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Any experiences with cortisone inj into a joint?


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My doctor is considering giving me a Kenalog injection into my lower back into two locations between my vertebrae for protruding/bulging disks. I find good and bad experiences on the Internet about it, so I figured I would check her and see what kind of experiences people have had.

 

 

I have had depo-medrol injection into my hip before, but it was just into the bursa and not into my spine. I guess that idea bothers me more than any other.

 

(They also use methotrexate, if anyone has had that shot, it is very similar)

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I had a cortisone injection in my shoulder when I had a frozen shoulder. I passed out cold. Then when I came to I could not stop hyperventilating. Days later I was in more pain than before the stupid shot.

 

No chance of anyone ever giving me another one.

 

I have a serious knee issue (but I am too young for surgery and its not bad enough yet, blah blah blah) so the doctor has tried numerous times to get me to agree to a cortisone shot. Not a chance! The other thing that makes no sense to me is it only last for X amount of time and you can only do it 2-3 times/year. I can't see doing this routine for the next 10 years or more.

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I had these and although they did not help they were very minimally painful due to Lidocaine or Benzocaine spray as the shot was being given. Make sure that you have exhausted all other possiblities as there are serious risks with epidural injections. I have not met anyone personally who has been helped by these with regard to lumbar pain. Knees , Yes, I have clients who had great results with injections . Backs never....Try oral steroids first if possible.

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My doctor is considering giving me a Kenalog injection into my lower back into two locations between my vertebrae for protruding/bulging disks. I find good and bad experiences on the Internet about it, so I figured I would check her and see what kind of experiences people have had.

 

 

I have had depo-medrol injection into my hip before, but it was just into the bursa and not into my spine. I guess that idea bothers me more than any other.

 

(They also use methotrexate, if anyone has had that shot, it is very similar)

 

SO had two cortisone injections into his arthritic middle finger (it was swollen to about 3x normal size). For him it was a positive experience, although it hurt, the swelling went down and he regained some mobility.

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I had two into my ankle.

Shot #1: helped the pain, no side effects.

Shot #2: somehow numbed the top of the foot, not the joint. Joint continued painfully.

 

I refused shot #3 because I learned by then it can compromise the joint.

 

Something to note: Physical therapy helped my joint far more than the shots ever did. If they had recommended that first, it would have been the better choice by a long shot.

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He goes to a pain specialist who was trained by one of the top people in the U.S. and considered one of the "best of the best" in our metropolitan area. He uses a fluoroscope to guide them, and it's done with full medical support in an ambulatory surgical center. He had several done several times a year some time back, but they stopped helping over a year ago so he doesn't do that any more.

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I would strongly advise you not to use this option except as a last resort.

 

I was persuaded to have two cortizone shots in my elbow. It was only AFTER the second shot that I learned two things:

 

1. The shot works only for a time. It will not fix anything. You will be in pain again within months. (Happened to me both times.)

 

2. Cortizone causes body tissue to become thinner and more brittle, and therefore both more injury-prone and more painful.

 

The two factors above cause a downward spiral in many people wherein they need increasingly frequent shots to manage their pain.

 

I have heard some claim that the cortizone, as an anti-inflammatory, will allow the body to heal by keeping the inflammation down. This was absolutely NOT my experience. A rheumatologist explained the above two facts to me, and those facts have been borne out by my conversations with others who have had the shots. If there are people who were permanently healed, I have not had the luck to meet them.

 

I would only allow cortizone injection if the pain were absolutely unbearable and if I had exhausted every other option for treatment or physical rehab.

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I had my lateral epicondylitis (tennis elbow) injected - with complete and blessed relief! (I went to a colleague who gave me the (essentially) pro forma speech about PT (doing it), braces (only work in about 50% of folks), NSAIDs (already took them). I said I just wanted the injection - and it was perfectly painless and completely effective (and that was about 8 yrs ago).

 

Elbows and spines are different beasts, though. I have had a patient have a series of vertebral injections from the pain mgmt docs, and, as GVA said in her dh's case, his pain relief was good, but not permanent (see below).

 

I have other patients (elderly ladies, mainly) who require knee injections 2-3x/yr - and they are able to walk with no (or less) pain - so they're relatively happy, since it keeps them from needing a wheelchair. (None would be candidates for knee replacement.)

 

As others have said, steroid (cortisone or similar) injections are not completely without risk, but, on the other hand, a single injection is VERY unlikely to cause the problems that you MIGHT see with long term use. The injection might give you time and ability to focus on therapy (which might be too painful - or even impossible - before the injection), which could strengthen the muscles around the joint (in your case, your spine) - and THAT could take some of the pressure off the joint, so that you might achieve some long-term relief. (I'm not a physical therapist or a physiatrist, but am just speculating on a mechanism whereby an injection could provide longer-term relief, as it did with my elbow - once the pain was relieved, I was able to strengthen the muscles more effectively.)

 

Ask your doc(s):

> how sure is s/he that your bulging/herniated disc is causing the pain you're having? (Diagnostic imaging of the spine has a high rate of abnormal findings in asymptomatic persons. In studies of lumbar spine MRI evaluation in asymptomatic adults, herniated disks were found in 9 to 76 percent of patients, bulging disks in 20 to 81 percent, degenerative disks in 46 to 93 percent, and annular tears in 14 to 56 percent - from http://www.aafp.org/afp/20070415/1181.html)

>what percentage of patients with your condition achieve complete relief? (from the same article: Epidural steroid injections may be helpful in patients with radicular symptoms that do not respond to two to six weeks of conservative therapy. Randomized trials have demonstrated short-term (i.e., weeks to months) but not long-term improvement in pain and disability with epidural steroid injections.29-31

>what percentage achieve partial relief?

