facet injections

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RoseCrone
Regular Member


Date Joined Aug 2008
Total Posts : 71
   Posted 8/7/2009 5:06 PM (GMT -7)   
Hi~
I usually post on the fibro forum but I think this question might get more responses here (I could be wrong)!
The Pain Management Center (PMC) wants to try facet injections on me, cervical and lumbar.  The last treatment I got there was trigger point injections (with steriods) that did not work at all.  (Physical therapy -manual work - works better on TrP than the injections!)  I know everything that this PMC does is trial and error...they keep trying different things to see what may help.  They have told me that even if something works it will be temporary since I have fibro.  The biggest problem is the expense (and the probability of the treatment working, even temporarily).  Even with pretty good insurance (I pay 20% of any hospital bills and this is a hospital PMC).  Just the visit with the Dr. that was a very brief exam (to verify I have fibromyalgia) and a discussion of treatment options that might help me created a $1300 bill, of which I have to pay 20%.  The bill for the trigger points has not come through yet, but it will be more than the "evaluation".   I can't imagine the cost of the facet injections, under x-rays.  Probably more than $2000. 
And then of course they may not help, or may only help for a short time.  I have had MRIs, etc and nothing shows any structural issues with my spine.  My PT thinks the pain is the myofacial trigger points and my rheumatologist says bursitis while my chronic illness specialist (sort of a pain doc) says I have fibromyalgia.  The PMC doc verified fibromyalgia with "devons's diagnostics".  Every specialist has their own ideas.  BTW, I was original diagnosed with MPD in 2002, fibro in Jan 2007, and did have a bout of bursitis in my shoulder about a year ago when a cortisone shot helped.  My worst symptoms are upper back, pretty much the whole quarter of my back on my left side, left arm pain (sometimes with tingling), neck pain all around, earaches (not from infections) on the left, TMJ pain both sides, and frequent headaches.   My right side has TrP also but they are "less active".  I don't think I have a muscle in my body that does not have active trigger points.  My left shoulder has been higher than my right for a few years now.  I have been to chiropractors (who have generally made things worse) and several differnent PTs - the one I am with now is the best.   I have pain in my lower back also, hip pain (left) and various other aches and pains that are nowhere near the intensity of the neck/ shoulder/back pain
I have tried all sorts of things over the years.  Cervical traction helped a couple of years ago but now causes more pain.  I use heat, lidocaine patches, various muscle rubs, Soma, Ultram, Klonopin (recently changed from Atavan) and the Rheumy prescribed Roxicet for breakthrough pain because after 2 years I am on the max dose of Ultram and have built up a tolerance so it does not work well.
Probably needless to say I have developed major depression as I am now going through a divorce to top off all of my stressors!  And I cannot tolerate any of the 3 classes of anti-depressants due to side effects (and I agree with those who complain about docs saying "you are in pain because you are depressed" - I was in pain long before I was depressed but I will agree there is a connection between the two).  The klonopin was recently prescribed as a short term relief for anxiety until an anti-depressant can be found that I can tolerate (sure ... I have had some very bad reactions and am scared to try anymore!)
Sorry for such a long post but wanted to provide as much detail to see if others have gone through or are going through what I am AND get different people's opinions on the facet injections.  They scare me physically and financially, especially knowing they could be for nothing.  I am not independently wealthy!
I keep getting told to "suck it up" with the pain but that is much easier said than done!  Or, "you have fibromyalgia, accept it and move on."  I have been trying to just move on.  I do normally work full time as a manager but am on short term disability through work (until I can get stablized again-whatever that really means I am not sure).  The constant crying at work, panic attacks, and calling in sick got to be too much.
Any inputs on facet injections are especially appreciated.
Thanks!
Rose     

RoseCrone
__________________________
Fibromyalgia, TMJ dysfunction, Myofascial Pain Dysfunction, Chronic Fatigue Syndrome, hypothyroid, bruxism, endometriosis, medically induced menopause (everything removed!), major depression, going through a divorce to top it off!
__________________________
Ultram, Soma, Ativan, Lyrica (on and off), Armour Thyroid, Famvir, can't tolerate SSRIs or NSRIs.


Draka
Regular Member


Date Joined Jun 2009
Total Posts : 256
   Posted 8/7/2009 5:53 PM (GMT -7)   
Hi Rose... I am sorry for your pain and also to hear of your pending divorce and depression... sorry... :(

I can let you know I had five cervical facet injections done 12/08 .... unfortunately I did not get any results...

