Cortisone shots and low back

[ams]

Anyone have experience with cortisone shots for chronic low back pain? Side effects? Most of the studies I've found were on knee and arthritic problems. Also, the lit seems to suggest that cortisone treats symptoms, not causes, and will resurface eventually. This is for a friend: he's been seeing a PT for about 6 months with some improvement, but not much. His MD is recommending cortisone and possibly surgery. He did try chiropractic but the DC thought that a different modality would work better. Has anyone tried acupuncture? Thank you for your thoughts.

[ericb]

Do you know if his problem is disk related - have they had an MRI?

[sexual_chocolate]

Anyone have experience with cortisone shots for chronic low back pain? Side effects? Most of the studies I've found were on knee and arthritic problems. Also, the lit seems to suggest that cortisone treats symptoms, not causes, and will resurface eventually. This is for a friend: he's been seeing a PT for about 6 months with some improvement, but not much. His MD is recommending cortisone and possibly surgery. He did try chiropractic but the DC thought that a different modality would work better. Has anyone tried acupuncture? Thank you for your thoughts.

 

what's the current diagnosis?

[spotly]

I'm considering cortisone for my torn rotator as well. Recognizing that it's mainly to get the inflammation down enough to relieve some pain while it's healing. I'm just nervous that it'll allow me to push the PT harder than I should without even recognizing that it's too much.

[ericb]

I've had lots of low back pain, and about 8 years ago, I was trying to figure out what was causing it. I had some bulging disks, and I had what appeared to be a congenitally misshapen facet joint. The physiatrist wasn't sure which if either things was causing the pain, so he used cortizone as a diagnostic tool. The epidural injection didn't help, ruling out the disk (supposedly), and a follow-up injection in the facet joint didn't help, ruling that out.....hmmmm. Basically two injections of cortizone, and no relief. Now the disk is officially herniated, but my pain is less (thanks to stretching, stengthening, ice, and inversion) than when it was "bulging".

 

There are probably many more knowledgeable about the medical effects, buy my understanding is that cortizone can weaken connective tissue. Ask your doctor if they are sure of what is causing the pain, or using it more as a diagnostic tool to eliminate possible causes. If they are pretty sure of what's causing the pain and that this will help, it might be worth it. If not, the side effects of cortizone may not be worth it. Also, if you can manage the pain without it (stretching, ice, etc.) it might not be worth it.

 

In my experience pain is one of the symptoms of nerve impingement - another impact is the interference with nerve signals and associated muscle weakness. In my case this caused a deficit in my glutes/hips muscles (external rotators), leading to poor knee mechanics, and according to my PT was very likely to be a contributing factor to my torn ACL. With that in mind, I like the fact that I have some pain to tell me when I need to step up the maintenance.

[marylou]

One shot is generally ok, but it's not something a person should make a habit of doing.

[billcoe]

Anyone have experience with cortisone shots for chronic low back pain? Side effects? Most of the studies I've found were on knee and arthritic problems. Also, the lit seems to suggest that cortisone treats symptoms, not causes, and will resurface eventually. This is for a friend: he's been seeing a PT for about 6 months with some improvement, but not much. His MD is recommending cortisone and possibly surgery. He did try chiropractic but the DC thought that a different modality would work better. Has anyone tried acupuncture? Thank you for your thoughts.

 

NO WAY! NO WAY! Are you shitting us? F dude! Poor bastard must have hit the bottom. Having had unbelievable bad back pain I sympathize.

 

In MY experience, MD's don't know SHIT about backs and necks but they can't bring themselves to out themselves and just proclaim their ignorance AND total stupidity on the subject. It's bad- they absolutely don't know jack shit but don't want to be thought of as blithering idiots ...but they truly are in this instance. Even a short time around them as they bluster and pontificate and a layman realizes how Friggan dumb MD's are in this area.

 

In fact they are too f*cken stupid to realize how friggan stupid they are. Thats how bad it is and you almost pity them except they keep f*ucking people like your friend up for life due to their stupidity and ignorance. Cortizon shots? Chrrrisst! God they're arrogant dumbasses.

 

[font:Arial Black]LAYTON? [/font] Where are you? Sh*t, where is the dude? Dudes posting about womens clothes right now I'll bet. Link for important info on sizing womens clothing

 

 

I'd defiantly explore my options but #1 on the list would be calling Dr Mike Layton or someone like him. That's exactly what I would do, F*ck the corizone shots, don't get crazy! I speak from personal experience. MD's don't know shit. Treat the cause - not the symptoms.