>what are the chances of Bad Outcome XYZ? (and what ARE x, y, and z?)

>what are the other options?

>how likely is it that your particular condition will deteriorate, and is there a way of predicting at what rate?

>is there an optimal time to HAVE an injection if you decide to do that - iow, if you wait, will it be too late (you know, like you can only have an epidural during labor before a certain point....)?

>how likely is it that you would need another injection - and would this particular doc consider repeating it once? twice? etc.

>is physical therapy likely to be more effective after the injection?

 

Best wishes, whatever you decide.

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Mixed review from me.

 

The one in my elbow was what I needed, and no problem has recurred.

(I will offer my thanks, however, for the information posted which came from a rheumatologist. Makes sense, and is good cause for caution.)

 

My dh, in contrast, was railroaded into having TWO shots for his back. Zip. Nada. Nichevo. Loss of $$$, but no loss of pain. The chiroquacktor accomplished much more for dh.

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According to my neurosurgeon, steroid injections are the next step for me. I have yet to find anyone who has had success with injections for bulging/herniated cervical discs, which is what I have. I will not be getting them any time soon.

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Try oral steroids first if possible.
I am allergic to prenisone, I have a pharmacist researching what other oral steroids are different enough from prednisone to justify a trial. I may see if I can try either Medrol or Dexamethasone first.

 

Something to note: Physical therapy helped my joint far more than the shots ever did. If they had recommended that first, it would have been the better choice by a long shot.

I have seen two physiatrists #1 who says he doesn't know what is wrong with me but guesses is a fragment that I have by my spine. Because he was very uncertain of the diagnosis, I went to see physiatrist #2 who confidently says it is the bulge/protruding disks. Physiatrist #2 gave me a list of exercises to do and says that they will be more intensive than the physical therapy. (PT was prescribed by Physiatrist #1). I went to a physical therapist for the first time last week and physiatrist #2 was correct, the PT only gave me one very, very simple exercise to do and so far has not apparent therapeutic value. I will continue with the exercises phys #2 gave me, they are simple but I can at least feel they are working something.

 

He uses a fluoroscope to guide them, and it's done with full medical support in an ambulatory surgical center.
The doctor I am considering, physiatrist #2 does the same. He treats it like a serious medical procedure, not just an office visit.He sent me home with information about both the pros and cons to review before he will order it.

 

Ask your doc(s):

> how sure is s/he that your bulging/herniated disc is causing the pain you're having? (Diagnostic imaging of the spine has a high rate of abnormal findings in asymptomatic persons. In studies of lumbar spine MRI evaluation in asymptomatic adults, herniated disks were found in 9 to 76 percent of patients, bulging disks in 20 to 81 percent, degenerative disks in 46 to 93 percent, and annular tears in 14 to 56 percent - from http://www.aafp.org/afp/20070415/1181.html) They can not prove it either way. I have a obvious bulge at L4-L5 and a protrusion at L5-S but no contact with the nerve, degenerative disk disease, and a fragment by my spine on the side that hurts (no other sig findings). Different doctors have different opinions. But because I have acute sciatica it is definitely something in the area. They feel that since the MRI is done laying down, and the majority of pain is when I am sitting/bending that the MRI findings of the lack of nerve contact isn't accurate. All of the symptoms point to either the fragment or protrusion pushing on the nerve.

>what percentage of patients with your condition achieve complete relief? (from the same article: Epidural steroid injections may be helpful in patients with radicular symptoms that do not respond to two to six weeks of conservative therapy. Randomized trials have demonstrated short-term (i.e., weeks to months) but not long-term improvement in pain and disability with epidural steroid injections.29-31 I am on week 9 and they feel my pain has plateaued at a 3-4. I have been on a conservative path using NSAID, ice, heat, TENs unit, 6 weeks off work, dd2 going to daycare full time to avoid lifting/bending, changes of schedule to limit driving etc. I have been at a pain level of 7-8 for a few days at about week 5-6 and have improved from there, but have plateaued lately.

>what percentage achieve partial relief? unknown

>what are the chances of Bad Outcome XYZ? (and what ARE x, y, and z?) He says rare, but doesn't discount that they do happen. He takes extra precautions to make sure of a good outcome (fluoscope etc)

>what are the other options? Basically what I have already done. I am looking into acupuncture, but am finding that it doesn't have great results in my type of problem.

>how likely is it that your particular condition will deteriorate, and is there a way of predicting at what rate? Unknown-they are surprised to find me still in pain.

>is there an optimal time to HAVE an injection if you decide to do that - iow, if you wait, will it be too late (you know, like you can only have an epidural during labor before a certain point....)? Unknown to me, interesting question but both doctors have said to wait 2 weeks, since they have a similar time line, I think they have a reason I am not aware of. I know one dr. wants to monitor my pain plateau a little first.

>how likely is it that you would need another injection - and would this particular doc consider repeating it once? twice? etc. He says it is possible, but he has no idea if it will be needed or if it is, at what rate.

>is physical therapy likely to be more effective after the injection? We didn't discuss this. Another good question.

 

Best wishes, whatever you decide.

 

 

Wow, I really appreciate this feedback from all of you. I don't really feel like it is the best answer, but feel like I am running out of options. I have been off work since the end of May and would really like to go back to work. You have given me some more to think about. It is nice to have some positive stories to cling to :001_smile:.

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