I believe the cost of injections done under a Fluroscope was approx. $1500.

I found the injections to be "creepy" feeling as it wasn't painful just felt weird due to the pressure.

Sorry I can't be of much more help..... but know a lot of us understand here.... feel better!
Lisa


Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 8/7/2009 6:03 PM (GMT -7)   
I know this is not going to help you any, but:

I had 8 facet injections done in my lower lumbar area and it made the pain worse. For almost a year I had a daily 1-1.5 point increase on the pain levels I was feeling prior to getting them done.

Now on the other hand my neighbor lady had the facet injections done a couple of months ago and once she got past the initial pain caused by the medications/steroids ( a few days) she says it has helped her back pain. As far as I know she only has a couple of herniated discs while I on the other hand have those as well as stenosis and arthristis of the spine which may have made the difference. I don't know.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 8/7/2009 8:31 PM (GMT -7)   
Hi, Rose,
Welcome to the CP part of HW. This is all frustrating, isn't it? And I sure get the financial part as I just lost my health insurance (COBRA ended).

I had facet joint injections more as a diagnostic procedure than anything. That was when I was being evaluated for fusion surgery, and they were trying to rule out everything. But I will say that they tried the facet joints because of what was found on the MRI, so I wonder about such expensive injections when you say nothing remarkable seems to show on your MRI.

For over twenty years I've had cervical spine problems that I've managed non-surgically with a lot of PT (and yes, it takes awhile to find a good one), massages (I was still working and could afford deep tissue work - which helped a lot), and doing the stretches and adjusting ergonomics (computer set-up, no more shoulder purses, cervical pillow for sleeping). It didn't cure everything, but all these activities have kept me out of neck surgery and functioning pretty well until I fell and then my lower back got screwed up. So I do think there's a lot you can do and it sounds like you've tried much of it.

A TENS unit might be helpful. I've also used those neck wraps you put in the microwave - now I have them in about every size!! Oh - and a chiropractor made my neck worse, too, and I've since read in a Harvard study that chiropractics is good for the lower back, but can be risky for the neck.

I don't know if this helps, but if there's nothing showing on the MRI, I would tend to tell you to trust yourself, or at least get another opinion - but then that costs money, too! I think - and this is just MHO - I'd tend to spend the money on a good massage therapist!

PaLady

nurse2
Regular Member


Date Joined Jul 2005
Total Posts : 229
   Posted 8/8/2009 9:49 PM (GMT -7)   
Hi Rose,
I've had multiple facet injections of a period of years but I've also had 4 cervical disc surgeries due to Scoliosis and degenerative disc disease. I question their reason for the injections if there is no structural problems.
I'm sorry about your divorce. That is such a horrible thing to go through especially if you have chronic illness to deal with on top of it. Having a supportive spouse can't stop the illness but at least you have a support system. My heart goes out to you.
Nurse2
Degenerative disc disease,osteoarthritis, status post 4 cervical spinal surgeries with plate insertions and fusion, Lupus, Sjogren's Disease, Fibromyalgia, chronic heacaches and chronic pain.
 
Find blessings in every day!
 


Splashdancer
Veteran Member


Date Joined Aug 2009
Total Posts : 927
   Posted 8/9/2009 8:10 AM (GMT -7)   
Hi Rose! I agree with PALady about the TENS unit - it might just help. Insurance might cover it, if not, it retails for around $100 (at least that's what we paid for it). As for the facet injections, I have not had them, but my fiance has. The last injection he had actually made the pain worse. Of course this is only his experience with it, but they didn't do much for my sister either. Just my 2 cents! I hope you find relief soon.

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 8/9/2009 12:09 PM (GMT -7)   
OMG Where do you get a TeNS for just 100????
TWO roads diverged in a yellow wood,  
And sorry I could not travel both  
And be one traveler, long I stood


Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 8/9/2009 12:10 PM (GMT -7)   
LOL my supplies are 135.00 every other month. LOL
TWO roads diverged in a yellow wood,  
And sorry I could not travel both  
And be one traveler, long I stood


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 8/9/2009 12:52 PM (GMT -7)   
Dani,
Didn't your insurance cover it? Mine has - although I can't get them to STOP sending supplies! I think with them it's a bit of a racket because they send the leads and electrodes, which is ok, but the batteries they send are worthless. Last about 20 minutes and done. I had to buy a 9V battery charger from radio shack, and rechargeable batteries. And then they send hand cream and alcohol swabs!

