Repeating nerve block procedures

Hi Backtolife.

Not to be critical, but why are you getting sedation? Some docs just do it automatically. I've never had it for dozens of injections, 3 ablations, many other procedures, but haven't had your particular one. My pain docs don't even offer it. I was scared the first time. Your nerve plexus isn't the easiest of spots to hit, so maybe your doc thinks he needs to take no chances of your moving. Definitely ask if there's a good reason for sedation. I much prefer brief pain, even if it's bad, to fuzziness.

Whether you get longer relief depends on what's wrong in the first place and what type of procedure is done. I found epidurals don't always last, or even work. For me they seemed to work when I started with pain clinic years ago, but over time they helped less. Maybe the spot you're getting it doesn't hold the steroid well.

Not the same as your injection, but facet joint injections sometimes last, although they are intended a a test to see if RFA should work. I've had some that lasted several months. My pain doc says RFA doesn't help with sciatica, only for spine pain, but it has stopped my sciatica 3 times.

Even ablations (RFA) don't last forever. I've been lucky and had over a year with my lumbar ones. The trick is whether it was the right procedure in the right place to begin with. Probably can't do RFA at the plexus.

Some injections have made things worse for me. I had one in the end of my tailbone that hurts 3 years later.

Again curious, not criticizing, but why are you getting a repeat injection if one worked? Some docs do a series of 3, but mine do only one and repeat it months later if it worked but the pain comes back. I'm sure there is a different theory here. It often takes a few days, even a week for some shots to help. Steroids don't calm down inflammation instantly.

Like Alcie, I don't get sedation. My PM used to do sedation for all his patients. I was the first one who just flat out refused to do it with sedation & honestly, there was no good reason for me to have sedation. If you get super anxious or can't stand a short burst of pain during the injection, then sedation is important, but now my PM only does sedation for people who specifically ask for it, or if he had to cancel a previous procedure due to them moving around or panicking.

I think the number of times something needs to be repeated depends on the patient & the block itself. For me personally, I would never ever repeat the same block more than 3x. If I don't get enough relief by that point to last me at least 3 months, I consider it a waste. Typically, if I don't get relief at one level, my PM will switch to another level, assuming that my pain my be referred pain. Injections are not high risk like surgery, but they do carry some risk. Furthermore, repeated steroid exposure to the same tissue in a short period of time weakens the tissue. There is not a definite consensus about how much is too much, but I've often heard 3x per year at the same level so that's what I follow. There are plenty of people who will insist more than once is too much, or that 3x/month is fine.

I have had three spinal blocks, with varied results. I've never been given anything for sedation except for a small dose of valium prior to the procedure.

The first one worked ok - 10 days of excruciating pain, followed by maybe 2 1/2 months of about 30-40% reduction in pain. I went from not being able to stand/walk for more than a few minutes to being able to stand/walk for 15-90 minutes, and no idea why I could stand longer some times. I still wasn't able to bend forward for activities, which was a bummer.

So we decided to do a series of two injections, four weeks apart, for the second round. The first injection was four months after the previous injection. I didn't really notice at the time (pain brain) but with the first of the series of two I had 9 days of severe pain, and then no real reduction of pain after that.

We went ahead with the second injection four weeks later, and I had about six weeks of terrible pain. This was different than my previous pain, because for whatever reason I wasn't able to get any relief from laying down. Usually if I prop myself with pillows I can get pretty instant pain relief when I lay down. In addition to this severe pain, I have significant swelling in my body, with even more in my left foot/ankle. I also had my skin literally rolling off and some other side effects as well. Apparently I had a reaction to the steroids, so now I don't know if I will get steroid injections in the future.

I don't know where to go from here, because I still can't stand/walk for more than a couple minutes at a time without excruciating pain, and PMD says she has no further ideas for treatment.

I certainly hope that you get better results than I did!