 

Layton just graduated and started running a ad on CC.com on the front page if you want to contact him. The guy who brought me out of back pain hell retired and 3 chiros later I learned that not all are created equally. But: thats where I'd be.

 

Christ dude! ...Good luck, it's got to be bad for your buddy. I speak from one who had extreeeeeeme pain, MD's suck, start with a chiropractor. I'm serious. Really.

 

Good luck.

[layton]

Hey! I was busy at work all day....

 

Anyway, just like any field, there are good MDs and bad ones, just like chiropractors. If chiropractic just isn't working, then by all means, explore other avenues. I would start with an MRI to see what's going on. One cortisone shot shouldn't kill ya, but usually they don't help much for low back pain. It may, however, take the edge off enough for the chiropractor, accupuncturist, physical therapist, and/or massage therapist to start doing some good.

 

It just depends on what the problem is, so I'd get an MRI if I were your friend. If nothings shows, then try a bunch of differnt treatments to find what works. If it is the disc, I would go with the chiro, sometimes it takes a bit more time to get over the hump (which the cortisone may do ... but don't get too many shots!!!).

 

Everyone is gonna say their treatment is the best, or course, so I'd start with least invasive to most invasive.

 

If your friend wants a consultation, he or she can certainly meet with me, I won't charge for talking with him/her.

[catbirdseat]

I've been dealing with low back pain myself. It's always stiff and sore in the morning when I get up. After an hour or so of movement, it loosens up and seems fine. It started after I'd spent a lot of time standing on a ladder installing windows and painting.

 

This has been going on for about a month. I've been doing a lot of hard labor every day and I think maybe I just will have to take a week off for it to get better. What do you think, Mike?

 

I have no history of herniation. The last x-ray and MRI was about five years ago and didn't show anything abnormal for someone my age. That was the last time I had a bad strain from a fall.

[layton]

Sounds like a biomechanical issue and what I treat daily. You're more than welcome to come in, or get a referral to someone else.

[catbirdseat]

I might be able to get insurance to pay for it. PM me with you office number.

[kweb]

Also, the lit seems to suggest that cortisone treats symptoms, not causes, and will resurface eventually. Has anyone tried acupuncture?

 

From what I learned after having low back pain for 8 years, doing everything possible, then finally getting my pain taken care of with surgery.........Cortisone is basically a super strong anti inflamatory. It can provide "long term" relief but if the cause of the pain is not corrected, the pain will return. I had two cortisone injections. Neither gave me any refief. I did get some relief with acupuncture but it took appointments once or twice a week for a number of weeks. And once I got back to strenous exercise, the pain (sciatica) returned.

 

The source of my pain was from many things combined. I had some mis shaped foramen, 3 herniated disks, and some torn ligaments. There was a ton of inflamation and scar tissue. I had a three level laminectomy with diskectomy less then a year ago. Although full recovery is likly to take 1-2 years, I have been feeling better then I have in many years.

 

I would recommend that your friend try everything possible and give each treatment time. Because I was able to do just that, and recieved only little if any, short term relief, I have no regrets of the surgery.

 

Thats just my opinon.....

[layton]

And a good opinion it is!

[marylou]

As Kweb said, cortisone is like getting a super strong anti-inflammatory. It's not uncommon to get six months of relief out of a shot, and that can help in getting another type of fix/therapy in there while the inflammation is down, or before getting something that's a possible permanent fix like surgery. About three years ago I got a cortisone shot into one of the ankle joints to carry me over to surgery. I worked fantastically well for about six months until it wore off and then it hurt like hell.

 

A couple of caveats about getting cortisone: for us young folks (under 60) docs generally only want to give one or maybe two shots because cortisone can cause joint degradation (arthritis in my case) and that's worse than the cure. If it's a muscle thing, it can be a permanent fix because the inflamed muscle gets rid of inflammation and can heal. Operative word being CAN, doesn't always work. I didn't get my surgery until three days ago, so my plan fell apart.

 

From my very limited experience with cortisone shots (just a few over my life) it can be EXTREMELY painful to get the shot. The last one was into the joint between the talus and the heel bone and it was the most painful thing in my life. Ever.

 

All good to know before making the choice to get a cortisone shot--and I'd never get one without knowing exactly what the problem was that the shot was supposedly treating.

[sk]

i had cortezone shots in my feet this summer and i thought i was going to die. my feet hurt like hell before the shots and hurt a million times worse after. i got no pain relief from the shots AT ALL.

