Epidurals and Nerve Damage?

[10sox]

The other thread about epidurals got me thinking. I have had 2 large disc herniations. My recent MRI's show no reason for my pain (no nerve compression). The pain is in my buttock and radiates down my leg. My buttock and back of thigh is also partially nurab.

Anyway, I have been getting epidural injections every few months. They really do help with the pain, but of course don't last more than a few weeks. So here is my question: Why do the epidurals take most of my pain away? Can nerves themselves be inflamed? Or is it something surrounding the nerves that are inflamed that then press on the nerves?

I am being told nothing can be seen on an MRI and since I have been partially nurab and in pain for almost a year now, it must "just" be nerve damage.

Thanks for reading this.

 

[Justoneofus]

You have two "large disc herniations". I think that's cause enough for pain and pressure at those areas and of course the rest of your spine having to act diffferently from those discs not being in a normal state. Discogenic pain can be very very painful just as others that press on the nerve.

Also, if you believe it could be nerve damage, have you discussed with your doctor about getting and EMG test done to see if you have any nerve damage? But if nothing is pressing on a nerve, maybe there is no nerve damage.. so an EMG can help confirm or dismiss this.

What levels are herniated? L4/L5 & L5/S1?

Also do you know what areas they are injecting you at? Is it the discs themselves or possibly in the facets? Do you have any hypertrophy in the facets at all?

 

[mznell]

Hi 10sox,

You ask many good questions. I don't think back docs mean to be vague. I think it is just such an inexact science that for most things they cannot give you the answers we wnt to hear.

First, many things don't show up on the imaging. What has the doctor told you is the reason for your pain? There could be scarring from the herniations that is pressing on the L5-S1 nerve root. I don't think there has to be visible nerve compression for there to be nerve irritation...but the fact that you are nurab, and have radiculopathy indicates some nerve involvement, somehow!!

SteroiRAB in general work to bring down inflammation. The fact that you get some relief from the ESIs is a good indicator that for whatever reason, there is inflammation pressing on a nerve root. When the steroid is injected, it bathes the nerve roots and calms them down.

I can't really comment further without knowing if you have disc involvement, stenosis, a cyst, etc. There are many things that could be irritating a nerve root. For example, if there is a tear in the outer merabrane of the disc, a chemical often leaks out and causes the surrounding area to become irritated. This would include the nerve root.

Other possibilities might be issues with the piriformis muscle or the SI joint, and pelvic floor dysfunction is another thing that can mimic lower back problems.