Back Pain Injections

by Benjamin

I have had chronic lower back pain for all of my life. I am 49 yrs old.I am 6'1" tall and weight 194lbs. I am in relatively good condition except for my back and I have high blood pressure that is controlled with meds. My family Dr.(who also sees my brother and 2 sisters also have back problems)this Dr. has noticed that our spinal columns are narrower around then average. He has called it genetic spinal stenosis. I don't know.

I do know at 49 I can only work for 4-6 hours and then I must get off my feet. That is with vicodin in me. I have been taking vicodin for 7 yrs now just to be able to function. Without it I am in tears most of the time. I have not had health insurance for those 7 yrs and vicodin has been the most cost effective way to keep me working (I have 3 teenagers and a wife to support.)

During those 7 yrs I have done 1 yr of physical therapy, ultrasound, and 3 series of back pain injections. Those injections seemed to work less and less so that the 3rd series , as I remember barely worked at all.

I now have health insurance and am wanting to get more proactive in resolving this, so I can function in a somewhat normal fashion( without drugs). My Dr. has referred me to another facility to have another series of steroid injections. I am thinking that they will be a waste of time considering the results of the last shot I had. Given what I have told you, can you tell me what you think? What route could I take to get back to a somewhat normal life? Thanks Benjamin

Hi Benjamin

It sounds like you have had a really difficult time with your back and I'm sorry to hear about that. You have given me a lot of detail but without a full assessment I can't diagnose your problem and so I can't offer you specific advice. I can however, point you in the direction of some information that you could discuss with your Doctor and hopefully together you can agree on your next move.

Firstly, I think it is great that you want to be more proactive about this problem. That will go a long way.

It's important to understand that most back pain doesn’t have an obvious cause, 95% of people with back pain have simple lower back pain and there is often no clear reason for it. Sometimes MRI scans and X-rays show up all sorts of things, age changes and disc bulges are really common, but that does not necessarily mean that the things found during these investigations are the cause of the problem. More on MRI scans and X-Rays for lower back pain.

Pain is complicated, it is entirely possible to have pain yet not have any obvious tissue damage. This is a tricky subject but it's really important to understand that pain does not always mean harm. Some more details with some examples of what I mean can be found in this pain section .

It is important to understand the difference between chronic and acute pain , and I think it would be worth reading the section on pacing too.

There are two types of injections for lower back pain, epidural steroid injection and facet joint injections, the most recent research I could find states the following:

"The evidence for therapeutic lumbar intra articular facet injections is moderate for short-term and long-term improvement and the evidence for caudal epidural steroid injections is strong for short-term relief and moderate for long-term relief in managing chronic low back and radicular (nerve root) pain."


Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain.
M Boswell et al, Pain physician, Jan 2007, vol. 10, no. 1, p. 7-111.

Best Wishes


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