 

the idea is that the shots will reduce swelling. that is not the experience that i had. my suggestion would be to get a second opinion. find someone who will help you deal with cause of the back pain.

 

 

 

 

[sk]

Anyone have experience with cortisone shots for chronic low back pain? Side effects? Most of the studies I've found were on knee and arthritic problems. Also, the lit seems to suggest that cortisone treats symptoms, not causes, and will resurface eventually. This is for a friend: he's been seeing a PT for about 6 months with some improvement, but not much. His MD is recommending cortisone and possibly surgery. He did try chiropractic but the DC thought that a different modality would work better. Has anyone tried acupuncture? Thank you for your thoughts.

 

NO WAY! NO WAY! Are you shitting us? F dude! Poor bastard must have hit the bottom. Having had unbelievable bad back pain I sympathize.

 

In MY experience, MD's don't know SHIT about backs and necks but they can't bring themselves to out themselves and just proclaim their ignorance AND total stupidity on the subject. It's bad- they absolutely don't know jack shit but don't want to be thought of as blithering idiots ...but they truly are in this instance. Even a short time around them as they bluster and pontificate and a layman realizes how Friggan dumb MD's are in this area.

 

In fact they are too f*cken stupid to realize how friggan stupid they are. Thats how bad it is and you almost pity them except they keep f*ucking people like your friend up for life due to their stupidity and ignorance. Cortizon shots? Chrrrisst! God they're arrogant dumbasses.

 

[font:Arial Black]LAYTON? [/font] Where are you? Sh*t, where is the dude? Dudes posting about womens clothes right now I'll bet. Link for important info on sizing womens clothing

 

 

I'd defiantly explore my options but #1 on the list would be calling Dr Mike Layton or someone like him. That's exactly what I would do, F*ck the corizone shots, don't get crazy! I speak from personal experience. MD's don't know shit. Treat the cause - not the symptoms.

 

Layton just graduated and started running a ad on CC.com on the front page if you want to contact him. The guy who brought me out of back pain hell retired and 3 chiros later I learned that not all are created equally. But: thats where I'd be.

 

Christ dude! ...Good luck, it's got to be bad for your buddy. I speak from one who had extreeeeeeme pain, MD's suck, start with a chiropractor. I'm serious. Really.

 

Good luck.

 

WORD BILL!!! MD's dont know shit about feet either. i got more help on this site from mikey and from the PT i saw than i did from either of the MD's i saw here in town. I don't blame my family doc but the PODIATRIST i saw should have helped and didn't. find the cause. it may be something you never expected.

[moira armen]

I have had a bulging disc for over a year now and it's reluctant to heal...well, I am reluctant to give up my lifestyle and so it's healing slower. I did PT for about 7 or 8 months and still do exercises daily plus swim a couple of days a week. Saw my chiro yesterday and she said I am doing everything right. She recommended something called "prolo therapy" I am not the one to say if that would be right for you or not, but you might want to ask your chiro about it.

 

I found that my chiropractor was much more helpful and knowledgeable than my MD, who pretty much just gave me a much needed prescription for antiinflammatories and painkillers and offered to refer me for a surgical consult. No thank you!!! My PT was also super awesome and extremely knowledgeable.

 

"Prolo therapy" is something that naturopaths do. It involves injections into the tissue to increase the inflammation thereby encouraging faster healing.

[layton]

Moira,

Prolotherapy is either done by MDs or Naturopaths. Before singing up, see how many the doctor does a year. Also, see what they are injecting. Naturopaths are gonna use more herbal-based and MDs will use more pharm based solutes and solvents. The most common is just water and sugar.

 

The purpose of prolotherapy is to create a controlled amount of inflammation in the joint to promote the formation of scar tissue in hypERmobile joints. A radiograph of the joint in closed packed position and then stressed (like a flexion extension study) should indicate the hypermobility. Most of the time, the doctor is just "guessing" whether it's hypermobile or not - usually a joint that does not respond to repeated (a few months) manipulative therapy.

 

One problem with the treatment is the joint wasn't hypermobile, and the other is that it indeed was, but now you've overdone it and it needs to be loosed up...just enough, to get back to stability. Very successful in SI joints, Wrists, and Shoulders.

 

If I were you I'd shop around between MDs and NDs. If you want the best possible reccomendation, see Dr. David Musnick in Bellvue, WA. He is also the author of Conditioning for Outdoor Fitness by the mountaineers press. And of course tell him I sent you.