One facet down, one to go

[annapurna]

Well, in hopes of giving some good info to others with the same problem, I'm posting the latest results of my continuing "facet-pain" saga. I've been working with a local sports medicine doc who is willing to really work on isolating the source of my continuing post-ADR pain. We have tried an SI joint injection which was a marginally positive, as well as an L5/S1 intra-articular facet injection (as opposed to medial branch block). The L5/S1 level is where I have my ADR, and it really took a beating over the years that my disc degenerated. I just assumed that the facets there were the pain source. We did the injections with fluoroscopic guidance, used dye to make sure we were in the joint space, then injected a lidocaine/maracain combo. Surprise, surprise - they were totally negative. "Feeling" was believing, I guess. Tommorrow I'll be getting a similar diagnostic at L4/L5, so, I'll see if that joint's the culprit (or at least a contributing factor). Sorting out pain generators is a lot of work, but, really worth it. This last summer I was all ready to get rhizotomy, which, from the looks of things now, may not have helped.

I'll post the results of tommorrow's test for anyone that's interested.

Best luck to all!

Laura
L5/S1 Zeegers Charite
mostly successful, some lingering left-side pain

[Mariaa]

Laura,
Please do post the results of tomorrow's test, I'm interested as I'm sure others are. Is your insurance paying for all the testing done as in under Pain Management diagnostics or medical diagnostics? Hope this question isn't too forward..
So it's sounding like it's not facet pain so far...

[Alastair]

Please keep us informed on this

Best
Alastair

[annapurna]

Mariaa,
Yes, the insurance is paying for all of this (or at least they say they are). As long as I don't leave northern Utah, they are actually quite good at paying up. If I go out of state, I'm on my own (no coverage). This (combined with zillions of frequent flyer miles) is why I often end up overseas for "big procedures" - if I'm paying in cash anyway, I might as well go to the best. Not a forward question at all - thanks.

[Mariaa]

That's great news re the insurance payment of the diagnostics. And smart planning re saving for the surgery overseas. If I weren't tied to a WC case I'm sure I'd be taking my backside overseas also..somehow!

[Jim M2]

Laura,
What would be the diagnosis for various outcomes from intra-articular facet injection as opposed to medial branch block? Is the medial branch the communitcation path for the intra-articular facet nerves?

Jim

[annapurna]

Good question, I'm really wondering that right now as my second intra-articular was also very negative (NO pain relief, at all). I asked my sports med doc who was giving me the injections as my three-level medial branch block in July had seemed somewhat positive. Aside from just a straight-out false positive (between 25% and >50% for single facet blocs of any kind), the medial branch blocks are a little different. Turns out that the medial branch nerves ennervate more than just the facet joints (surprise, surprise). They also ennervate some deep spinal muscles that contribute to stability and can get pulled and irritated, etc. When doc's check for the effectiveness of a rhizo, they often do an EMG on those deep spinal muscles. Based on this fact, I'm wondering whether a part of my apparent positive in July was due to anesthetization of those muscles? The other thing that's making me think that this last set of injections was accurate was the fact that the apparent epicenter of my pain is much lower than my facet joints. I could feel where things were numb from the shot, or the facet capsule felt a bit pressurized from the lidocaine/maracaine mix, and my normal pain was not anywhere nearby.

My next step now is to start looking at other pain generators such as ligaments, muscles, and the SI joint.

Laura

[Mariaa]

Laura,
Now that the facet results are in at least you can let that theory go as to pain generator however I'm wondering where do you feel your pain at? I'm sure you've said this in some of your other posts tho I thought it would be quicker to just ask here~
Your reasoning re the July injections seems to make sense, esp. based on your most recent injection results.
Good luck with the continuing elimination process. Maria

[JeffreyD]

Laura,
This is extremely interesting.
If your pain generator is ligament or soft-tissue related (I assume from damage caused pre ADR or possibly from the surgical distraction), what would the course of treatment be?
Thanks for updating us on your quest,
Jeff

[Jim M2]

Good question Jeff!

Laura,
I know you've put alot of thought into these diagnostics. Do you have any recommendations on which type of injections I should try first?

Thanks,
Jim