Spinal Stenosis-A Personal Chronicle-Part I of a II Part Article on Stenosis
(11/28/14)- An Federal Drug Agency advisory panel decided not to recommend applying a stern warning on steroidal injections for neck and spine pain. The FDA had asked the panel to recommend as to whether stricter warning labels as to the safety of these injections was required.
The majority of the panel voted 15 to 7, based on evidence showing only the risks of a specific type of neck injection, and therefore clearing the path for no need to increase the warning labels for back spinal injections. The neck risk is greater since the injection needle passes very close to a small cluster of important arteries in the neck. Injecting the steroids increases the risk that an artery will become blocked.
(11/20/14)- So far, so good. I am writing this note with trepidations and hoping that the shots that I received at the end of September continue to be effective in dealing with my herniated discs at L2 and L3. I am staying at a pain level of 1 to 2 in that area, so it is not a problem at all.
The same can be said for the shots that I received for my stenosis problem at L4 and L5. Yes, I sure do know that I take one day at a time, and every day that I have no appreciable pain from these problems, makes it a good day. I can do whatever I choose to do physically, and can continue to walk back and forth to work, as long as the weather permits me to do so.
(10/21/14)- It is now three weeks since I got the spinal steroidal cortisone shots that I wrote about on 10/1/14 below, and so far they are working. I use the word shots because I did receive two of them which were necessary since I had disc problems at L2 and L3.
A popular misconception is that you can only receive 3 series of shots within a 6-month period of time, but that thinking probably has arisen because Medicare will only pay for 3 shots given within that period of time. As a practical matter, if the shots don’t work the first time, they are not going to help when they are given a second time.
In my case the injection did work for a short period of time after they were administered, so that is why I consented to having them administered a second time. That along with the fact that they had worked when I had been given the shots for my prior problem at L4 and L5 were the facts that made me take them again.
(10/1/14)- On 6/22/14 below, I wrote that the spinal steroidal cortisone shots that I got for my herniated discs at L2 and L3 had worked, but unfortunately I started to have the pain reappear several weeks thereafter. The pain level would vary between the 3 to 5 mark, so it was bearable, but certainly made things uncomfortable.
I decided that I would have to try something to alleviate this problem so I consulted my same pain management doctor that I have written about in this article and he told me the options that were available to me. One option would be to continue to live with the problem, but that would not be something that I would want to do.
Option 2 would be to get the shots again, and since they had worked for a short while the first time he gave them to me, the doctor felt that trying again and depending on what happens with the pain level, following up possibly with a second series of shots to reinforce the first ones.
Option 3 would be to consult a surgeon and proceed with that type of treatment.
After thinking over for a week, I decided I would try the shots again, which I proceeded to have done yesterday. I will update you with the progress I do, or don’t make in the coming weeks.
(6/22/14)- Fortunately, the spinal steroidal cortisone shots for my problem at L2 and L3 have worked. The surprising thing about it has been how quickly they worked this time. I have previously written about getting the shots for the problems I had at L4 and L5, wherein the decrease in pain level took place very slowly over time.
In this case, I went from a pain level of 4 to 5 on Monday, before getting the shots, to 3 ¾ to 4 ¾ on Tues, to 3 ½- 4 ½ on Wednesday, to just about 0 today. I have no idea why it worked so much faster this time, then all the other times I have gotten the shots, but maybe it was because I was starting at a much higher pain level for these previous shots.
I would caution anyone else who gets the shot, that it usually takes time to become effective, so don’t expect it to kick in right away.
(6/18/14)- About a week ago I decided that, after weighing my choices, I would opt to have my spinal cortisone shot in connection with the 4-5 pain level that I was experiencing in connection with my problem at L2. At that pain level it was not a matter of negatively impacting my quality of life issue as I had with the 10+ pain level from my condition at L4 and L5, but I figured I would give it a try. Please see our item dated 6/4/14 below.
It turned out that the MRI showed a problem at L3 as well as L2. Yes, I could have continued to go along without getting the shots, but I decided that I would give it a go. I took into consideration that if I was fortunate the shots I got back in December 2013 would, at best, last me another year or two before it would have to be dealt with again.
My health has been good, and the normal aging process would continue to work its toll on my body. I knew I could get to my pain management doctor’s office with no trouble, whereas I could not make that statement about the future.
My doctor gave me no assurance that these shots will work. I know that the shots are “not good’ for the rest of my body. I have been getting these shots since 2002, and I knew that the procedure in getting the shot was “no problem” for me. I know that only time will tell if the shots I got on Monday will work, but to me, it was worth trying.
When I was relating my experience to my brother Harold, he was very correct in pointing out to me something that I failed to ask my doctor that I definitely should have asked him. When I signed the release form for the procedure from my pain-management doctor, he clearly pointed out to me the risk of developing a spinal infection, but I failed to ask him what if any were the other negatives in connection with getting the shot?
I did look it up on the internet and saw that cartilage damage could result from getting a cortisone shot. The doctor and I did not even discuss the event of a couple of years ago that concerned the multiple deaths and serious illnesses that ensued for patients ending up with spinal meningitis as a result of getting spinal injections that contained tainted serum. You are entirely in the hands of the doctor and his serum manufacturer in that they have checked it out
I would also like to point out to anyone considering getting this type of shot must, and I repeat must make sure that the medical professional who is administering it have extensive experience with this procedure. In my own case, the pain management doctor that has been administering it to me since 2002 had been highly recommended to me by my regular doctor, and even back then had extensive experience in this area.
The procedure was done in the doctor’s office rather than in one of those surgical procedure clinics because the office knows that is how I wanted it done. It is not just a matter of the lower cost involved since I am covered by my health insurance plan, but is a much simpler procedure when done there.
It is done in a different room than the examining room, and the nurse operates a piece of equipment (probably some kind of x-ray machine) that told my pain management doctor exactly where L2 and L3 are located. I felt no pain at all during the procedure and was able to converse with both him and the nurse while being worked on.
The injection of the medication takes about 10 to 15 seconds for each shot to be administered and you feel it flowing into your afflicted area. I did not feel any pain at all. That is not to say it is a pleasant experience, but in my case, it is not a painful one.
Once the shots have been administered and the nurse cleansed my back, I dressed and walked out of the office immediately thereafter, and had no restrictions on what I could or could not do.
I will let you know in the coming days if it worked.
(6/4/14)- Back on 1/22/14, I wrote about the pain I was experiencing in my right groin area when I was sitting, that the MRI indicated was due to my disc problem at L2. That problem still persists today at the 4-5 level. I had on appointment with my pain management doctor yesterday for consultation purposes to see if I should get a cortisone shot to alleviate that misery.
The doctor tested my legs for strength, and thankfully both legs are still strong. I do not have any pain from that problem whenever I walk. He told me that there was no assurance that the shot would work in this case as well as my previous shots had worked for the stenosis problem at L4 and L5.
After talking it over with him, we decided to continue with the watchful waiting approach to this problem. If the pain level reached a 6, then it would be time for the shot
(5/15/14)- As an update to my item written on 3/15/14, the pain in my groin area which was determined to having been caused by a herniated disc between L 2 and L 3, the pain level continues to be in the 2 to 3 level. That is a level that does not interfere with my quality of life, so I will avoid getting the steroidal spinal cortisone shot as long as it does not get to the 6 level.
Even though I have written positively about the results that I have had from getting the shot, I do understand it is “not good for the body” As I have written below, I have gotten the shots in 2002, 2004, 2007, 2011 and 2013, and as a result I have been able to avoid more drastic steps to alleviate the problem.
I am not having any problem for the stenosis problem related to my issues between L4 and L5, and I am very thankful for that.
(3/15/14)- Although I had not been having any appreciable pain in my leg, I began to have a pain level 3-4 pain in my right groin area when I was sitting. When I would stand, the pain would go away. Since my job requires sitting at a desk for fairly long periods of time, this became a gnawing problem.
My pain management doctor sent me for an MRI to help determine what was causing the problem. I live in Manhattan in New York City, and when I scheduled my MRI with an imaging organization I was pleasantly informed that they are open on Sundays, and it involved no waiting time at all when I did go there for a 10:00 AM appointment.
The results of my MRI were forwarded to my pain management doctor, and after he had a chance to review the results and set up a consultation appointment with me, he told me that my problem was being caused by a slightly herniated disc between L2 and L3 that was impinging on my ganglion (edge of the nerve), which in turn was causing the pain in the groin area. We could do one of two things about the problem.
Option one was to get a steroidal shot, or option two was “watchful waiting”. I decided on the “watchful waiting” approach, since the pain occurs only when I am sitting.
Everything is still working well from the shot I got on December 5, 2013, since that problem related to a herniated disc at L5, which was causing such the high level of pain in my right calf and leg area back in 2002.
(1/22/14)- I have lived with my spinal stenosis since 2002, and it is an illness that I will never be able to figure out. Shortly after I wrote the item on 12/12/13 that everything was going well, I began to experience a 3 level pain in my right groin area. I know from my prior experience with the disease to ride it out for a few days and see what happens, especially since I had gotten my shot so recently.
This time it was different. The pain did not go away and its level began to increase. After a week, it had gotten to the 4 to 5 level. I waited another few days, but the pain did not go away. I decided that I would call my pain management doctor and set up an appointment. The appointment was set for January 21, and the pain level continued to be in the 4 to 5 level until January 14. On that date, the pain level started to recede to the 3 to 4 level.
With the pain level receding I called my doctor to cancel the appointment. It is now down to the 1 to 2 level, so it is not a problem at all. I did not take any medication for it, and I have no idea why it receded. As it is said: “It is not mine to question why”, but now I can smile.
(12/12/13)- It is now one week since I got my latest spinal steroidal cortisone shot and I am doing A-Okay. The shot worked quickly so that I was down to a 1 to 2 pain level the next day. Just as a reminder for people who are getting the shot for the first time, it usually takes about 5 days for it to become effective. Once it becomes effective, the alleviation of the pain is gradual, so don’t think it hasn’t worked if you don’t feel 100 per cent right away.
I think that until you are first properly diagnosed with spinal stenosis, and then treated for it is the hardest period of time, because in addition to the pain, you have the anxiety of not knowing whether or not you will ever be able to lead a “normal active life” again. That period of time is much more difficult than what I just went through. Nevertheless, if the shot works, it certainly is the easiest way to be treated for spinal stenosis.
(12/6/13)- First I will write about the fact that I got my spinal steroidal cortisone shot in my pain management doctor’s office on Thursday, December 5 and all went well. I have gotten these shot in 2002, 2004, 2007 and 2011, and I did not encounter any problem whenever I got them. Actually, it is 2 shots that I got each of those times, but each one is given so closely together it is hard to distinguish the fact that it is 2 shots.
I don’t know what the correct word to use in describing my feelings or pain level as the serum enters my backside and then my right leg, so I will use the word discomfiture to describe it, but that is not an accurate description of what I felt. The shots are over in a minute or two, and I was able to get off the table immediately and walk away to dress myself.
Some people will feel a little woozy afterwards, but I did not feel that way at all. I was immediately able to resume all my normal physical activities immediately thereafter, but in some cases it is best to have someone there to take you home. I have had no negative after effects at all and will go to work tomorrow.
Now, I will go into the 2nd issue in connection with getting these shots, namely, cost factor. The shots that I received in 2011 were administered in a physicians’ center, rather than in the doctor’s office as were all the other shots.
The administering of the shot in the physicians center was a “whole production”, whereas the shot in the physician’s office is plain, simple and to use the correct words, “not an elaborate production number”. The cost differential between where the shot is administered is huge. It is almost 4 times as great when administered in the physicians’ center, as opposed to his office.