I got the unit at no cost through my PT. At the time the sales rep. gave him some to give to patients as a pilot project, since these are a little different from the TENS. Mine's actually called an Intraferential Stimulator and combines the frequencies of the TENS (made for assistance with pain) with the frequencies that help increase blood supply to the area, so my PT said it's more like the one he uses in his office. My unit is great (not as nice as the one in my PT's office but since my insurance is gone I'll have no more PT!), but the supplies issue, well, I think that's how they make their money.

PaLady

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 8/9/2009 1:15 PM (GMT -7)   
 
Dear Rose,
 
     Good afternoon *huggs* I am glad you stopped by. I dont know if I have ever introduced myself... But!! My name is Dani.  smilewinkgrin
 
     I have levoscoliosis. I would be here all day if I tried to list the problems individually with each vertabre section. Some areas hurt in the curve , others don't *shrugg*... in anycase, I recieve "procedures"  every 3mos. Sometime it is just under $4,000.00 other times, most recently (last 3 set of procedures) , I need a little more and $3,500.00 will be added. I do this every three month. (2x now ive made it 4mo) It IS an option for me as literally all of my pain is inflammation. But, if I were in a position of "maybe it will help, maybe it wont" I think I would be just as torn up about the decision. For me, the injections let me live a normal (sometimes a lil slow  smilewinkgrin  ) life. I really really respond VERY well to those. And the doctors knew before hand they would help , also I got confirmation myself, after my second set of "procedures" in 2008. Basically, right away, very first thing was I no longer need 12 pills, heating pad, hot water & naps. Then within a week had enough mobility to start light exercise. within three weeks I had gained weight, mobility /range of motion, energy, memory, sleep. Within a month I had "me" back (cool and improved "me" at anyrate  scool  ).  I guess im trying to say, for me, the injections was a DRAMATIC differance right away. I think that if you can "try", give it a shot. But gosh it sure is expensive, so want to make sure it is "worth" it.
 
     I do not know of a TeNS unit so cheap  shakehead   But!! I got mine through zynex medical and if you can get your doctor to perscribe you one... you can Rent or Buy. I appreciate the company I go through as they send my supplies without a hassle (but would love to find a cheaper option!!).  I use my TeNS 3x per day for 40mins ea. on 10sec rotation cycles. Works perfect for my busy lifestyle.   smilewinkgrin
 
     I know it is a hard decision to make. But, you will more than likly know right away if they are a good option for you. For me the differance was so dramatic there was no denying the multiple benefits. I hope you have a great day and it was very nice to meet you.
 
*huggs*
  dani
 
  p.s. Thursday night is chat night you should come and hang out with us :-)
TWO roads diverged in a yellow wood,  
And sorry I could not travel both  
And be one traveler, long I stood


Splashdancer
Veteran Member


Date Joined Aug 2009
Total Posts : 927
   Posted 8/9/2009 1:24 PM (GMT -7)   
Dani, I live in Florida. My fiance's doctor ordered a TENS unit and we paid $95.00 - no insurance.

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 8/9/2009 1:24 PM (GMT -7)   
 
Dear PALady,
 
     *huggs* I shouldnt ask here but I will anyway. Are you okay?.. bleh, i have alot to toalk to you about smilewinkgrin   I need to wait
 
But yes!! My insurace covers it, but I do not want to go into the headache of having insurance from another state  smhair
 
You wouldnt believe how much of my insurance companys policy I know by heart... crazyness I tell you! But, I am open to cheaper option FOR SURE! Anyway I can get the discounts, ive gotta give it a try. blush
 
well, I think that's how they make their money.
 
I was just thinking I wonder if I can get them to send just my leads and not batteries... I too have to use a charger. The batteries die the SAME DAY! I mean... sheesh.  You know my daughter lectures me about our trash....   rolleyes     ...shes 8.
 
Sorry rose!! *huggs* I dont mean to ramble in your thread, so sorry!
 
*Huggs*
  dani
TWO roads diverged in a yellow wood,  
And sorry I could not travel both  
And be one traveler, long I stood


Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 8/9/2009 1:46 PM (GMT -7)   
 
 

:-) Can you send me an email with the copany name? I sure would love to get a chepaer option a try. I wouldnt mind paying for shipping.

