epidural steroid injections
Multiple studies in recent medical research has shown that epidural steroid injections do not provide long-term relief of radiating back pain. The studies say that patient’s pain and discomfort typically return within a few days or weeks.
Epidural steroid injections are given to reduce inflammation in the nerves that pass through the spinal canal. Many pain management specialists believe that nerve inflammation is the root cause of the patient’s discomfort and the cause of radiating pain and numbness down the patient’s legs. Patients with these problems are often diagnosed as having “Sciatica,” a term to describe injury or compression of the sciatic nerve.
As chronic pain specialists we see many patients with radiating lower back pain. When we first examine these patients at least 25% of them will say that they have been diagnosed with sciatica. After the examination we find that many of these patients do not have sciatica at all and this is why epidural steroid injections have failed them.
Ligament damage the cause of “sciatica-like” symptoms?
The sciatic nerve runs from the spine down both legs and into the feet. This is why pain “radiates” from the lower back to the toes, it is following the path of the nerve. When epidurals fail, it is because they are solely treating the symptom of inflammation and not the root of the problem, why is the nerve getting inflamed? In most of the patients we see it is damage or weakness in the ligaments that hold the spine together, allowing for excessive movement in the vertebrae that traps or impinges the spinal nerves.
The spine is a complex, complicated structure. This is why there are so many diagnostic labels to describe the patient with lower back pain and why many doctors find it difficult to come up with an accurate diagnosis. While there are many causes of back pain, it is estimated that 70% of all cases of lower back pain are caused by ligament problems, some estimates go even higher.
Loose Ligaments and Inflamed Nerves
Ligaments are small but strong connective tissue, they provide a web framework that holds bones together. In the spine they help keep the vertebrae in place. Ligaments are resilient in that the stretch like rubber bands to accommodate movemnt in the body. It is when the ligaments are over-stretched that they weaken and allow the vertebrae to move or “float around.” It is this excessive vertebrae movement that can cause the nerve and discs to become trapped, herniated and impinged.
Treatment options beyond epidurals and alternatives to surgery.
When epidurals do not work many physicians will move the patient unto surgery. Procedures will be recommended that will “stabilize the spine” such as spinal fusion, or surgeries or laser methods that will create more space for the nerves by removing bone from the vertebrae. This is why we see many patients with “failed Back Surgery Syndrome,” a procedure was performed that did not address the cause of the patient’s pain ligament weakness or laxity.
In our clinic we offer our patients options that treat the cause of the patient’s problem and solve their chronic pain challenges. Two options are Prolotherapy and Platelet Rich Plasma therapy. Both are injection treatments. The big difference between these two treatments and epidurals is that they heal the problems, epidurals do not heal, they treat the symptoms. Prolotherapy and Platelet Rich Plasma therapy work the same way they create a controlled inflammation at the site of the damaged ligament to bring immune system cells such as fibroblasts to the site to induce a new collagen matrix to restore ligament strength and function. The ligaments strengthen and help push the vertebrae back intop place, alleviating pressure on discs and nerves.
Prolotherapy utilizes dextrose, a simple sugar to achieve this controlled inflammation, platelet rich plasma therapy utilizes blood platelets drawn from the patient to achieve the same results. PRP is usually reserved for more severe cases of tissue degeneration or in the case of an athlete requiring a quicker return to action. Both Prolotherapy and PRP require weekly treatment typically lasting only 4 – 6 weeks.
If you have had epidurals and they have failed to provide you with long-lasting relief and would like to explore Prolotherapy and/or PRP, finding the right doctor is the first step.