I did not previously write about that fact, and I don’t know why I refrained from doing so. I objected strenuously to the bill for the shots administered in the center and discussed this matter with my pain management doctor. He is the same one that I have used since getting my first shot in 2002, and in my eyes, he is the best. I have all the confidence in the world in him. He is a very qualified physician and I trust him and feel safe in his hands. When I complained about the bill he did compromise with me.
Yes, I have health insurance through my employer, but still, I felt that the billing was excessive. I see no reason whatsoever why the shot has to be administered in a center rather than in the doctor’s office, but maybe, for insurance purposes, some doctor’s liability insurer requires him to do so in a center. If you are to get a shot, please be sure to discuss this matter with the doctor beforehand. My doctor’s office already knew where I stood on this issue.
(11/17/13)- Things can change very quickly with stenosis, and yes, within a 2 week period of time, that is what happened in my case. This time, the symptoms were different than the other times. I was able to walk with minor pain, but when I would sit, I would begin to have pain in the back of my right buttocks, upper right leg and the calf of my right leg. All the other times, the pain was at its worst when I walked.
I went to see my pain management doctor yesterday, where I was first interviewed by the physician’s assistant, and then by the doctor. They looked at my medical records, questioned me and concluded that the pain was being caused by the same basic stenosis problem. The doctor did not think that I would need an MRI to confirm his conclusion, and I was willing to go along with him on that issue
I was scheduled to get a spinal cortisone shot early in December. I will get the shot in the doctor’s office, rather than in the clinic where the same doctor administered the shot to me the last time, because if the shot is given in the doctor’s office it is covered by my insurance. If given in the clinic it would have been considered out-of-network, and therefore not fully covered by my insurance.
(11/6/13)- It is now 2 years and 1 month since I received my last spinal steroidal cortisone shot, and with my fingers crossed I say I not in any great pain because of my stenosis.
About 2 months ago I began to suffer a pain in my right knee, and after a visit to my doctor and some x-rays, it was determined that the pain was being caused by osteoarthritis in my knee. Osteoarthritis is a common problem in the aging process, and I do not think that the steroidal shot had anything to do with it.
Thankfully, the knee problem has not been severe, so I still can walk back and forth to work. I never was a runner, so as long as the problem does not restrict my walking I am A-okay.
(9/25/13)- It is almost 2 years since I received my last spinal steroidal cortisone shot and I am still pain free for all intents purposes. In summary, I received shot in July of 2002, 2004, 2007 and in October of 2011, and they all worked.
The September 24, 2013 edition of the NY Times had an article by Nicholas Bakalar entitled “Steroid Shots and Back Pain” in which he discussed a recent review of studies that determined that injecting any liquid, even plain saline solution, works just as well. The results of the study were published in a recent edition of Anesthesiology online.
In the article it discussed the fact that researchers pooled the results of 43 studies involving more than 3,600 patients who got various kinds of injections for back pain. They found that epidural spinal steroid injections provided more relief than steroid injections into the muscles.
The study also concluded that there was little difference between the amount of relief provided by steroidal and non-steroidal epidural injections. Dr. Stephen P. Cohen, a professor of anesthesiology at John Hopkins was the senior author of the study.
(8/6/13)- In retrospect I was too quick to judge the effectiveness of the "butterfly" pillow. Although the numbness is not 100% gone, I would now roughly estimate that I do not encounter the numbness issue very frequently. It certainly has helped to improve that situation a lot.
I now am in my 22 month since my last spinal steroidal cortizone shot, and I continue to not have a problem with this matter. Just to recap my previous shot records; I have had the shot in July of 2002, July of 2004, July of 2007 and October of 2011.
(7/1/13)- The numbness in my arms after lying on my back for a while is something that I will just have to live with. I have tried a butterfly pillow and that did not help at all. The numbness goes away shortly after I rise, so it is nothing like the pain of the stenosis when that problem arises.
Speaking of which, it is now roughly 21 months since I got my last shot and I can say, with a good deal of relief, the pain has not returned, so I am a "happy camper". I know it will come back, but I also know the shot will work to alleviate the pain so all is well on that front.
(6/12/13)- I was first diagnosed and treated for spinal stenosis in 2002. I have related in this article that the pain from this illness is extremely severe, and until I got a spinal steroidal cortizone shot, my quality of life was severely impaired. When it was at its worst, I could not walk for more than 25 feet at a time.
Over the last few years, whenever I lie on my back in the same position for more than 15 minutes, I would experience numbness in both my arms. It was something that I could live with, since it was only numbness, not pain.
I had never even bothered to mention it to my personal physician until today when I went for a general check-up. My doctor then proceeded to explain to me that spinal stenosis also involves the nerves in my neck being pressured when I rested on my back, and that what was causing the numbness in my arms.
He went on to explain to me that to alleviate that problem, I should get a butterfly pillow, which in turn would lessen the strain on my neck and its nerves, and thus help to abate that numbness problem. I will try it and let you know in a latter addition to this article how I make out.
(2/26/13)- The articles we have written about in connection with spinal stenosis are not intended to conclude what may be the best treatment for the illness. They are intended to make the viewers more aware of the pluses and minuses involved in the different treatment options.
For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomes -- whether or not the patient later undergoes surgery, according to a study in the February 15 issue of Spine.
The study raises questions about the benefits of steroid injection -- a widely used treatment for the common problem of spinal stenosis in the lower (lumbar) spine. "There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically," according to the study by Dr Kris E. Radcliff of Thomas Jefferson University, Philadelphia, and colleagues.
Do Steroid Injections Help in Spinal Stenosis? The researchers analyzed data from the Spine Outcomes Research Trial (SPORT) -- one of the largest clinical trials of surgery for spinal disorders. In SPORT, patients meeting strict criteria for spinal stenosis (or other common spinal problems) were randomly assigned to surgery or nonsurgical treatment (such as physical therapy and medications). Patients with spinal stenosis have narrowing of the spinal canal, causing back pain, leg pain, and other symptoms.
The current analysis focused on the effects of ESI as part of treatment for spinal stenosis. Steroid injection is commonly recommended for patients whose symptoms don't improve with initial treatment.
Dr Radcliff and colleagues compared outcomes for 69 patients who underwent steroid injection during their first three months of enrollment in SPORT versus 207 patients who did not receive ESI. The two groups were similar in terms of most initial characteristics, although patients receiving steroid injections were more likely to prefer nonsurgical treatment: 62 versus 33 percent.
'Significantly Less Improvement' in Patients with ESI "Despite equivalent baseline status, ESI were associated with significantly less improvement at four years among all patients with spinal stenosis in SPORT," the researchers write. Among patients who eventually had surgery, those who had ESI showed less improvement in physical functioning through four years' follow-up. For those treated nonsurgically, steroid injections were associated with less improvement in pain as well as functioning.
There was also evidence that surgery was more complicated in patients who had previously been treated with epidural steroids. On average, surgery took about one-half hour longer in patients who had received ESI, who also spent about one day longer in the hospital. Patients who received ESI were also more likely to "crossover" from their initially assigned treatment to the other treatment group. There was no evidence that receiving steroid injections helped patients to avoid surgery.
Lumbar spinal stenosis is a common problem in older adults. Epidural steroid injection is a common treatment for spinal stenosis, despite a lack of evidence showing its long-term benefits. The SPORT data provides an opportunity to examine how steroid injections affect long-term outcomes of spinal stenosis.
The new study has some important limitations, especially in that patients weren't randomly assigned to epidural steroid treatment. However, the results suggest that patients with spinal stenosis who receive ESI have less improvement at four years' follow-up, whether or not they subsequently undergo surgery.
Dr Radcliff and colleagues conclude, "Despite the common treatment practice of incorporating one or more ESI in the initial nonoperative management of patients with spinal stenosis, these results suggest that ESI is associated with worse outcome in the treatment of spinal stenosis," write. They believe the "most likely" reason for the worse outcomes after ESI is that the injection causes worsening of the spinal narrowing or result spinal nerve impingement, although other explanations are possible. The authors call for further research to clarify the "indications and results of this common procedure."
(2/5/13)- It is now 15 months since my last spinal steroidal cortizone shot, and my pain level continues to be in the 2 level. It is interesting, but because of the illness of my wife I have been remiss in doing my stretching exercises.
By being remiss I mean that instead of fully doing all of the exercises that I normally would be doing on a daily basis, I have been doing only about 70% of them. Mental determination plays a big part in doing exercises on a continuing basis, especially when they hurt in doing them, but I am sure I will be doing them on a regular basis from now on.
In spite of my failure to fully complete my exercises the pain level continues to be at a very manageable level.
(1/10/13)- In the last 2 months I have received a few e-mails asking me if I would still recommend a spinal steroidal cortizone shot for spinal stenosis in light of what has occurred with the meningitis and abscess problem that have come to the forefront of the news.
Obviously you have to have faith in your medical professional who administers the shot and the facility that he/she uses where he/she administers the shot. It is also obvious that you can not personally check on the safety of the shot being administered to you.
In my case I answered both these questions yes, so I do feel safe using the doctor, his professional experience and recommendation to use his facility.
(1/7/13)- As of December 28th, the Centers for Disease Control and Prevention (CDC) has confirmed that 656 people in 19 states had become ill with meningitis or other infection like severe internal abscesses in the area where the drug was injected.
Some have had both meningitis and spinal infections. The death toll stands at 39. The New England Compounding Center, which was the source for the contaminated serum has been shut down.
(12/2912)- The Centers for Disease Control and Prevention (CDC) has confirmed that, so far, there have been 620 people in 10 states who have come down with fungal meningitis as a result of the tainted serum they received in their spinal steroidal cortizone shots.
As if that is not bad enough, the CDC has now notified medical professionals to be on the lookout for spinal infections near the injection site. There have been at least 200 confirmed cases of abscesses at the site among the patient who were given the contaminated serum.
The agency has urged doctors to consider MRI scans for patients who do not seem to be getting better after having the shot administered to them. This advice was more aggressive than previous recommendations, which had called for scans only if patients had new or worsening symptoms.
(11/26/12)- It is now a little bit over a year's period of time since I received my last spinal steroidal cortizone shot, and I continue to have no problem with the problem. Just to recap the timelines for my shots, I got them in 2002, 2004, 2007 and the last one was administered in November 2011.
I know that I am very fortunate in both the fact that the shots worked and also their years of effectiveness is longer than what normally can be expected. I never had any adverse effects from the shots even though I have been given them multiple times.
Yes I too do fear that the problem someday will not be as dealable as it has been with the shot, but I will face that issue when it happens.
(11/22/12)- As of November 19, 2012, a total of 490 cases, which includes 34 deaths, have been reported in 19 states related to outbreak of fungal meningitis and other infections associated with contaminated steroid medication. (see CDC’s website for up-to-date information about case count and distribution by state). Exserohilum rostratum continues to be the predominant fungus identified in patients and confirmed by the CDC laboratory.
(11/2/12)- The number of confirmed deaths from fungal meningitis by the Centers for Disease Control and Prevention now stands at 29 and the number of illnesses now totals 404.
(10/28/12)- The number of confirmed deaths from fungal meningitis by the Centers for Disease Control and Prevention now stands at 25 and the number of illnesses now totals 313.
Many of the medical facilities that bought the serum that is for a spinal steroidal cortizone shot now say that they will no longer buy it from pharmaceutical compounders. This is a knee jerk reaction, because not all compounders have the same unsanitary conditions that are now being brought to light that occurred at the New England Compounding Center.
There are brand name serum manufacturers that have been found by FDA inspectors to have unsanitary conditions at their plants. Obviously, compounding will have to be brought up to safer sanitary levels, but let's not rush to judgment on this issue.