*huggs*

dani


TWO roads diverged in a yellow wood,  
And sorry I could not travel both  
And be one traveler, long I stood


uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 8/10/2009 7:55 AM (GMT -7)   
 
Facet joint injections are primarily diagnostic injections, meaning that they help your ='CWshowAd(4, "doctor", this);' style="DISPLAY: inline; PADDING-BOTTOM: 1px; MARGIN: 1px 1px 2px; CURSOR: hand; COLOR: #6699cc; BORDER-BOTTOM: #6699cc 1px solid; POSITION: static; TEXT-DECORATION: underline" onmouseout=CWhideAdTimer();>doctordetermine the cause of your back pain but may not provide you with any long-term relief from the pain. These injections eliminate pain temporarily by filling the facet joint with an anesthetic ='CWshowAd(9, "medication", this);' style="DISPLAY: inline; PADDING-BOTTOM: 1px; MARGIN: 1px 1px 2px; CURSOR: hand; COLOR: #6699cc; BORDER-BOTTOM: #6699cc 1px solid; POSITION: static; TEXT-DECORATION: underline" onmouseout=CWhideAdTimer();>medication that numbs the facet joint, the ligaments, and joint capsule around the facet joint.
 
If you can stand the pain of the initial injections it may be worth it to get some relief... I had this done in my back many years ago and it helped for a little bit, and believe me, a little relief is better then no relief.  I understand about the cost, if I didn't have TennCare I couldn't afford even the Dr. visits, let alone any of the procedures...
 
Good luck,
Me. confused

I have been a spectator for so long..Now it's time to participate.......
 
Post Lamenectomy Syndrome, Spinal Stenosis, DDD....
1999 Hemi Lamenectomy/2005 Spinal Fusion(L4-S1)
Methadone 120 mg. a day/  30 mg. Oxycodone as needed(up to 4 x a day)
High Blood Pressure: Lisinopril HCTZ 10 mg. daily
Type 2 Diabetes: (March 16, 2009)
Metformin HCL ER 1000 mg. at night..Glipizide 10mg. 2X in the morning
Lantus 35 units at bedtime with Solostar Pen                                                                   

 


RoseCrone
Regular Member


Date Joined Aug 2008
Total Posts : 71
   Posted 8/10/2009 9:37 PM (GMT -7)   
A big thank you to everyone who responded.  As I thought, this is one of those things that helps some and not others.  And makes some people worse.
As for it being a diagnostic procedure, I have read this before.   I think that the PMC doc is using it that way...if this helps then there are further steps to take with regards to pain from the facets.
I made the decision to go with it earlier today.  After this, if they help or not, I am going to try to get my insurance to pay for a non-hospital affiliated pain management center that does the same sorts of things which should be a lot less out of pocket for me.  Some relief is better than none, as everyone says.
I have used TENS and the other electrical stimulator at PT.  TENS helped a little but not really enough to get one.  My insurance would cover it. 
I had to chuckle about the heat wraps...I have several sizes and shapes.  My favorite has a clay insert instead of gel...really comfy, but the shape is not great.
Again, big thanks and hugs back!
I'll let you all know how things work out, my appt is not until Friday.
Rose
RoseCrone
__________________________
Fibromyalgia, TMJ dysfunction, Myofascial Pain Dysfunction, Chronic Fatigue Syndrome, hypothyroid, bruxism, endometriosis, medically induced menopause (everything removed!), major depression, going through a divorce to top it off!
__________________________
Ultram, Soma, Ativan, Lyrica (on and off), Armour Thyroid, Famvir, can't tolerate SSRIs or NSRIs.


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 8/10/2009 10:57 PM (GMT -7)   
Rose,
If it's being used for diagnostic purposes, then I think you're making the right move. When I had facet injections, that's what they were for, because the surgeon thought my pain was coming from there. So before they did surgery they did nerve blocks, and one series was with the facet joints. Turns out they didn't help, but we were able to rule out that location as the cause.

A lot of hospitals either have payment plans or maybe you can negotiate down your share of the cost, especially if you're having any financial difficulties. I was able to stretch out my share of the hospital bill when I had my surgery. Thank goodness!

Good luck on Friday. Let us know how it goes.

PaLady
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