I’ve been on a two week paincation. I apologize that I forgot to take pictures of the great time I had. You know, of the television tuned into Game of Thrones and MSNBC, the Kindle versions of B.V. Larson sci-fi novels, the cat box, the cat hurl, growing laundry pile, and the lazy Susan populated by the ever-increasing medication assortment and as-needed narcotics. Like a spice rack for chronic illness.
I saw my awesome pain management doctor just three weeks ago. The second block was wearing off and I was scheduled for the next injection in two weeks. It’s a big practice, every two weeks he does the fluoroscopic-guided injections and I had just missed it by one day. Honestly, I didn’t think it was a big deal and I did not protest. Sure, the pain came back but I took various meds on a schedule and I figured I might lose 2-3 days of work as I got closer to the appointment. I would be okay.
Wrong. The pain grabbed me for two weeks and I’ve had to unexpectedly take time away from the office–just as I had gotten into a new groove with projects and such.
I’ve mentioned this nerve block thing a lot in my blog, but I never actually explained the process. A few folks have written to me over the last few months or so and asked me about what is involved in this procedure and expressed some fear about having it done. So for those of you still curious, I’m going to take a little turn from my usual social commentary and explain this procedure. Like a lot of things involving needles, the first thing you think to do is nothing–walking in the other direction. Thing is, it’s easy peasy and the pay off, once it kicks in, is worth every moment.
In my case the pain comes from severe arthritis of the facets in the lower part of my spine. The facets are small stabilizing joints located between and behind adjacent vertebrae. Each joint is surrounded by a little capsule of connective tissue and produces a fluid to nourish and lubricate the joint. The joint surfaces are coated with cartilage allowing joints to move or glide smoothly against each other (though mine aren’t gliding so smoothly these days). When I had the tumor flares in L4 and S1, the vertebral bodies were severely weakened and the weight that they would have normally supported was shifted to the facets already severely compromised by arthritis. The result? Some bitterly angry facets.
The facet joint injections–colloquially called a nerve block–is as much a diagnostic tool as it is a treatment for pain. So the first time I had this, the relief of pain let my doc know that the right spots had been identified for treatment. Two medications are injected into the joints to bring pain relief: numbing medicine (Marcaine) and a steroid. The numbing medication provides instant relief and lasts for about 3-4 hours, the steroid is a more longer acting anti-inflammatory and kicks in later. The procedure has mixed results: some feel relief for a week, others can feel relief for 3-6 months, others never feel it again. It is very individual and, I am told, impossible to predict with any certainty.
The procedure itself takes only 10-15 minutes. Using sterile technique the injection site is cleaned. The injection of local anesthetic is the worst part as it stings little bit–less than a bee sting. Once the skin and muscle is numbed, you’ll feel a little pressure as the needle for delivery of the medications is inserted, especially if you have a lot of inflammation in the joint. The physician utilizes an imaging technique known as fluoroscopy that allows real time images of the vertebral column to be seen so that the needle is placed correctly. I can tell you that when the numbing medication is injected in the joint you feel immediate relief. I walked into the office leaning on my cane. I left carrying it.
There are any number of videos that show you these injections on real people, but don’t watch them. All you see is someone being stuck by a needle and that always freaks people out. Instead this nifty animation tells you what you need to know.
For me, the results of each nerve block have been unique. The first time that it was done I had relief for three days and that was it. Because of the amount of steroid that is used I had to wait four weeks to repeat the procedure, but when it was repeated I felt relief immediately and was literally pain-free for the next three months. This third time it’s taking awhile to kick in, but I know that once it does I’ll be on an even keel again.
This is not meant to be medical advice. And if your physician recommends that you pursue this course of treatment you should do your due diligence with regard to research that involves side effects, allergies, etc. But don’t be afraid. For me it is nothing short of miraculous.