(10/25/12)- Although the number of confirmed deaths from fungal meningitis resulting from the spinal steroidal cortizone shot has been changed to 17, not 23, the number of confirmed cases of the disease has risen to 304. The outbreak has taken place in 23 states, and the number of fungal contaminated vials now stands at 17,000.
(10/23/12)- The number of confirmed deaths from fungal meningitis as a result of a spinal steroidal cortizone shot now stands at 23, according to the Centers for Disease Control and Prevention. The number of confirmed menigitis illnesses now stands at 283, and so far, it looks like about 14,000 defective vials of the contaminated serum have been identified.
The incubation period for the disease has now been extended to up to two months from the time the shot has been administered.
(10/19/12)- According to the latest figures from the Centers for Disease Control and Prevention, the death toll now stands at 19, with over 250 confirmed cases of fungal meningitis as a result of the tainted steroidal spinal cortizone shots that they received. The outbreak has now been reported in 15 states.
Congress passed a law in 1997 that gave the FDA authority to oversee compounders, but the Supreme Court struck down that law in 2002. The court ruled, in a 5-4 vote, that the law violated the compounders right to free speech under the First Amendment to the Constitution, since it resticted their ability to advertise.
(10/13/12)- Andrew Pollack wrote a very informative article in the October 12 edition of the N,Y. Times that brought out several interesting points of information about a steroidal spinal cortizone shot. The article was entitled "Seeking Injection for Pain Relief, and Finding Themselves in Pain for Life".
The death toll now stands at 14, with 156 more taken ill according to the latest figures from the Centers For Disease Control and Prevention (CDC).
The article went on to state: "Moreover, the steroids, while approved for uses like relieving inflammation in joints, have not been approved by the FDA for epidural injections, next to the spinal cord." Please keep in mind that doctors are allowed both ethically and legally to use approved medications for off-label usage.
When I got my first injection, my pain management doctor cautioned me that the shot only works in about half the cases, and usually is effective for about a year.
The article went on to point out: "The injections are made into the epidural space just outside the spinal column. This is the same site used in numbing the pain of childbirth, though women in labor receive an infusion of a local anesthetic, not an injection of a steroid.
But the needle can sometimes go astray, putting the drug into the spinal fluid or arteries, causing nerve damage, hemorrhages and death to nerves by depriving them of oxygen. Many doctors use imaging and fluorescent dye to position the needle, but even that technique is not foolproof."
As this article goes on to relate, I received spinal steroidal cortizone shots in 2002, 2004, 2007 and 2011, and since they worked in my case, I am happy with the results that I got from these injections.
(10/12/12)- Health officials at the Centers for Disease Control and Prevention reported that there havebeen 12 deaths and 137 confirmed cases of fungal meningitis as a result of the defective serum used in about 13,000 spinal steroidal cortizone shots injections. There have been a total of 10 states where there has been confirmed cases of fungal meningitis
Originally health officials had identified the fungus as Aspergillus, but upon further study it has been corrected to the Exserohilum fungus.
Members of the House Energy and Commerce Committee, which oversees the FDA are calling for an investigation of drug compounding companies for the purpose of setting up new regulations to protect the public's safety when dealing with their products.
The New York Times edition of October 11 carried the story about one of the patients who died as a result of the injection. I was surprised to read in the article that she had been scheduled for 3 injections, which were to be administered to her every other week for 6 weeks.
In my own case, I was scheduled for only one injection, and then I was to wait and see if it was effective. I was also told, that even though I was insured through my employer's insurance plan, that if I was under Medicare coverage it would cover only a total of 3 shots administered within a 6 month period of time. In my own case it took about 10 days for the shot to work, with the improvement taking place gradually over several weeks time.
(10/8/12)- When I got my first steroidal spinal cortizone shot in July 2002, the injection was given to my in my pain management doctor's office and the cost was about $1,700.
When I got my most recent shot in October 2011, it had to be given in a clinic, not the doctor's office, and the total cost ran around $4,000. I had to pay a slight amount in the first instance, since I had not reached my maximum deductible amount at the time of that shot, whereas I had complete coverage in the second case, since I had reached my maximum deductible amount at the time of that shot.
I was able to resume my normal physical activity the next day after the shot with no after affects. No therapy is required after receiving the injection.
I do not know what the cost is involved with back surgery, nor the length of time required to be able to resume normal physical activity after the surgery, but I would imagine it varies from individual cast to individual case.
(6/15/12)- We recently received an email from Valerie Cecil advising us that
a link that we used to the National Foundation for the Treatment of Pain was no
longer in operation. We wish to thank her for taking the time to let us know
about it, and at the same time she recommended http://ergostoreonline.com .
As an add-on to this article about spinal stenosis, I would like to write, that some good can come from some things that are not so good. The bad is the pain you suffer from stenosis, i,e. the pain from this disease is so severe it makes it easier to take the pain from other illnesses. Although my stenosis is quiet now, I am having a lot of pain in my right shoulder. When I compare the shoulder pain to the stenosis pain, I can shrug it off as a pain but not a quality of life problem.
(5/30/12)- I have now passed the 6-month mark since my last spinal steroidal cortizone shot and I am doing fine on that score. Fortunately as the pain management doctor stated, once it works once it will work a second time, but he has no idea how long this shot will last. In my case the shots have lasted anywhere from 2 years to 4 years, so hopefully this will continue to the case.
(4/14/12)- It is now almost 5 months since I received my last spinal steroidal cortizone shot, and I am pleased to say that the shot continues to work. My pain management doctor had stated, that if the shot works once, in all likelihood it would work again. Well in my case, this is the fourth time that I got the shot, and so far, so good.
Just to recapitulate, I got my first shot in July, 2002, my second shot in July, 2004, my third shot in July, 2007, and my fourth shot in November, 2011. Not only have the shots worked in my case, they have lasted for a longer period of time than is "normal". My doctor had told me that the shot, when it works, normally for a year to a year and a half.
(2/11/12)- Fortunately enough, the spinal sterodal cortizone shot that I received on November 23, 2011 has worked once again, and I am okay on that front.
University of Connecticut men's basketball coach Jim Calhoun has been in the news lately, with an announcement that he is taking an indefinite leave of absence because of a back problem. He will turn 70 in May, and it is spinal stenosis that has caused him severe pain and has impaired his mobility.
"I had back pain like never before last summer, thought it was back spasms," he told the Associated Press. He went to see a neurologist who told him it was stenosis, as well as a few other problems so he went for physical therapy. Recently the pain worsened, so he had to take the leave of absence so that he could deal with the problem.
Yes, I certainly would agree with Coach Calhoun, that spinal stenosis causes a level of pain that I had never experienced in my life before, and yes, it certainly does interfere with one's quality of life.
Whatever procedures he undertakes, we at therubins certainly hope it works, so that he can resume his regular lifestyle.
(12/11/11)- I knew that sooner or later my good fortune would come to an end, and that my spinal stenosis and its accompanying pain would eventually return to haunt me. My good fortune in avoiding this dreaded disease came to an end early in November,
Here is a recap of the history of the timing of my epidurals:
My pain management doctor told me that the shots work in about half the cases when it is administered for the first time, and if it works, it does so for about a year, so fortunately for me, I have been a rare positive exception to this timetable.
The shots had worked in alleviating the pain from the spinal stenosis on all the 3 prior occasions that it was administered to me, and the doctor advised me that in all likelihood this meant it would work for the shot given to me on November 23rd.
My problem started this time early in the month of November when "the pain" returned in my right calf, my right thigh and the area around my left ankle. I had previous occasions wherein "the pain" had returned and I was able to wait it out for a couple of days, but this time I knew I was in "big trouble". It wasn't that the pain level went to the 10 mark, it is just that it was the exactly the same type of pain as the one I had in my previous bouts with the disease.
On the 7th of November I called my pain management doctor to make an appointment to see him. I was told that the earliest date available was December 7th, and since I was at a pain level of 5 I thought I could make it to that date. When my pain level began to increase I realized that I would never be able to last until that appointment date, so I called his office and stated that it was an emergency and therefore had to move up the date for my appointment to the earliest one available. That date turned out to be November 17th.
I was fortunate in being able to get a date (November 23rd) for my shot so soon after the visit to my doctor's office, but that was because not too many people wanted to have procedures done on them the day before Thanksgiving.
The significant difference between the illness this time, and the first time I had gotten the problem was that I could walk, with a pain level of 5 or 6 to the bus stop, so I was able to get to work this time by public transportation.
The first time I had gotten the problem I had to take a taxi to and from work. I have been walking to and from work all my life until this problem arose, which involved walking a little over 2 miles each way.
On the 3 previous occasions when I had gotten the shot, it was administered in the pain management doctor's office. This last time the procedure was done in what is called an "ambulatory surgical center". These ambulatory surgical centers are owned by the doctors performing the procedures therein, so just in passing, there certainly is a potential for a conflict of interest with this system.
There had only been one day in which my pain level rose as high as 8 in the time from the original onslaught of the pain until I had gotten the injection, but in general my pain level had been in the 5 to 6 area. Anyone who has had a pain level of 10 knows what I am talking about when I say that at that level, especially when taking place over any length of time, is unbearable.
Each of my bouts with the spinal stenosis has had its own particular patterns, and this latest bout turned out to be a lot different from the previous 3 that I was involved with.
In about 2 days after having received this recent shot my pain level went down to the 4 to 5 level from the 5 to 6 level that it had been at before the shot. This time around the pain level would go as low as 3 but then would go back up to the 6 level. This up and down pattern was different than any of the 3 prior occasions that I had received the shot, because as a general rule the pain level would slowly, ever so slowly, recede.
As I write this present update I am now in the 3 area of pain level, and have been able to walk to and from work for the last several days. I do feel the worst is behind me, but as those of us who suffer from this affliction are well aware of, it is one heck of a painful process before it comes under control.
(8/21/11)- On 7/21/11 below, I asked the question, "Can stenosis be cured?" I now realize how foolish that question was because there is no "cure" for spinal stenosis. On the other hand, steps can be taken to try and prevent a recurrence of the extreme pain level that is experienced by anyone with the affliction.
I have become a firm believer in that proper stretching exercises can act as a preventative in dealing with the problem. There are days in which I sure do not feel like doing the stretching, but the fear of the pain returning is reason enough for me to continue with the regimen of doing them.
(8/19/11)- I raised my eyebrows recently when I read that James Levine, the Metropolitan Opera's music director had received not one, but two previously undisclosed back operations for spinal stenosis since the spring, when he canceled a Met tour of Japan and his schedule at the Tanglewood Music Festival.
In March he had stepped down as the music director of the Boston Symphony because of his stenosis problem. He was first operated on for his spinal stenosis a year earlier but the excruciating pains returned and he was unable to carry on his profession..
The first operation took place on May 31, but the stenosis problem returned and the second operation occurred on July 20. In other words, the second operation this year occurred within 2 months of the first operation.
I as a layman, who has also suffered from spinal stenosis, question the wisdom of having 2 spiinal stenosis operations performed within a few months, after a previous operation failed last year. He is now scheduled to make his first appearance of the season leading the Metropolitan Opera orchestra on October 13th in "Don Giovanni".
I do understand how fortunate I have been in that the spinal cortizone shots, along with the stretching exercises that I have done, that I have received in the last 9 years have worked to keep my condition under control. Still 3 operations in a little over a year has to have some better explanation behind it.
(7/21/11)- I now have gone over 4 years since the last time I received a spinal steroidal cortizone shot for my spinal stenosis. Is it possible that my spinal stenosis was in fact something else? Can spinal stenosis be "cured".
