Frequently Asked Questions
What are the common causes of back pain?
There are many causes of back pain; this includes muscular, bony and disc causes. Muscular causes are usually muscle strain and sprain. Bony causes include slippage of one vertebral body upon another called spondylolisthesis. Disc causes include herniation or “slipped disc;” the disc then can no longer act as a “shock absorber.” This can result in severe pain and nerve impingement or “pinched nerve.” Severe inflammation can result because of some powerful chemicals that are released which can cause back and nerve pain going down an arm or leg.
What are the signs of a herniated disc?
A patient will usually report lifting something heavy, or making a sudden twisting maneuver and feel a “pop” in the back with shooting pain down the leg. The patient should go immediately to their primary care physician who will perform a history and physical exam, and may get an MRI or CAT scan of the low back, which helps to visualize the discs radiographically. Another helpful test is electromyography; which can show if there is an electro-conduction problem down a nerve.
When are epidural steroid injections indicated for back pain?
If the patient has signs and symptoms of a herniated disc, the primary care physician will usually place them on pain medication, oral non-steroidal anti-inflammatory medications and a trial of physical therapy which can help strengthen muscles and decrease inflammation and hence decrease pain. If the patient does not get adequate relief or if there is some persistent pain, the patient is a candidate for epidural steroid injections.
What are epidural steroid injections?
Steroids are powerful anti-inflammatory medications, which can be injected percutaneously (through a needle) into the epidural space under fluoroscopic (X-ray) guidance. This ensures that an adequate concentration of steroid medication is injected in and around the inflamed area for maximum benefit with minimal complications. This is of greater benefit than if the steroid was taken orally. The use of epidural steroids is a safe and effective way to treat back pain and is well documented in the medical literature.
Is there a limit to the number of injections you can have?
The number of injections is based on experience with epidural steroid injections within the medical profession since the 1960s. The number of injections is deliberately limited and will depend on the cause of the back pain and the patient's response to the steroids. Usually two to three injections in three to four weeks will bring the patient adequate relief. Occasionally the type of injections will need to be varied and a fourth and fifth injection will be performed. The side-effects of the steroids can also limit the number of injections. Some of the common side-effects include increase in blood sugars and the retention of fluids to name a few.
What happens next if the patient does not get relief from injections?
The majority of the patients that present to Physicians Pain Care respond to epidural steroid injections alone. A few patients who do not get adequate relief with epidural steroid injections may become candidates for spinal cord stimulator trials, or will go on to larger centers to receive other treatments depending on the cause and persistence of the pain. Rarely patients will proceed to invasive surgical procedures.
How do I schedule a procedure?
Please call our front office at 410-273-2570 to schedule an appointment for your first visit, at which time you will be evaluated for your pain problem by Dr. Saldanha. Prior to your visit you will receive a Pain Assessment Form by mail, which must be completed and returned at your first visit. If you are referred by another physician, that office will usually forward all your records. If not, please make sure that you bring a copy of your MRI results and insurance information with you at the time of your initial visit.