As a doctor who treats patients with back pain and sciatica all day, lumbar epidural injections + fish oil is a great and powerful combination that I use on my own intermittent left S1 disc/nerve problem. Why do I use this combination on my own problem? First, epidural injections can be a great way to calm down an inflamed spinal nerve when the fire just gets too much to manage. I consider this like putting allot of water on a really big nerve fire. In addition, we stay away from very high dose steroids in our epidurals and have replaced the milligrams with nano-grams of steroid. This is because this is closer to the dose range that the body uses naturally. In addition, since we have our own stem cell culture lab, we add in platelet lysate or a VEGF rich supernatant from cultured platelets. What’s all that mean? These natural preparations made from the patient’s own blood platelets bring natural growth factors to bear to help the disc bulges heal themselves. Fish oil is a natural management tool for the day to day inflamed spinal nerves (sciatica) many of us get form sitting too long or just chronic bulges. Our friend Joe Maroon (a Neurosurgeon at the University of Pittsburgh) conducted a study where he was able to get about 60% of his patients off of NSAID’s like Motrin by substituting a high quality fish oil loaded with Omega 3 fatty acids. We personally use the same brand he uses, which is Nordic Naturals. Too often fish oil is made from oxidized and cheap junk fish, while these guys do the processing right. What to do when the epidurals and fish oil no longer work well? We use the patient’s own stem cells injected into the disc tears that are causing the bulges (to help heal the tears and reduce the size of the disc bulges). This method usually helps our patients avoid low back surgeries (where the disc is too often weakened by cutting off the disc bulge). Repair is better than cutting out-at least that’s what we believe at The Centeno-Schultz Clinic.
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:
The low back has disks that act as cushions between the back bones. In order to fix back disks without surgery, the disk has to be repairedin some way. This is because as we ageor the disks are injured, they can bulge and press on spinal nerves, causing sciatica. Many things have been tried through the years, including spinal decompression therapy. This newer form of traction is interesting, but in our clinic we have not seen a significant benefit over traditional traction to justify it’s high price. Instead of this modality, consider an inversion table, which you can use at home. Other non-surgical options haven’t existed until recently. A new procedure injects your own adult stem cells into the low back disks to repair damage. This can help repair the tears in the disc that caused the disk to bulge (which then presses on the exiting spinal nerves). This new procedure can be performed through a needle, without the need for surgery or big recovery times. A video that helps to explain how to fix back disks without surgery can be found at this link. This video reviews how traditional low surgery removes the bulging part of the disc, which can weaken the disk and lead to more complications such as a re-herniation of the disk. A case report with an MRI is discussed.
Mid back pain is defined as pain in the thoracic spine. The causes of mid back pain are very similar to the causes of low back pain. As a result, many of the treatment options are similar. These include epidural steroid injections, facet injections, trigger point injections, prolotherapy, and physical therapy. Mid back pain is different in that surgical options become much more dangerous, as the lungs are in the way and commonly have to be deflated. In addition, mid back pain can also involve pain coming from the ribs and the joints that attach the ribs to the spine. Upper extremity numbness due to changes in the shape of the ribs can also accompany mid back pain. Scoliosis or an abnormal curvature of the spine can also cause mid back pain. Like the low back, some of the causes of mid back pain can be treated with injections of stem cells.
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.
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.
As a physician who has treated thousands of patients with chronic low back pain, back surgery is a two edged sword. Back surgery can be avoided in 99% of the cases and is performed 90% of the time when it shouldn’t be. New treatments such as transforaminal epidurals work in many patients. Back surgery has significant complications and often produces more back surgery. If you have a disc bulge, treating your low back and leg pain with stem cells is now one way to avoid back surgery. This new stem cell treatment can repair a disc bulge rather than cutting on the disc, which ultimately weakens the disc.
Avoid Back Surgery 