I do not know the answer to these questions but I do know that I am very thankful that I do not have that horrible pain that is associated with the illness. In the last year or so I have been very, very diligent in doing my stretching exercise, which in my case I do late at night, in utter darkness with no sounds interfering with my task.
I do the exercises late at night because I feel I am most relaxed when I do them at that time of day. I have no physical limitations at all, and after having had the bouts with the pain and inability to even walk more than 10 feet without having to stop because of the pain, I am one very, very thankful person.
(3/29/11)- Faced with large deficits on the federal, state and local levels, is this country going to cut back on medical coverage to help alleviate the fiscal problem? This is a question that is going to arise with greater frequency as the deficits continue to grow.
Back in 2006, the state of Washington created an 11-member committee of physicians called the Health Technology Clinical Committee (HTCC) as part of the state's Health Technology Assessment program. One of the purposes of the committee is to weigh the benefits of drugs and medical treatments as opposed to their effectiveness, cost and safety. The decisions of this committee affects the health care coverage for about 750,000 state residents including state employees, Medicaid recipients and prisoners.
Why I mention this in connection with this article is that on Friday, March 18th the committee held a hearing to determine whether or not the state should continue to pay for steroidal corizone shots to alleviate pain and improve the quality of life of the recipient of the injection.
To summarize my own experience with spinal steroidal cortizone shots, I had my injections in July 2002, July 2004 and my last shot was given to me in July 2007. Strangely enough, even though all the shots were given to me in July, there was no significance in them all being given in the same month.
My pain management doctor informed me that he estimated that the shot works in about 50% of the patients to whom it is given, and that it is effective for only about one year. Mine therefore is the more unusual example of the effectiveness of the shot.
It is difficult for me to even imagine that it has been over 3 1/2 years since I had my last steroidal spinal cortizone shot, but I am elated to report that I continue to be doing very well. As a matter of fact I would say that there have been a few days in which my pain level has been in the 1 to 2 level, which is sheer ecstasy.
I have been doing my stretching exercise every evening, and even though I don't like doing them, I realize that it may be because of these exercises that I continue to be able to avoid getting another shot.
The HTCC decided to continue to pay for the steroidal cortizone shots if, after two injections there was a meaningful improvement in reducing pain and in motor function. In any event, the state would not pay for more than 3 shots within a 6-month period of time.
(7/13/10)- Well, I just celebrated my third anniversary since I last got a spinal steroidal cortizone shot for my spinal stenosis in July 2007. The first time I got a shot was in July 2002; the second time I got the shot was in July 2004; and the third time I got it was in July 2007.
Not only is this the longest interval that I have gone without getting another shot, but I would also add that the pain level in my legs is between the 0 to 1 level, which is the lowest level it has been at, since this whole thing began.
I wish I could tell you a reason for the success that has occurred in my battle with stenosis, but I really do not know why it has happened. I certainly am aware as to how fortunate I am, because when you are fighting with a pain level above 7 your quality of life is not good to put it mildly. In the February through July period of time in 2002, my pain level was at the 8 to 10 mark.
The stretching exercises surely do help, but when you are having a high pain level it is almost impossible to do stretching exercises. I do not take any pain medications per se. In fact the only medication that I do take is Lipitor for my cholesterol and a baby aspirin for the prevention of heart trouble.
(5/16/10)- I am now 2 months short of 3 years from last having had a spinal steroidal cortisone shot for my spinal stenosis. I would now estimate that my pain level fluctuates anywhere from a 1 to a 2 level, which actually represents a slight improvement from when I last wrote about my problem 2 months ago.
I recently met a massage therapist who claimed that stretching exercises could help alleviate the pain for most spinal stenosis sufferers, but I cannot attest to the veracity of this statement.
Strangely enough 2 people who I know have had successful back operations that were performed on them at the Hospital for Special Surgery in New York City, and are now basically leading a pain free life.
I do my stretching exercises every evening, and although I do not always do all of them, I try to do at least 70% of them.
(3/20/10)- It has now been over 32 months since I got my last steroidal spinal cortisone shot for my spinal stenosis, and my pain level continues to be low, in the very manageable 2 to 3 level.
I don't remember the last day that I skipped doing at least some of my stretching exercises. By that I mean I don't always do the complete amount that I am supposed to do, but I do at least half of them if not all of them.
I wish I could give you a reason why I have remained relatively pain free, but I have no idea why that is the case.
I do extensive walking almost every day and I am sure that is a positive, but it would not be an accurate reason to account for my going so very long without requiring another shot.
Hopefully, I will be able to continue to write that I am still relatively pain free, when I write the add-on to this article, but I will continue to let you know how things are going.
(12/3/09)- It is often stated that sometimes "no news is good news", and that sure is true in my case and my experience with my spinal stenosis. It is now going on 29 months since I got my last shot and I am elated to say that I continue to be relatively painless, and am fully able to engage in any physical activity that I choose to participate in.
Just to summarize my case, it was in July of 2002 that I got my first steroidal cortizone shot, and that one was good for two years. I received my second shot in July of 2004 and that one lasted until July of 2007. Thus it is now almost 29 months since I got my last shot, and I hope I can continue in the shape I am in right now.
I really am pretty good about doing my stretching exercises every evening of the week, and I do not have to take any pain medication at all.
I wish I could tell you why this has been the case, but I am still entirely in the dark as to why the shot works for some people, while it does not work for others. In some cases the shot is good for only one year, but as I have written I am now almost at the 2 1/2 year mark with my last shot.
(8/12/09)- It has been over 4 months since I last wrote about my stenosis problem, and I am elated to report all is quiet on that front.
There were a couple of days when the pain level got up to the 3 mark, but that did not last for very long. For most of the time I have been staying at the 1 to 2 level and that certainly is not a problem.
It has now been more than 2 years since my last spinal steroidal cortisone shot, and it is something that is in the back of my mind every day. For the last few months, for whatever reason, I have become more conscientious in doing my stretching exercises almost every evening, but every once in a rare while I become lazy and don't do them for a day.
Speaking about doing those exercises, for whatever reason I find I am most relaxed at the very end of the day, so I do them usually starting around 9:00 P.M., and when done properly it lasts for between an hour to an hour and a quarter. I do not listen to anything while doing them, since I find I can concentrate on doing them properly in total silence.
(3/26/09)- Back in November I wrote about the problems that Danilo Gallinari, the New York Knick number one draft choice for 2008 was having with his back. Mr. Galinari did return to action on the basketball court in mid-January, but the back problem has persisted and he is out of action once again. The pain in his back has persisted, so that he estimated that he was operating at only 60% to 70% of efficiency.
He recently visited a back specialist in New York, and visited two top back specialists back in Italy where he comes from. Mr. Galinarii was found to have a bulging disk last summer, but it since has receded. MRI tests since then have not shown any damage. Doctors now believe that the disk may be impinging on a nerve, but that is not evident in the tests.
According to the latest press report, Mr. Gallinari is now leaning towards having surgery. Knick officials indicated that they believed he was injured in a game last summer when he collided with another player during a summer league game. Team officials stated that they understood that the pain was being caused by an impinged nerve that could be resolved by shaving down the bone around the nerve.
I once again emphasize that I am not a medical doctor. I do remember my pain management doctor advising me at that time, that if the steroidal cortisone shot did not work, I would be offered the option of having the nerve or nerves in the area involved in causing the pain to be to killed. Thankfully this situation never arose in my case, since the shot did work.
The nerve killing procedure is done in the hospital, since the surgeon would isolate the nerve or nerves involved by looking at my body through an x-ray machine. I would have been an outpatient, and not have had to stay in the hospital for even one day. I would be able to walk out of the hospital that day, and gone about doing whatever I wanted to do immediately thereafter.
As I stated I am not a medical doctor, but in my item dated dated 11/16/08 below, if the steroidal cortisone shot does not work by the 2nd time that it is given, it is not going to work when administered a third time. This is purely laymen's advice that I am giving to any viewer of this article, but if the shot does not work after two injections, I do not think that any sufferer of this kind of pain should be getting a third shot.
On the other hand, as has been true in my own case, if the shot does work, even though it may alleviate the pain for only one year, as a general rule, it will work again if the shot is given to a sufferer in a subsequent year.
(11/16/08)- I saw an article in today's NY Times' Sports Section that bothered me a lot. The article was written about last night's Knick game that they won against the Oklahoma City Thunder, and was written by the team's beat reporter Howard Beck.
In the article about the game Mr. Beck wrote that Danilo Gallinari, "their highly regarded lottery pick, is out indefinitely with a back injury"…"Gallinari has been bothered by a bulging disk since early July."
Mr. Beck went on to write: "He received a cortisone shot Thursday-his third since mid-September." I am not a medical doctor, but if Mr. Gallinari were my son, I would caution him against receiving any more cortisone shots. Those shots are not good for the body's system, and if they haven't worked by the 2nd shot they are not going to work by the 3rd shot.
As I stated, I am not a medical doctor. I am only a layman who has gotten steroidal spinal cortisone shots because of my spinal stenosis. Getting the shots over the last 5 1/2 years does not make me an expert.
Mr. Beck's article went on to state that the team's coach, Mike D"antoni said, after having consulted with several medical specialists who had examined Mr. Gallinari: "I'm sure with rest and the right kind of work that he will get better." In my opinion the right kind of work does not include getting more cortisone shots.
(11/14/08)- I have received several emails regarding how things are coming along with my battle with my spinal stenosis, so in response thereto, I am updating my situation herein.
There have been a couple of days since I last posted the item on 9/12/08 below, when it seemed as if the pain was worsening, but much to my relief, the pain was only transitory and the pain abated to my normal 1 to 2 pain level. I do worry when the pain starts to get a little worse because the fear is always with me, but I have learned to let a few days go bye before really getting alarmed.
Fortunately I continue to be able to do whatever physical activity I choose to do, and the stenosis does not interfere with my performance in the least bit..
Of all the articles that we write about on this site, we receive the most emails concerning questions from individuals who are suffering from this problem. Unfortunately, it can strike people much younger than myself, but the medical profession continues to try and find solutions for the problem.
(9/12/08)-It is now over 6 months since I last updated you on how I am doing since my last spinal sterodial cortisone shot, which took place in July 2007. Just to refresh your recollection, which is all spelled out in detail below, I got my first shot in July 2002, and it worked until July 2004 when I got my second shot.
The shot that I got in July 2004 worked, leaving me relatively pain free until July 2007, when I got my next shot. As of this date, I continue to be relatively pain free and can engage in any physical activity that I choose to participate in. I continue to walk back and forth, on a daily basis, to and from my job, which entails walking a little over 2 miles each way.
By relatively pain free, I mean the pain level is in the 1 to 3 area, on a pain level scale up to 10 being the most painful. Even when it is at the 3 level, it does not stay there for more than one day, and that level of pain is not a problem in any shape, manner or form.
I know that I have received many emails from viewers of this article who reported that the shot did not work for them. In fact I would say that I got more emails saying that it did not work, as compared to those who said it did work.
Incidentally my pain management doctor told me, that if the shot worked once, in all likelihood it would work again.
Please feel free to email me, if you have any questions on this matte,r that you feel I may be able to help you with.
(2/28//08)- To operate or not to operate; to get a steroidal cortisone shot or not to get a shot; to try and deal with the problem of spinal stenosis with physical therapy or some other possibility are all potential methods of treatment questions faced by all of us who have the disease. In my own particular case I have written about how I have dealt with the problem through the "spinal steroidal cortisone shot" methodology. The purpose of my article is not to make the selection for any of the viewers herein, but to hopefully keep you updated on what modern science has available to treat the problem.
