) but they also need records showing that they are managing your care effectively.  This may include frequent checkups along with injections and other modalities to show that they are treating your pain diversely.  I have heard that many PM doctors have threatened to take away a patient's pain meds if they didn't comply with regular injections or other interventionalist therapies.  I think it is absurd to make patients do a modality that doesn't help and that can be expensive when repeated on regular intervals.  Plus it is weakening the bones!  If it doesn't work, it doesn't work.  You would think having a record saying the patient tried it once or twice would be enough but many times that is not the case.

I am also surprised he is wanting to take you off the oxymorphone after only being on it for a month.  Long acting opiates are prescribed to managed pain over an extended period of time.  A month is not an extended period of time to me!  

Given that you have similar issues in your low back as I do, you may find that the injections will give you some additional relief.  I didn't start to really feel significant relief until after the 2nd or 3rd or injection.  It can take some repetition to get the pain relief to stick.  

I am thinking that you will do just fine with the epidural.  The epidural consists of an injection of lidocaine to numb the affected area (to me this was the worst part).  If they gave you an injection of lidocaine to numb the site before injecting the steroid, more than likely, you will not feel anymore pain from the epidural needle.  You do typically get a shooting pain down your leg when the medicine is injected; however, I didn't find this pain to be too bad just annoying.  

Another possibility is you could try oral steroids first to see if they help your pain.  You won't get as much as medicine in a concentrated area like you would with the epidural injection but you should get some noticeable amount of pain relief.  If not, it is good indication that the epidurals will not help.  

I hope that you can remain on the medication that works for your pain while trying out interventional therapies to see if they will provide any additional relief.

femmy

[thirdeye33]

Hi Tuck,
Thanks for the response...I've been hoping to hear some input.
It has only been 24 hrs. and it's hard to tell, cause I'm so sore. I do feel like I have a lot of pressure off my shoulder blades, where I was carrying so much tension and spasm. I hoping this will work so bad!!. My PM doc, does not want to leave me on a pain med and said if this doesn't work he says steroid epidural is the only solution. I understand that he doesn't want me on pain meds for a length of time, but I've only been on my new one (oxymorphone) for 1 month. I like this about him, since I hate meds, but is this the norm w/ PM docs? He is really pushing the epidural on me and I don't like it! I'm at the point where I feel like lying about my pain level(if needed) at my next follow up in 4 weeks.
How long did the soreness last w/ your trigger point injections, btw?
It hurts and kills me to raise my right arm.

Thanks again :)

[Tuckamore]

Hello Thirdeye,

I am sorry that the injections were so painful and you obtained no relief. I've had trigger point injections in the past, before I had a correct diagnosis. I can't say they were painful but they did absolutely nothing to ease my pain. If they are what I know to be Trigger Point Injections you should have had reduction in pain in the first 12-24 hours...... if it was going to work.

I've also had steroidal injections (two) which were not very effective. If my pain was an 8 when I had the injection(s) it went down to a 7.5 with the first and 7 with the second. It lasted just several weeks.

I do know others have had steroidal injections with much better results then I have had. I think it depends on the skill of the practitioner, your partial condition and of course how your system/body responds to the procedure/medication.

Personally I think anything that can't make you worse is worth a try. I hope you'll consider all options. Please let us know how you are doing.

My Best to You,
~Tuck