Why Steroid Injections Don't Help?

energyofhope · #1 (**permalink**) 08-06-2009, 10:56 PM

I have always wondered why I don't get benefit from selective nerve blocks or epidural steroid injections. At best, the results are absolutely neutral, with no reaction whatsoever. But at worst, when they've hit the problem spot head on, I go into a terrible long lasting flare-up. When the flare-up subsides, my symptoms return to the same intensity levels as before the injection. So, the injections either don't help, or make things worse, no benefit...

Has anyone else experienced the same pattern? If so, have your doctors ever given you a good explanation for this (opposite) result. It would be good to figure out if this points at a specific kind of pathology.

I suspect that something that chronically irritatates/inflames nerves is responsible, but then I've read that many people with this diagnosis get benefit from the injections, so I don't know. Any ideas?

mmglobal · #2 (**permalink**) 08-06-2009, 11:15 PM

A couple of possible reasons may be:

1. The pain is coming from somewhere else and the injectant is being applied to the wrong area.

2. The injection is being performed in the right area, but the injectant is unable to get to the inflammation site because it is blocked by scar tissue, for some reason flows elsewhere or the injection somehow 'missed'.

3. The injectant may get to the area needed and may reduce inflammation, but the pain generators are so profound that they are not significantly impacted by the injection. (like when an amputee percieves pain in an foot that no longer exists.) Permanent nerve damage causing phantom pain?

energyofhope · #3 (**permalink**) 08-07-2009, 12:05 AM

The enigma is more along the lines of a bad reaction to the steroid. (There is no such reaction to a local anasthetic of equal volume) What type of pathology results in this response?

Does steroid take a longer time to be absorbed by the body while other substances are absorbed faster? Is this responsible for extra pressure (maybe more so in the presence of a lot of scar tissue) Just a hypothesis...

Mark, can you please bring it up with the doctor community when you have a chance?

Katie · #4 (**permalink**) 08-07-2009, 04:03 AM

I've had the same reaction, unfortunately. The first couple helped a tiny bit, the rest did nothing or made things worse. All the doctor said was that it works for some and not others.

I refused to have any more, including those that would be guided by imaging. I didn't want an more steroids 'floating around' in there.

energyofhope · #5 (**permalink**) 08-07-2009, 04:13 AM

I refused to have more injections as well. I am not a masochist.

mmglobal · #6 (**permalink**) 08-07-2009, 05:23 AM

I had 8 ESI's in my lumbar spine. After 6 with one doc over several years, with (I think) 4 yeilding good results, I had another by a different doc. It made me WAY worse. When I explained what had happened to the first doc, he said, "I'll bet that he had to stop and back up, didn't he?" He was absolutely right... the needle ran into bone and he backed up and went again.

I've observerd > 50 discograms now. Some doctors are able to get the needles where they want them to go with smooth and accurate movemens. Others are herkey jerkey and bump into things, back up, do it again, and again, take the needles all the way out... try again and again. That's one reason why use of versed is popular... the patients won't remember that.

The difference from one needle jockey to the next is dramatic. Having said all this, I'm not suggesting that this relates to eOh's case. It's just another possibility for why ESI's sometimes make things worse.

Mark

JKDE302 · #7 (**permalink**) 08-12-2009, 05:06 PM

Quote:

Originally Posted by energyofhope

I have always wondered why I don't get benefit from selective nerve blocks or epidural steroid injections. At best, the results are absolutely neutral, with no reaction whatsoever. But at worst, when they've hit the problem spot head on, I go into a terrible long lasting flare-up. When the flare-up subsides, my symptoms return to the same intensity levels as before the injection. So, the injections either don't help, or make things worse, no benefit...

Has anyone else experienced the same pattern? If so, have your doctors ever given you a good explanation for this (opposite) result. It would be good to figure out if this points at a specific kind of pathology.

I suspect that something that chronically irritatates/inflames nerves is responsible, but then I've read that many people with this diagnosis get benefit from the injections, so I don't know. Any ideas?

That is 100% the same way i felt....

jessmith07 · #8 (**permalink**) 08-12-2009, 05:26 PM

that's funny to hear that there's someone else out there that gets itchy from narcotics...I thought I was the only one!

energyofhope · #9 (**permalink**) 08-23-2009, 05:10 AM

I've always suspected there are others like me... now I know this is so for a fact. Thank you all for replying!

dridobits · #10 (**permalink**) 08-24-2009, 03:32 AM

Hi Energy and welcome, I'm not sure I met you before. I found your post interesting. I get better response from oral prednisone than injections. I am wondering if the injection doesn't get to the right place. One of the docs that's injected me has done a decent job, the other a village idiot.

You mentioned "I suspect that something that chronically irritatates/inflames nerves is responsible"....well this is true when there is a chemically sensitive disc. That's my big problem....that's why they are doing a front and back fusion on me as it's the best way to get rid of the disc completely. I hadn't heard of anything beyond that being an irritant. Chemically sensitive discs are also known as "low pressure" discs.

energyofhope · #11 (**permalink**) 08-25-2009, 01:55 AM

Yes, I agree about the disks being a possible culprit for some people. In my case though, I no longer have organic disks left - mine are Prodiscs and bone from fusion. So, I am thinking more along the lines of a possible cyst or scar tissue causing this chronic nerve irritation. It's a mystery, really...