Last April, the results from the Spine Patient Outcomes Research, or Sport that degenerative spondylolisthesis,another common spinal problem and herniated discs had no better outcomes when treated with spinal surgery than if treated by physical therapy. This study was started in 2000, and was paid for by the National Institutes of Health.
The trial involved about 2,500 patients at 13 treatment centers around the country. Patients were initially divided into surgery and non-surgery groups, but during the various related studies many people randomly changed their minds and opted for the other type of treatment. The study was headed by James N. Weinsteing, surgeon and chairman of orthopedics at the Dartmouth Medical School in Hanover, N.H.
The results of the study in relation to spinal stenosis were published in a recent edition of the New England Journal of Medicine. The results showed that spinal surgery was the most effective way to deal with spinal stenosis. Dr. Weinstein stated: "I still believe we have too much spine surgery overall, but this study shows that where there is a "specific diagnosis of stenosis, spine surgery will bring a benefit."
The study followed 803 patients, of whom 398 ended up getting surgery. After two years, of those who had surgery, 63% said they had a major improvement in their condition, compared with 29% among those who got non-surgical treatment.
In terms of self-reported pain and physical function both groups improved over the two-year period, thought the final scores for patients who had surgery were in the 60% range, while scores for those who stuck with non-surgical treatment were in the 40 range.
In regards to my own experience in connection with my bout with spinal
stenosis, it is now about 7 months since my last spinal steroidal cortisone
shot, but this time unlike my comments from 12/2/07 "trouble had been
brewing". I will update you on what has been happening to me, and I would
appreciate any feedback that any of you may have as to whether or not you have
had a similar experience. I would also appreciate hearing from those of you who
went the route of having the operation, and your ensuing comments about that
About 4 weeks ago my pain level moved up into the 3-4 area over a period of time. I began to feel a "tightening" pain in the right calf muscle. It was not a bad pain level but it was increasing slowly but surely. At the same time I began to experience soreness for the first time in my right side above my hip-bone, and in the right buttock area. I could continue to walk so I carried on with only a 3-4 level of pain while doing so. This time, unlike my previous experiences with the problem in 2002 and 2004, I did not have any pain in the groin area.
It was about 30 days ago that the "tightening" in the right calf muscle became more and more of a problem. The pain on my right side also increased, but now my walking pain reached the 4-5 level. As anyone who has had stenosis can tell you, as time passes you never forget how bad the 10 level pain is, so lesser degrees of it are much more bearable.
About 25 days ago was when I knew that the problem was surely not getting better, and not going away. Even though my first and second shot experiences, as I described below, had lasted for a 2 year and 3 year period of time I did not think I could go on much longer before calling my pain management doctor to arrange another shot.
The pain management doctor had told me, that since the shot had worked before, the likelihood was that it would work again, I am not anxious to have it done, because I am aware of the fact that it is not good for the rest of my body.
Believe it or not, what caused me to put off the call off was my recollection of the fact that I previously improved spontaneously after holding out for a few more days. Obviously the pain level had remained relatively low, by which I mean it never got above the 6 level.
When I woke up on the morning of February 11th I immediately sensed that my pain level had gone down perceptibly. I am writing this add-on item to this article the night of the 11th, and my pain level is back down to the 1 to 3 level, and yes, it may be my imagination, but I think the episode is behind me for now. I did not post this item until this date because I wanted to make sure that this episode was truly and thankfully behind me.
(12/2/07)- It is now about 5 months since my last spinal steroidal cortisone show and all is well with myself. My pain level is still at the 1-2 mark and I am able to do an unlimited amount of walking with no problem. I have no idea how long it will last but I am just thankful that it is no problem for me at all.
The following sites were listed in a recent article, dated November 20, 2007 by Jane E. Brody in the N.Y. Times, entitled: "Many Treatments Can Ease Chronic Pain":
American Chronic Pain Association: e-mail- ACPA@pacbell.net Web site- www.theacpa.org Address- P.O. Box 850,
Rocklin, CA. 95677-0850; (916) 632-0922 or (800) 533 3231.
American Pain Foundation: e-mail- email@example.com Web site- www.painfoundation.org Address- 201 North Charles St., Suite 710, Baltimore, Md., 21201-4111; (888) 615 7246
(8/17/07)- It is now slightly over one month since I got my last steroidal cortisone shot, and so far so good. I would say that my pain level is in the 1-2 area and not creating any problems for me at all. I have resumed playing tennis and walking back and forth from work every weekday without having the pain interfere with the activity.
Of course every morning when I get up I cautiously put my feet onto the floor wondering if my legs will be okay. That feeling will never go away, but so far it is no problem at all.
The first time I got the shot it lasted 2 years and the second time I got the shot it lasted 3 years. Will this shot last for years or will the pain resume today? That question will always be with me, but it is in the back of my mind, and does not impede me in any way from doing whatever physical activity I choose to do on a particular day.
Unfortunately I have heard of a case in the last week where the steroidal shot did not work As far as I know there is no way to predict if the shot will work or not.
(7/14/07)- It is time for me to update you as to what has happened to me since I wrote the last item about my stenosis problem on May 27th below.
Throughout the end of May and early June the pain in my leg continued to elevate so that by June 2 I knew that I could not wait until July 3 to get a shot. I called my pain management doctor's office to see if I could get the date for the shot moved up but the doctor did not return my call. If you go to the earlier items that I have written about my "stenosis saga" you will see that this was not an unusual occurrence.
Finally I got in touch with my personal physician and had him call the office of the pain management doctor. Although my pain management doctor was not available for an appointment earlier than the July 3 date, his associate was available for a June 11 date so I readily accepted that day to get the epidural.
By June 11 my pain level was up to number 10. Please keep in mind that 1 is the lowest level of pain and 10 is the highest.
I arrived at the doctor's office on June 11th and after a short wait I was taken in to see the physician's assistant for an interview as to my problem. She had all my prior records available in connection with my visits to this office in July 2002 and July 2004. After this interview the doctor came in and he also asked me about my problem.
He told me that the procedure has changed since I received my last shots in July 2004. He explained the new procedure to myself and I agreed to take the shots. I use the word shots because it entailed receiving more than one steroidal cortisone shot. The shots are not injected directly to the spine as they were done before.
I was told, as I was on the prior occasions that I was given the shots, that it would take between 3-5 days for me to start to feel some positive effects from it. My pain level did go down in the following weeks but not to the point where I had hoped it could get. I knew that I was not home free so I tried calling my regular pain doctor again, but this time I was able to get in touch with him.
His office told me that the July 3rd date was still available so I gladly accepted that day. He told me however to go have some a new MRIs taken since the last one that they had was the one I took in 2004. His office faxed the prescription to me and I in turn called the imaging office to schedule an appointment.
The imaging organization did MRIs on Saturday, so I was able to get an appointment for the earliest time on Saturday. As an aside, it was great to go to the imaging organization on a Saturday morning and find it empty except for myself. In all my prior MRI sessions in the prior years that I took it the office was mobbed.
My pain management doctor had me take the MRI in the same office as my prior one in 2004, since he felt that they were therefore best informed when it came to comparing the present MRI with the past MRI. I got to the pain management doctor's office in time for my appointment, and once again his physician's assistant interviewed me.
She spent about 10 minutes interviewing me and taking notes. I indicated to her that I was not sure if I should get the shots since my pain level was in the 4-5 range, which was better than the 10 level when I got the shot.
My doctor appeared in the examining room shortly thereafter and he showed me the results of my MRI. He indicated to me that there were two main areas of concern that showed up in the MRI. The main problem he felt that was causing my pain was an inflamed disc between L5 and S1 that my right leg nerve was rubbing against. The other main problem area was the stenosis or arthritis between L5 and L 4.
We then went on to discuss the options available to me in connection with treating what he felt was the main cause of my problem-the disc inflammation between L5 and S1. We could do nothing and see if there was any continuing slow improvement without any treatment, or take a more aggressive approach and take the shots.
He explained to me what I already knew. If you left it alone to improve by itself this could easily fail. If you took the shots there was no assurance that the shots would work. He was very fair and impartial in allowing me to arrive at my own decision in the matter. I opted to take the shots.
I then was taken into the room where the procedure was performed. In addition to the technician who operated the fluoroscope machine and my pain management doctor, there was a second doctor in the room. It turned out that this doctor was an associate of my doctor who was new to the office. He asked my permission to allow this doctor to be present because he wanted to show him how he did the procedure.
The entire procedure took about 15 minutes. It was not painful, but I sure wouldn't call it a carefree session either. I felt no ill effects from the procedure, and was able to dress and go home right after it ended.
For the first few days after July 3rd there was no improvement, but in the ensuing days the pain in my right leg slowly but surely began to subside. It came down to a 3 level and I was able to resume walking to and from work, which incidentally is about a 40 block walk each way.
As of this writing my pain level is in the 2-3 area which is easily manageable. I can walk wherever I want to go and it is not a problem. I have no idea how long it will last, and I take each day as it comes. Will it last 3 years as the last shots lasted or will my relief end tomorrow? I don't know. All I do know is that I am walking with a very low pain level and it surely is very manageable.
I know that our item dated 5/28/07 below, which deals with lumbosacral pain is not an encouraging one for this condition. Be that as it may, all I do know now is that I am quite content to be able to do what I am physically doing now.
(5/28/07)-Based on a literature review, the American Academy of Neurology Therapeutics And Technology Assessment Subcommittee has drafted new guidelines on the role of steroid shots for lumbosacral pain. The lead author of the study was Dr. Carmel Armon, chief of neurology at Baystate Medical Center in Springfield, Mass, and professor of neurology at Tufts University in Boston. His search of the literature yielded 37 studies, but only 4 met the committees predetermined standards. All 4 of these studies concluded that the injections proved "no efficacy at 24 hours, some efficacy at 2-6 weeks, no difference or rebound worsening at 3 months and 6 months, and no difference at 1 year."
Dr Armon is quotes as saying: "While some pain relief is a positive result in of itself, the extent of leg and back pain relief from epidural steroid injections, on the average, fell short of the values typically viewed as clinically meaningful."
Complications of epidural steroid injections are usually minor and transient. The most frequently reported symptom is a headache. Rare major complications include aseptic meningitis, epidural abscess, arachnoiditis, bacterial meningitis, and conusmedullaris syndrome.
According to Dr. J.D. Bartleson, a neurologist at the spine center of Mayo clinic in Rochester, Minn, "Epiduaral steroid injections are likely overused. There is a bias that they are extremely helpful, which is not bourne out by the data."
(5/27/07)- I am now approaching the 35th month since my last spinal cord streoidal shot, and I am beginning to feel the pain from the stenosis returning in my right leg. I am fortunate that it has taken this long before returning, because in most cases, the relief from the shot lasts only up to 24 months, if it even works at all.
Fortunately and strangely enough this time the pain is not that great when I walk so as to prevent me from walking. The pain is at its highest level when I sit (at the 5-6 level). I remember the doctor told me that sitting causes the most pressure on the spine.
The pain is in my thigh and calf muscle, but I am not experiencing the pain that I had the last time in my hip area. I called my pain management doctor's office on May 25th, and I was told that the earliest date that I could get for an appointment for the shot was July 3. That sure is a long way away from May 25th, but I will just have to manage until then. Since I can walk relatively pain free I hope to be able to make it, and continue to be able to go to work.
At first I stopped doing my leg exercises for 5 days, since I could feel the pain coming on and thought that might help, but I shall resume doing them, and see if that helps any.
