Posts Tagged ‘back pain’

Adverse Effects from Epidural Steroid Injections

January 9, 2009

Epidural steroid injections have become a mainstay of treating herniated discs (sciatica).  As a interventional pain specialist I’ve seen them work well to avoid surgery hundreds of times. However, there can be adverse effects from epidural steroid injections.  These side effects are generally much less than surgery.  The side effects from epidural steroid injections can be: increased pain or numbness, an increase in epidural fat causing pressure on the nerve, immune and repair function suppression, just to name a few.  In our clinic, we consider that the most concerning of these side effects of epidural spinal shots for pain are caused by the extremely high doses of steroids commonly used.  Steroids are a two edged sword (like cortisone). They do bring down swelling around the nerve.  However, for an unknown reason (likely due to medical tradition and certainly not medical science), most physicians use about a million times more steroid than your body uses on a day to day basis.  We’ve found that lowering the dose of steroids from the milligram range to the nano-gram range doesn’t diminish the anti-inflammatory effect, just the side effects.  This is because your body naturally produces it’s own steroids in nano-grams (one billionth of a gram) and not milligrams (one thousandth of a gram).  We also commonly add in platelet lysate (growth factors isolated from the patients blood and processed in a our cell culture lab).  These growth factors (especially VEGF) can help bring in much needed extra blood supply to the poorly vascularized and nutritionally challenged disc, helping the disc heal itself.  We can also create a VEGF rich supernatant (we call it super VEG) by culturing the patient’s blood platelets.  What if the disc/nerve (sciatica) problem still persists?  We then turn to using the patient’s own stem cells to heal the tears in the disc and get rid of the bulge.  For more information, click the link in the last sentence or check out the video below:

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Chronic Back Pain

December 3, 2008

Chronic back pain has multiple causes.  Often these patients are placed on narcotic medications to treat chronic back pain.  Other common options offered to chronic back pain sufferers include low back surgery.  Regrettably, both of these options used to treat chronic back pain can often make the problem worse.  Again, finding a specific cause of the chronic back pain is an important part of planning treatment.  For example, chronic back pain due to a disc bulge pressing on a nerve or the dura can often be treated sucessfully with a stem cell injection into the disc.  Other treatment options for chronic back pain include epidural steroid injections, facet injections, trigger point injections, prolotherapy, and physical therapy.

Back Pain Relief

December 3, 2008

Back pain relief strats with a specific diagnosis.  You can’t get back pain relief without knowing what’s causing the back pain.  Once the structure causing the back pain is known, back pain relief is the next step.  If you have a disc problem, the cutting out a piece of the disc or fusion is rarely a way to get back pain releif.  Other options for disc related back pain relief include stem cell injections.  If you have a facet joint problem, back pain relief may be gained with either the injection of stem cells into the joint or facet joint radiofrequency.  SI joint problems can also cause back pain and injecting the SI joint with anti-inflammatories or stem cells may allow for back pain relief.  Prolotherapy may also provide back pain relief.  Other options for back pain relief include: acupuncture and acupressure , epidurals , physical therapy , and massage therapy.

What Causes Back Pain?

December 3, 2008

As a physician who has seen thousands of patients with back pain, there are many causes.  These include disc problems where the disc is painful or can be damaged causing a bulge or herniation.  Back pain can also be caused by a disc placing pressure on a nerve.  If this is the case, newer stem cell procedures can repair the disc bulge.  Back pain can also be caused by irritated or damaged facet joints.  Yet another cause of back pain is the SI or sacroliliac joint.  Muscles and ligaments being overloaded or injured can also lead to significant back pain.  Back pain can also be due to occult problems like vertebral compression fractures, cancer, a balooning out of the aorta, etc…  

The most important part of a back pain work-up is identifying a specific strutcure that is causing the pain.  Just throwing narcotics or other medications at the problem is extremely counter-productive.  Too often back surgery is the conclusion when the cause of back pain goes undiagnosed.  This can cause significant complications.