Epidural injections widely used for back pain
DEAR DR. ROACH: I have suffered sciatic pain on my left side for over a year, and an MRI revealed spinal stenosis and arthritis. My doctor, who specializes in physiatry, has recommended an epidural injection with ultrasound. While I trust him, I have been doing some research, and am reluctant to go that route for various reasons. Some of the resources I have checked say the benefits are not conclusive. I asked about acupuncture, and he said it would be an option. I already have tried physical therapy and more-conservative measures. What would you recommend? — M.M.
ANSWER: Epidural injections (the epidural space is located just around the spinal cord) usually are performed with some type of visualization, such as X-ray or ultrasound, and they involve injecting a local anesthetic (which wears off in a few hours) and a steroid (which can last for weeks). They are widely used. However, a 2014 study showed that although there was a small benefit of adding steroid to the local anesthetic at three weeks, after six weeks from the injection, that difference was no longer significant. Adverse effects were seen in 22 percent of the steroid and anesthetic group versus 16 percent in the anesthetic-only group. Although this difference was not statistically significant, even a 15 percent risk of adverse effects is pretty high ( fortunately, serious adverse effects were rare).
You asked about acupuncture. There are no high-quality studies evaluating acupuncture as there are for epidural injections; however, several small studies have shown improvement in pain scores. Acupuncture is probably safer than epidural injection, but no medical procedure is free of risk. There are many well-documented cases of pneumothorax (collapsed lung) from acupuncture, although the absolute risk is very small.
Physical therapy, including exercises done in the water and bicycling, are the mainstay of conservative treatment. I have consistently argued for caution before considering a surgical treatment for spinal stenosis, but some carefully selected people will benefit from surgery.
DEAR DR. ROACH: My husband had an MRI about 10 years ago before back surgery, and we were informed that he has only one functioning kidney. The other is atrophied and useless. We were not told that he needed to take any precautions, but now I wonder if we should have asked more questions. Are there any medications or foods he should avoid? He is 54 and otherwise healthy. — S.H.
ANSWER: I’m not sure why your husband’s kidney is atrophied. There are several possible causes, but the most likely is congenital dysplasia, meaning your husband likely had this at birth. Chronic infection is another cause, but normally this is comes with symptoms and isn’t incidentally discovered, as your husband’s apparently was.
People with one functioning kidney generally have no problems and need no special diet or medication restrictions. The other kidney increases its function to (mostly) make up for the other kidney’s absence.
In studies of people who have donated a kidney, the rate of progression to end-stage kidney disease was small but slightly increased compared with people with two kidneys. The risk of high blood pressure may be slightly higher.
For someone in your husband’s situation, I would recommend good general care of his remaining kidney — a healthy diet, avoiding dehydration and keeping away from high doses of medicines that can affect the kidney, such as ibuprofen and Tylenol. In very large doses over years, they can cause kidney disease. Occasional doses are fine.
TO READERS: The booklet on heart attacks, America’s No. 1 killer, explains what happens, how they are treated and how they are avoided. Readers can order a copy by writing: Dr. Roach — No. 102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery. Dr. Roach regrets he is unable to answer individual letters, but will incorporate them in the column whenever possible. Email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com. (c) 2015 North America Syndicate Inc. All Rights Reserved