Epidu­ral in­jec­tions widely used for back pain

Cape Breton Post - - IN MEMORIAM / TV HIGHLIGHTS / ADVICE - Keith Roach

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

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