A new program sponsored by the National Committee for Quality Assurance (NCQA), an organization that monitors health-care quality and accredits health plans has determined that there has been overusage of steroid injections in connection with back pain.
The NCQA will rate doctors on whether they advised patients to maintain normal activities and avoid more than four days of bed rest. The organization will measure the percentage of patients with back pain who received an epidural steroid injection without radiating pain. These injections are most effective for the treatment of pain that radiates along nerves caused by more serious conditions such as a herniated disk.
(10/20/06)- We at therubins received the following email from one of our viewers:
"how come on the articles with regard to spinal stenosis not a word mentioned about healthy eating, supplements, minerals etc. t.s."
Stenosis is a horrible disease that alters the afflicted individual's quality of life. You will try anything to alleviate the pain. As the article pointed out, I tried everything from acupuncture to painkillers, etc, In my case the spinal steroidal injection has alleviated the bulk of my pain. I do my stretching exercises, and so far it is under control.
In the email cited above, the viewer asks about eating right, dietary supplements, minerals, etc. We would appreciate anyone who has had experience with any of these items to email and tell us about your experience with it. We will withhold naming you, or even putting in your initials if so requested.
If you have any other possible suggestions as to a treatment that either helped or didn't help please let us know about it. The items from our viewers will be posted in a separate article from this one located at Spinal Stenosis- What Has Worked or not Worked for Me - Part III of a III Part Article on Stensosis.
(10/18/06)- I am very happy to report that my spinal stenosis pain level has stayed at just about the same very manageable level that it was at when I last wrote about it on 7/19/06. I have not taken any gabapentin, or neurontin for many months now and I do think that the drug is just a mental crutch, and does not really help the condition.
The answer as to why my condition has stayed at a very manageable level has to be related to the stretching exercises that I have been doing. Please keep in mind that my pain management doctor estimated that the spinal steroidal cortisone shot would be good for about 24 months at maximum. It is now over 27 months since I got my last shot.
I do my stretching exercises very late at night, because I have found that is the time when I am most relaxed in doing them. In my case I do not have any background music, or anything else that I listen to because I feel it only distracts my attention when doing the exercises. I do not do all of my exercises every night, because quite frankly there are days in which I just plain don't feel like doing them.
On those days that I do not feel like doing them, or doing less of them then I should be doing, I listen to my "bad conscience" and just don’t do them. To do them properly it takes about 1 hour and 15 minutes each night. I do have a good deal of physical pain when I do them, and it is not any easier to do even if I have done them fully for say a week at a time.
For whatever reason that I do not understand, I curse a lot when I do them, and that is indeed very strange for me, since I do not normally curse. Once you have endured the pain of spinal stenosis, and seen how negatively it impacts your quality of life, you will try anything to keep it from coming back.
(7/19/06)- Spinal stenosis is a strange illness. When I last wrote about what was happening to me, I related how the pain had abated so that I was able to cancel the appointment for the spinal cortisone shot on April 7. My pain level stayed at a manageable 2-3 level for a few weeks thereafter, but then the pain started to return up to the 3-4 level.
By the middle of June my pain level had risen to the 4-5 level, and I started to take my 300-mg gabapentin pills twice a day. My pain level increased to the 5-6 level, and when it stayed there for a few days I called my pain management doctor's office to schedule a shot. The earliest date that I could get it would be July 28.
I wanted to get the shot sooner, but that was the earliest date available so I would have to live with it. I knew I was in trouble, because I was scheduled for the week of July 8 to do some volunteer work out of town that involved physical labor. I figured that I would have to cancel the volunteer work and stay home, and that was a big letdown to me.
By late June I cut down my intake of the gabapentin to one pill, once a day because I did not feel it was helping me. Shortly thereafter my pain level went back down to the 4-5 level and I cut out the gabapentin altogether. Slowly but surely my pain level continued to decrease. I had continued to do my stretching exercises throughout this whole period of time.
By the first week in July my pain level was back down to the 2-3 level and I was elated for two reasons. The first reason was because once you have had a pain level of 8 or above your quality of life become severely restricted. The second reason was that I knew I would be okay to do the volunteer work, and I had really wanted to do it.
As I write this item my pain level is in the 1-2 range. I will gladly settle for that for the rest of my life. Was it the gabapentin that did it? Was it my continuing to do my stretching exercises? Was it my strong desire to do the week's volunteer work? I have no idea as to what caused the improvement.
I am now into the 25th month since my last shot. I have no idea when the pain level will become unmanageable again, but I am thankful for this added time that I have had, relatively pain free.
As they say: "Stay tuned".
(4/4/06)- When I got my last spinal cortisone shot in July 2004 I was reminded of the fact by my doctor that it usually is good for about 2 years when, as and if it works. My first experience with the shot was in July of 2002, when I also was advised that it probably would be good for about two years, if it worked.
I was therefore a bit disappointed when the stenosis began to act up on me last week. This time however it was different than what had occurred the first two times that I had had the attacks.
The first time that I had the problem was in 2002 when the pain in my left leg was so severe that I could not walk for more than 10 feet without having to stop and rest. I could however lie down, and the pain would abate.
In the second episode in 2004, the pain took place in my right leg and once again I had a great deal of pain when I walked, but I could lie down, and the pain would abate.
In this most recent episode, I had minimal pain when I walked but I could not lie down without a severe pain ensuing. In the two prior episodes, the pain came upon me more or less gradually over a several weeks period of time, whereas in this third episode the pain came about very swiftly. One day I was feeling well, with a minimum of pain, while the next day I could not go to sleep because of how severe the pain was when I was lying down.
When I called my pain management doctor's office last Monday, they told me that April 17th would be the earliest that my doctor could schedule me for the injection. The pain continued to worsen whenever I lay down, so after another call to his office they were able to move the date up to April 7.
I did continue to do the exercises, since I could walk and get around with a minimal amount of pain. On Tuesday, I read Jane Brody's column in the New York Times, wherein she wrote about how gabapentin (the generic version of Neurontin) had helped her with her menopausal symptoms. Please see our article "Herbal Usage for Hormone Replacement Therapy- Part IX."
Since I still had some gabapentin left over from when I first had used them in connection with my first episode with the stenosis I decided to experiment and see if they might help me now with my present pain. I have found that, for whatever reason, the pain is abating and not a problem now especially when I lie down.
I called my doctor's office to cancel the appointment for the spinal cortisone shot. Obviously I am monitoring the situation and will write again in this article to update how I am doing. I am presently taking the 300-mg dosage of gabapentin twice a day.
(11/1/05)- In discussing the stretching exercises that I do on a daily basis, I forgot to include a few pertinent details of my program. One of the most important items is the fact that I find it is best for me to do them very late in the day because I am much more relaxed at that time then I would be if I did them earlier in the day.
You have to be as relaxed as you possibly can be to do the exercises properly. When I am on the floor doing them my mind often wonders off, but in doing them late at night I stay much more relaxed then if I were doing them earlier in the day. Obviously each individual may vary in their thinking on this matter, so follow your own timing schedule in doing them.
There are days in which I do not want to do them. I can not understand why these days happen…maybe it is my own stubbornness, but they do happen. Every once in a while I will pass up doing them, but most of the time I will at least do the majority of them completely. Some of the time I may do as few as 50% of them but then I think about the level of pain that occurred when I had the full blown effect of the disease, and that usually makes me do a few more of them.
Probably the most unusual thing that I do when I am doing the stretching is that I curse a lot to myself as I do them. I normally do not curse at all during the day. The exercises do not hurt that much, and they certainly are not hard physically to do, but for some reason or other, it makes me feel better to curse as I do them, so what the heck, I lie there, do them to the best of my ability and silently curse away to myself.
When I do the exercises in their entirety, and do them properly, it takes about 1 hour of my time to get them done.
(10/26/05)- In her Personal Health column of October 4, 2005, Jane Brody wrote and excellent article entitled "What You Can Do About That Aching Back". Although the article is entitled to the aching back ailment, it dealt mainly with spinal stenosis. In my own particular case it was not the back that caused me the excruciating pain, but rather the pain in my left leg that was incapacitating me.
I would like to quote from her article because of all the interesting items that she pointed out in the article:
"Arthritis-the wear-and-tear kind- is by far the most common cause of a potentially debilitating disorder called spinal stenosis, a narrowing of the passageways for spinal nerves. The problem is most common in people over 50, though the young are sometimes affected through injury of a birth defect.
Not everyone with spinal stenosis has symptoms, but 250,000 to 500,000 American do, and with age as the leading risk factor, the number afflicted is expected to grow significantly as the population ages….
The spine houses all the nerves that enable the brain to tell the rest of the body what to do. The spine is a column of 26 bones, 24 of them vertebrae-7 in the neck (cervival), 12 in the upper back (thoracic0 and 5 in the lower back (lumbar). The other two are fused vertebrae that form the sacrum in the hip region and the coccyx at the base of the spine.
Vertebrae are linked by facet joints that stabilize the spine and, at the same time, allow it to bend. Ligaments keep the vertebrae in place during movements, and fibrous disks with jellylike centers provide cushioning between them.
Now for the crux of the problem: The spinal cord, a long bundle of nerves from the base of the brain to the second lumbar vertebra, passes through a bony channe called the spinal canal.
On its way, two spinal nerves-one to the left side of the body and the other to the right- emerge between the vetebrae, and another bundle of nerves, the cauda equina, extends from the end of the spinal cord.
If the channel for the spinal cord and its many extensions becomes narrowed, pressure on the nerves can cause pain, cramping, tingling or numbness in the area served by the nerve….
Arthritis is also associated with deterioration of the spinal disks, which flatten, become brittle and may develop tiny rips that allow the jellylike substance to leak and press on the nerves. The ligaments too, degenerate with age, becoming stiff and thick, shortening the spine,narrowing the canal and sometimes compressing nerves.
Other causes of spinal stenosis are tumors, trauma, Paget's disease of the bone, and a genetic disorder called achondroplasia….
Various diagnostic tests are sued to check for spinal stenosis or other problems that cause similar symptoms. Among then are spinal X-rays, CT scans, a CT myellogram, a bone scan and best of all, an M.R.I….
Drug remedies include over-the-counter or prescription painkillers like acetaminophen (Tylenol and the like) and nonsteroidal antiinflammaroty drugs (Nsaaids) like aspirin, ibuprofen, Celebrex or Mobic.
In conclusion I would like to reiterate my personal opinion that the most important therapy available to sufferers from spinal stenosis is the stretching exercises, that are painful to do, but I believe are worth all the pain and suffering that they cause. At the same time I have to admit that there are days that I pass up doing them because of how tough mentally as well as physically they are to do on a daily basis.
(9/14/05)- I think I have been able to dodge the bullet again for the time being in connection with my battle with my stenosis. I know that eventually it will catch up to me, but every day that I put it off is a plus.
About 3 weeks ago the pain level in my left leg went from 1-2, up to 2-3 and then up to 3-4. With a pain level of 4 I was able to continue to walk as much as I wanted to walk, but I was very tired at the end of the day. Because I was tired I decided to forego my stretching exercises and see what would happen. You really have to be ready psychologically to do the stretching, and I was not ready to do it. I let 4 days pass without doing any stretching at all, even though I continued to walk to and from work.
I took one ibuprofen tablet a day, but that was the only medication that I took. Finally on the 5th day I gradually began to resume my stretching exercises. I felt very guilty that I was not doing them, and finally my conscience won out and I began doing them again. Gradually the pain level began to decline again so that I am now back at the 1-2 level, which is no problem at all.
