Lumbar canal stenosis is one of the most common causes of Low Back Pain that occurs in many active patients, especially those in their late 50’s and 60’s. The symptoms may begin many years earlier, sometimes 5-10 years, and over 2-3 months become more severe and cause the patient to become less active and the pain medications no longer give as much pain relief. The patient’s family usually states their spouse, parent or sibling is having pain that is not relieved with medications and is not able to enjoy their usual daily activities. The patient’s MRI indicates “degeneration of the disc(s)” and maybe even the small joints in the lower back.
Lumbar Canal Stenosis
Symptoms
- Walking and standing become limited due to pain
- Pain gradually worsens in the lower back and or buttocks over several months
- Can walk a certain distance before pain begins
- Pain is relieved by sitting
Causes
- Degeneration of discs
- Overgrowth of small facet joints
- Narrowing of the spinal canal causing pressure on the nerves and inflammation
Treatment
Lumbar Canal Stenosis is usually related to the natural and irreversible aging process; therefore, non-surgical treatment options are aimed at relieving the pressure of nerves that cause the inflammation and pain. Relieving the inflammation decreases the pain and allows the second phase of treatment – Rehabilitation to be effective. The non-surgical options are medications, rehabilitation, and pain management.
Medications/Over-the-Counter & Prescription
Non-steroidal anti-inflammatory medications (NSAIDS), muscle relaxers, and various narcotics and non-narcotic pain medications are ingested to control the pain and minimize the side effects. When the side-effects outweigh the pain relieving effects, the following options are considered.
Rehabilitation/Gait & Balance Program
At The Carrasco Pain Institute we have created a therapy program specifically designed to treat the patient who suffers from Lumbar Canal Stenosis. The program is designed to help relieve pressure off the nerves. Relieving this pressure helps to decrease the pain and numbness associated with Lumbar Canal Stenosis.
The therapy will include heat, E-Stim, stretching, strengthening, gait and balance training, and soft tissue mobilization with massage. The goal of rehab is to increase back movement, strength, endurance and restore function. In many cases, the patient has a greater and more rapid improvement when injections are performed before and during rehab.
Epidural Steroid Injections
What is an epidural steroid injection?
An epidural injection involves the placement of local anesthetic and a small amount of corticosteroid into the epidural space. The procedure may be performed in the cervical, thoracic, lumbar or caudal region of the spine. The epidural injection is performed in an effort to decrease the amount of pain a person is experiencing. The steroid is used to decrease the inflammation of the nerve roots. Epidural injections are often used in an effort to avoid surgery.
What should I expect?
The epidural injection is an outpatient procedure. You will receive a sedative through an IV for the procedure. You will probably not remember much about the procedure. During the procedure the nursing staff will monitor your blood pressure, pulse, respiration, and oxygen level. After the procedure you will be monitored for 30-45 minutes, and after you recover you will be discharged home with a family member or a friend.
How often can I receive an epidural steroid injection?
Many times epidural injections are performed in a series of two or three injections, two weeks apart. Most commonly a person will have no more than three injections within a six month time frame. The total number of injections an individual may undergo is based on the total amount of steroid injected.
Are epidural steroid injections safe?
Dr. Carrasco performs the procedure under fluoroscopic guidance which is a type of x-ray that will allow the doctor to confirm needle placement in the epidural space prior to the injection. After the procedure, you will be given a set of discharge instructions. You will be asked to call our office the next day to update our staff on your condition. The most common side effects are temporary fluid retention, increased appetite, and possible slight weight gain. Individuals with diabetes may note an increase in their blood sugar. We ask you to consult your primary care physician for help with the management of your blood sugar during this time.
The Dr. Carrasco Show : Suffering In Silence
Pain should have self imposed limits… It should have side-stepped someone who has been active all of their lives. It should have respected someone who has dedicated 62 years of his life to serving others. But instead it seeped painfully into the deep recesses of the mind of a man, a man trained to place his trust in God.