I did not bother to call the pain management doctor, because I figured I would wait till it got up to 6-7 before giving him a buzz. I know that there is nothing that the doctor can say other than schedule me for another shot, but I am not anxious to take one of them unless it is absolutely necessary. I had two of them in July of 2002 and one in July of 2004, and even though it is not painful to get them, I realize that the shot is not good for the rest of the body.
(5/24/05)- One of the very nice things about living in a city like New York is that you will meet a lot of your friends out on the street when you least expect it. Sunday afternoon I ran into a woman who I have known for many years. She is a woman who I would estimate is about 65 years of age. Lo and behold she started to tell me about her battle with spinal stenosis.
Her story was very similar to mine. She had never heard of spinal stenosis till she was diagnosed with it herself, and then much to her amazement she found out how common the disease is among older people. It was her neurologist who diagnosed her condition, and he told her to try exercising, stretching and in doing these things she could hopefully avoid surgery.
Originally she was not getting any better, so she went to a second neurologist who recommended surgery for her. She did not want to undergo surgery so she went to a third neurologist who recommended physical therapy for her. At this point her pain was excruciating and she could not walk more than 10 feet without having to rest. The same certainly could be said for me, when I was at the height of my battle with the disease.
This woman did not have any spinal steroidal cortisone shots whatsoever. She attributes her improved condition to the ability to work her way through the pain as she was doing her physical and stretching exercises. She goes for her therapy three days a week, and does her stretching exercises in the morning. I on the other hand prefer to do my stretching exercises late at night. We both agreed that many days we have to force ourselves to do it, but yes it must be done.
At one point do your throw up your hands and say the therapy and exercise program that you are on is not working? No one can answer that question for you, but yes I do know there may come a point where you just have to give up the therapy and exercise program and try something else, so that you may restore some quality to your life.
At first the stretching and the treadmill did not help her, but she stayed with it. Slowly, ever so slowly, the therapy began to work. In her case it took over several months of hard, painful work and therapy before it all came to fruition. She still does have some pain, but nothing compared to what it was when the disease incapacitated her.
In my case I do my stretching exercises every evening, except when I get ornery and rambunctious and just do a few of them. It is painful, but nowhere near the pain that the stenosis was at its height. Five days a week I walk to and from work, meaning about a total of 4 1/2 miles a day.
Both of us agreed, that every morning when we take that first step out of bed, we dos so with a great deal of trepidation. Will the excruciating stenosis pain return? So far, so good, but we sure have learned to appreciate a simple thing like being able to walk.
(4/29/05)- Although I have not had to use any heat pads or spinal electrical stimulation in connection with my spinal stenosis it may be helpful to some of you to be aware as to some devices now available to consumers to help you with pain management. Researchers feel that heat affects certain nerve endings, which send signals to help block the sensation of pain. Heat also relaxes muscles and increases blood flow.
Modern science has come up with several devices to improve on delivering heat to the body by methods better than the old heat pad that confined your mobility. One of the latest heat wrap pads contain gel or beads that are heated in the microwave and can stay warm for between 30 to 60 minutes. It is a moist heat, which some doctors believe is more effective as a pain reliever than other types of heat. Many of these same gel products can be frozen and used to reduce swelling after an acute injury such as a sprained ankle.
Proctor & Gamble has a disposable eight-hour wrap product called ThermaCare that contains iron, which produces continuous, low-level heat when exposed to air. The price for these disposable products is about $3.50 apiece. Heat should not be used if there is bruising or swelling.
Medtronic Inc. has received FDA approval for an implantable rechargeable spine stimulator that can last up to nine years. Advanced Neuromodulation Systems Inc. has also received FDA approval for its implantable rechargeable spine stimulator called Eon Neurostimulation System, and Boston Scientific's product in this medical equipment area is called Precision.
(4/13/05)- As I had suspected the Neurontin, and/or gabapentin, the generic version, thereof were really not helping me in my battle against spinal stenosis. It has now been 4 weeks since I have taken even one of the gabapentin and my pain level did not worsen. I would like to recap that situation for you in regards to the Neurontin.
After I had been treated for my spinal stenosis with injections of cortisone into my spine in July 2002, I also began to take Neuronitn (300mgs), the epilepsy drug three times a day. It was an off-label usage, but the doctor felt it might be helpful in alleviating the pain in my foot. I was able to decrease my intake of the drug to one time a day, but as hard as I would try, I could not completely eliminate taking the drug. My problem in eliminating the drug entirely revolved mainly around my fear of the pain level increasing back to the 6-7 level from the 2-3 level that I was at. A lot of that is due to the psychological fear that I had, but once you have experienced the pain of spinal stenosis, the fear does not go away.
I tried to eliminate the drug several times before this last time, but each time before this last time, I would give in once my pain level got back to 4-5 for fear that it would worsen. I finally was able to stick to the elimination of the drug entirely on this last attempt.
In my opinion the thing that has helped me the most in the battle with stenosis has been the physical stretching and walking exercises that I have tried to do on a daily basis. There are three different stretching exercises that I do repetitively three times each day. If you have stenosis I am sure your physician or medical professional has given you physical exercises to perform to help your condition. I think that the most important element to make the exercises helpful is that you be as relaxed as possible when doing them. You have to find your own comfort level in doing them. I found that in my own case this meant doing the exercises late at night at home on my rug was the most relaxing way for me to do them.
I will not describe the three exercises that I do, because each of you has your own physical regimen to do. There are days in which I only do about one-third of the prescribed amount either because of physical pain that I am in, or because I am not mentally prepared to do them on a particular day, for whatever reason. Every once in a while, I will pass on doing the exercises that day, and even though I do feel guilty for not having done them, I feel that is best for me on that particular day to do none. Most of the days I do the exercises faithfully, and feel more than anything else, this is what has been able to keep my pain level down in the very manageable level of 1-2.
(1/24/05)- The following is an email that we received here at therubins in which the possibility is mentioned between Cipro, the anti-biotic exacerbating the spinal stenosis condition.
In our article which relates what happened to me, I discuss the fact that I was given Cipro to treat the diverticulitis that was discovered when I took an MRI in October 2001. I had already been suffering from a high level of pain at that point, but my pain level did continue to worsen in the ensuing months. Did the Cipro have anything to do with this worsening pain level? I do not know.
Upon receipt of this email, we at therubins decided to ask our viewers if any of them experienced a similar situation. We obtained permission of the writer of the email to publish the question, but we did agree to omit the name of the author of the email. We are not scientists or medical professionals. We would however appreciate your emailing us if you experienced a similar increase in pain level after taking Cipro. Her is the email in question"
I surfed onto your page while researching a possible connection between Cipro and spinal stenosis.
I too was given Cipro for diverticulitis and since then I have developed various neurological problems and had various ligament/muscle pains as well. Prior to Cipro I led an active life.
I'm just a regular person and I am trying to figure out what went wrong. I only just found out I have spinal stenosis in my neck area. I just got the MRI report, last week.
Please, if you have time and are willing, could you look up some websites which have helped me too - If you want to go through Google that's fine. Again I'm just a regular person trying to find some answers. Some of the websites outlining how dangerous Cipro and other FQ antibiotics can be, are: www.fqresearch.org, www.fqvictims.org
Basically I am trying to figure out if the Cipro may have caused or worsened my stenosis. Cipro can and does (re: FDA report) cause permanent nerve damage, narrowing of arteries and permanent connective tissue damage. When I read your page and it described how you were once very active and now consider climbing bleachers an achievement, it sounds just like me now. Just getting around is an achievement now and not something I can do every day.
Any insight either way is very welcomed. Thank you !!
Signed (name deleted)
(12/8/04)-It is now 5 months since I got my spinal steroidal cortisone shot in July. Please keep in mind that I had gotten 2 spinal steroidal cortisone shots in July of 2002 also. I am back to taking Neurontin-300-mg, once a day. Whether it is mental or physical, I am not sure, but just the fear of having the full pain from the spinal stenosis return is enough to keep me on the pill. Last Saturday I was able to take a long, long walk with only relatively little pain to impede me, so I am now going to stay on the one-a-day regime for a while. At worst the pain only rises to about a 3 level which is no problem, but the fear of it going back to the 10 level is still with me.
When I ordered my refill from Medco Health Services, which is the prescription benefits manager used by my employer through whom I must re-order my medication, I was advise that the prescription had been changed to gabapentin from the Neurontin as called for in the prescription.
When my physician wrote the prescription for Neurontin he checked the box that allowed the pharmacy to substitute a generic version of this drug if one was available. I have no objection to the substitution whatsoever. Under my company's prescription drug plan, I pay $35 for the prescription instead of the $70 as my co-payment, since the cost drops if a generic is used as a replacement for the brand name drug. I will keep you posted if I notice any difference when I take the generic drug instead of the brand name drug.
(10/16/2004) Alpharma said that a federal appeals court had lifted an order blocking it from selling a generic version of Neurontin, which is Pfizer's 4th largest selling drug. The ban was issued in July 2004 after Apotex challenged Alpharma's right to six months of market exclusivity for gabapentin, the curcial ingredient in the medicine. Apotex would like to be able to sell its own generic version of the drug. Alpharma and Pfizer had reached an agreement that allows Alpharma to sell its generic version of the drug. Apotex's appeal of this ruling is set for a hearing on December 6, 2004. Please keep in mind that the prescription drug health insurance companies will not cover a generic version of a drug, while they do cover the brand name version of the drug.
It is now almost five months since I cut down on the usage of Neurontin from two 300-mg capsules a day to one 300-mg capsule a day with no increase in my level of pain. As a matter of fact I have actually reduced my intake of the drug to skipping taking it at all every third day. So far so good! Neurontin is prescribed as an anti-seizure medication, and so most of its usage has been for off-label purposes. I still skip taking the drug every third day, and have not changed this routine because of the mental fear within me that the pain will return. Again I do not know if the Neurontin helps, but the memory of the pain level is so great that the fear of its return is still prominently in my mind.
Ivax Corp. has introduced its generic version of Neurontin called gabapentin, which is in tablet form as opposed to the capsule form that Neurontin comes in. Pfizer is also introducing its next generation of the drug called Lyrica, and is presently trying to get FDA to approve the drug. Lyrica, also known by the name of pregabalin, was approved in Europe as a pain and seizure medication in July. The FDA has given Lyrica the "approval" for treating the pain from nerve damage caused by diabetes, for a painful side effect for shingles, and as a treatment to cut down on seizures in epileptics.
Well I almost made it to the two-year mark before I needed to get another steroidal cortisone shot for my spinal stenosis. On July 2, 2004 I got what thus is the third one of these shots, with the first one having taken place on July 13th 2002. The administration and procedures for the shot was exactly the same as I wrote about later in this article.
This time the pain was emanating from my right buttock area and was a dull pain rather than the extremely sharp pain in the left leg area that I wrote about earlier. This dull pain did not occur when I was walking but only took place after I was sitting for about 1/2 an hour. The pain would disappear if I stood up and walked around for a minute. The only time that this was truly a problem was when I was driving my car for a longer length of time.
I went to my orthopedist who had x-rays taken of my pelvic area. The x-rays showed no broken bones so he once again referred me to the same pain management doctor that I had used for my earlier problem. That doctor had me take an MRI. The MRI showed that I had some compressed discs in my lower back, and also some slightly herniated discs in the lower spine. I have been told that herniated discs are a leading probable cause when pain arises as a result of sitting.
I took the shot on July 2, 2004 and it should take between 3-5 days before I can tell if it is helping me. I have learned from my earlier experiences with the shots to give it an even longer period of time to see if it is working.
About two months ago I cut down on my intake of the Neurontin to one 300-mg pill a day from the original amount of three pills a day. So far I am doing just as well on the one pill a day regimen as I was doing on the two pill a day regimen. I am not having any major problem with my left leg. I would judge the pain level in the left leg as between a 2 to a 3 so it really is not a problem.
On May 15, 2003 I went to a Yankee game at the Stadium and I sat in Row V, Section 3, Upper Deck Reserved. I will not forget that day for the rest of my life. That row is second from the top of the upper deck at Yankee Stadium. Pre-spinal stenosis I never would have even given a second thought to what an accomplishment it was to climb to that level of the stadium. Post-spinal stenosis I have learned to appreciate all the simple physical accomplishments that I had never even given it a thought about before.
The big question in my mind deals with the taking of the300-mg dosage of Neurontin. I am using it for off-label purposes, since the medication is approved mainly for epilepsy. Although my doctor has told me that I can take the medication for a prolonged period of time, I am not a "happy camper" to be taking any extra medications. Please keep in mind that the original prescription called for taking the drug three times a day.
Incidentally, Teva Pharmaceutical Industries of Israel announced that the FDA had tentatively approved its generic version of Pfizer's Neurontin. Annual sales of Neurontin were about $2.7 billion worldwide in 2003, with about 85% of the sales being made for off-label usage. Analysts expect generic versions of Neurontin to become available early next year. The drug has been prescribed to about 10 million patients since it was introduced in 1994.
I realize that taking steroidal cortisone shots is not good for the rest of the body's system, but as anyone who has this disease can tell you, it is a very painful disease. A petition has been filed with the FDA,by a personal-injury law firm, Finkelstein & Partners (Newburgh N.Y.), asking that the agency act on claims that the Neurotin may be tied to suicidal behavior. The law firm has filed three lawsuits against Pfizer on behalf of people who committed suicide or attempted it while on the drug.
The petition is based on the agency own adverse-event reporting database, and it asks that the FDA require the company to add a suicide risk item on its label for Neurontin. According to the petition, the number of suicides reported by Pfizer to the FDA jumped to 17 in the first 6 months of 2003 compared with a total of 8 reported in 2002. In a statement, Pfizer said it remains "confident of the safety and effectiveness of this product".
I have received several e-mails from readers so that I have gained some additional knowledge about the disease. In my own particular case if the shots did not work, the next step would be a nerve blockage procedure. Incidentally several of you have written to say that the insurance carriers, Medicare and Medicaid have taken a very long time to approve the nerve blockage procedure for coverage. The problem seems to be that there is no assurance that the nerve blockage procedure will work. I do not have any statistics to indicate what the success rate is for the nerve blockage procedure, but the fact seems to be that there is no guarantee that it will work. As will all know, when you are in great pain you are willing to try anything.
Spinal stenosis refers to the narrowing of the spinal canal, nerve root canals or intervertebral foramina due to spondylosis or in plain English, degeneration due to aging. Believe it or not, I had never heard of the disease until I became a victim of it myself. One of the purposes of our site is to help older people and their loved ones gain additional knowledge about their problems, and how through knowledge, they can better deal with those problems. I am almost 71-years of age and have always been in excellent health. The only time that I had spent in a hospital besides a few experiences in the emergency room had been when I had an ambulatory operation for a hernia 5 years ago. In that procedure you do not even stay in the hospital for one day.
There is an interesting book that has been written by Dr. James N. Dillard with Leigh Ann Hirschman (Bantam Books, $24,95) which deals with the topic of examining different alternatives to help you manage and soothe chronic pain. The name of the book is "The Chronic Pain Solutions: The Comprehensive Step-by-Step Guide to Choosing the Best of Alternative and Conventional Medicine". Dr. Dillard is on the faculty of Columbia University College of Physicians and Surgeons and at the University Pain Center in Manhattan. He is a medical doctor, an acupuncturist and a chiropractor.
He writes that "Chronic pain does more than hurt, it takes control over the way you live." Chronic pain in some form or other affects more than 50 million Americans. It ranks third as a health problem in the United States behind heart disease and cancer. The book examines the best of what Western medicine offers along with alternative therapies, such as diet.
The book deals with pain that arises from all levels such as from migraine headaches to neural disorders. He discusses and agrees with the usage of painkillers if needed, but he also devotes a good portion of the book to getting the pain under control with as few drugs as possible or none at all.
In this article I will continue to update you about my problem with spinal stenosis, and how my treatment is evolving. I will not name any of the physicians or hospitals involved in my treatment.
I would rate my pain level in my left leg and groin area at the 2 1/2-4 1/2 level, with a 10 being the highest level of pain. From this evaluation you can see that I therefore am rating my pain level as manageable. Although I do realize that the steroidal shots will wear off at some point, and that the pain level will increase, I am quite comfortable with living with that thought in the back of my mind. I can walk very long distances again, with no problem at all. I have now resumed all of the physical sports such as tennis that I played before the problem arose.
I can not say with any degree of assuredness that it is the Neurontin that is helping me accomplish this comeback. I have now reduced the Neurontin to taking it only once a day and so far the pain level has not increased to any great degree. I do not know that staying on the Neurotin is entirely "safe", but I have experienced the pain that stenosis can bring on me, and I can do without that "pleasure" very nicely thank you. The foot doctor and the pain management doctor both have advised me that, to the best of their knowledge, I can stay on the Neurontin for a long time without it having any major negative effect on me. I have experienced a slight level of nausea lately but it is not too bad a problem.
As of this date I have some pain in my left leg, and I have had some pain in the groin area around my right leg. I have been taking Neurontin, as was prescribed for me by the physician who examined my left leg in connection with the pain from the tibialis muscle and sural nerve that I discuss later in this article. I can do physical exercises and walk because the pain is not that bad. I am aware of the fact that Neurontin is approved for epilepsy, and its usage in connection with my pain problem from the sural nerve is an off label-usage. Yes I do worry about its safety, but when one has excruciating pain as I did have, I had to have something that would help alleviate the pain.
I received my first steroidal cortisone shot on July 13th 2002 and my second shot on July 31st 2002. There were 2 different times right after having gotten the second steroidal injection when I did have a high enough level of pain that I did set up an appointment for the nerve blockage procedure. In both cases the procedure was set up to take place two weeks after I had called it in. I was therefore able to postpone them both times since the pain level decreased to manageable levels in the interval before the procedure was to take place.
Someone I know who also has spinal stenosis told me that the H.M.O that he
belongs to has denied his application to have the nerve blockage procedure done
on him. He has appealed the decision, but unfortunately, the process is taking
months to evolve even though he presently is in great deal of pain. As of this
date that individual still has not received the needed approval for the
procedure from his H.M.O.
In spinal stenosis, the spinal canal, which contains and protects the spinal cord and nerve roots, narrows and pinches the spinal cord and nerves. In most cases this results in lower back and leg pains. I never did encounter any lower back pain at all, but in its latter stages I did have a great deal of pain in my left leg when I walked or sat down. The primary causes of spinal stenosis are heredity and aging. To the best of my knowledge I think my problem resulted from aging rather than from heredity. The disease is sometimes referred to as lumbar stenosis also.
A little over four years ago I began to encounter a slight stinging pain in the area around the inside of my left femur bone. At the time I even thought the pain might have been coming from the left groin area itself. The pain was intermittent and I thought that it might be the reappearance of the hernia problem. I mentioned it to my physician and he sent me to be checked out for the possibility of a hernia. I was examined and it was diagnosed as not being a hernia problem.
I ignored the problem for a while since it was not that painful a situation. As time passed I began to get a pain in the outside area around the left femur bone as well as in the inside area around the same bone. My physician then sent me for a MRI, which took place about October of 2001. The MRI revealed that I had diverticulitis. I was treated for the diverticulitis with the anti-biotic Cipro for 10 days. MRIs can reveal spinal stenosis although no such determination was made in my case.
The pain then began to extend to the exterior area around my left kneecap as well as the some other areas of the left leg. I also was experiencing a great deal of pain in my left tibialis anterior muscle and all my left leg toes except for the big toe were slightly swollen and not readily flexible. In the following months I also went to see a vascular doctor, and also a neurologist all to no avail.
I was told to take it easy and not do as much exercise and walking as I have been accustomed to doing. I have been an avid exerciser and walker all my life. As an example I walk to and from work every workday no matter what the weather is for many, many years. I will walk to wherever I have to go to in the city, never using public transportation because I love walking so much. At this point I will add that I never did stretching exercises before I exercised or played ball and that was a big mistake on my part. I now do my basic stretching exercises every day and feel that they have helped alleviate my problem somewhat.
My pain continued to worsen so that by June 20, 2002 I could no longer walk to work. I went to an orthopedist who x-rayed my spine and determined that the discs in my lower spine were compressing leaving very little room between the discs.
I was given several stretching exercises to do that might help with the compression of the discs in the lower spine. I also went for a CAT scan, and it was determined that I had spinal stenosis. By this time I could not walk more than 25 feet without having to stop so that the pain could abate. I decided to try acupuncture also because as we all know when you are in pain you will try anything that might help alleviate it. Ultimately I went to 4 sessions with the acupuncturist. The acupuncture did not help my problem.
My orthopedist referred me to a pain management specialist who gave me an epidural steroidal injection. My epidural steroidal injection consisted of a cortisone injection in the epidural area in the lower spine, which is the area that surrounds the spinal cord and the nerves coming therefrom. The injection is intended to reduce the swelling and/or inflammation of the nerves in that area. If the first injection does not help relieve the pain you can try having a second shot a few weeks later in the hope that the second shot will do the trick. Three cortisone shots within a 6-month period of time is the maximum that the physician would administer to me.
I was given the first shot in the pain management doctor's office on July 13, 2002. I sat up on the doctor's table and he then administered a local injection to the area near my spine somewhere between the mid to lower back. The purpose of that injection was to numb the area preparatory to the steroidal injection. A minute or two later he administered the steroidal injection very close to my spine, after having felt the spine to ascertain exactly where he wanted to inject the needle. That whole procedure lasted 5 minutes at most. After he had finished I was told to lie on my side, on the table for 15 minutes and rest. I felt no pain from the procedure whatsoever, and I was able to leave his office and take the train to work.
I estimated that my pain was about 90% gone after the injection. Two weeks later on July 31, 2002 I was given a second steroidal injection since I did continue to feel some pain in my left leg. I was able to walk to work after having rested for a short while after underging the same procedure as I described above. I went for physical therapy for a two sessions thereafter and I now do stretching exercises daily.
Thereafter I went to see a physician, who specializes in legs, since I still had some pain in my left tibialis anterior muscle, pains emanating from my left sural nerve and swelling in my left foot by my toes. The doctor prescribed Neurontin, which is a drug that is usually used in connection with epilepsy. In my case the Neurontin hopefully would relieve the pain in the leg. I was to take the Neurontin (300-mgs) three times a day.
It is difficult to tell whether or not the injection will work in all cases and the extent of pain relief if any that it will afford. The injection will gradually wear off, and there is no telling as to how long it will be good for even if it works. A maximum of 3 injections is recommended at most in a 6-month period of time.
As far as I am concerned I am quite happy to be walking again. My pain management doctor had told me that if the shot did not work, the next step would be a nerve blockage procedure that is done in the ambulatory surgery area of the hospital. I have read that there may be some side effects as a result of the shot such as weight gain, increase in blood sugar level on a temporary basis, water retention and suppression of the body's own natural production of cortisone. I have not had any or these negative effects so far.
We recently received an email from Emily Schultze, the marketing associate for a site named www.spine-health.com requesting a linkage from our site to theirs. We visited their site and found it to be really terrific in regards to information about back and spinal pain. We highly recommend your taking a look at this site.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting a Nursing Home"
by Allan Rubin
updated November 28, 2014