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MRI Shows Pinched Nerve In Neck. Suggested With Epidural. High BP And Recovering Cancer Patient. Any Suggestion?
Question: I saw my orthopedic doc last week. She looked at my MRI results. Pinched nerve in my neck, vertebrae 5 & 6th is where the problem lies. Constant pain in neck shoulder down arm to fingers. Tried Vicodin but it doesn't help me.. I stick to plain Tylenol.. She suggested an epidural is the next step. Issues are AFIB on coumindin, high BP, glaucoma, ileostomy, recovering cancer patient ( uterine). So do you have any other options or are you in agreement with the epidural?
Brief Answer:
Conservative management is the initial choice.
Detailed Answer:
Hi, thanks for writing to XXXXXXX
As per your description, you have cervical disc disease with radiculopathy causing you pain in the neck and radiating down into the fingers.
The initial line of management is always by conservative means as follows -
Soft Collar: Soft collar allow the muscles of the neck to rest and limit neck motion. This can help decrease pinching of nerve roots with movement. Soft collars should only be worn for short periods of time, because long-term wear can decrease the strength of neck muscles.
Medicines: Analgesic are needed in the acute phase. Muscle relaxants are essential for relieving muscle spasms once the acute pain subsides. Neurotropic vitamins like METHYLCOBALAMINE (activated Vit B12) or PREGABALIN will help in alleviating the neuropathic pain.
Cervical traction: may enlarge the disc space, permitting the prolapse to subside. Intermittent cervical traction for not more than 30 minutes at a time.
Physiotherapy: Once the acute phase of pain has subsided, Isometric strengthening exercises of the paravertebral muscles are started. Improving neck strength and flexibility with simple exercises may lessen discomfort and pain. Moist heat can be useful.
If your symptoms are not improving with the above measures, then Epidural steroid injection is indicated. Generally, these injections will provide a significant improvement in the symptoms for over few months.
As like any other invasive procedure, Cervical Epidural steroid injections are also associated with few risks and complications (though the incidence is very less & infrequent) like non-specific headache, transient lightheadedness, nerve root injury, epidural hematoma, subdural hematoma, stiff neck, hypotension, respiratory insufficiency, epidural abscess, cord infarction and cerebellar infarction etc. All these complications may not occur in each and every individual but they have to be considered in your case owing to the comorbid conditions you have and your age factor. So, the risk-benefit ratio has to be taken into account in your case.
So, I suggest you to consult your treating doctor and discuss the issues.
Hope I have addressed your query. Happy to help further
Regards
Conservative management is the initial choice.
Detailed Answer:
Hi, thanks for writing to XXXXXXX
As per your description, you have cervical disc disease with radiculopathy causing you pain in the neck and radiating down into the fingers.
The initial line of management is always by conservative means as follows -
Soft Collar: Soft collar allow the muscles of the neck to rest and limit neck motion. This can help decrease pinching of nerve roots with movement. Soft collars should only be worn for short periods of time, because long-term wear can decrease the strength of neck muscles.
Medicines: Analgesic are needed in the acute phase. Muscle relaxants are essential for relieving muscle spasms once the acute pain subsides. Neurotropic vitamins like METHYLCOBALAMINE (activated Vit B12) or PREGABALIN will help in alleviating the neuropathic pain.
Cervical traction: may enlarge the disc space, permitting the prolapse to subside. Intermittent cervical traction for not more than 30 minutes at a time.
Physiotherapy: Once the acute phase of pain has subsided, Isometric strengthening exercises of the paravertebral muscles are started. Improving neck strength and flexibility with simple exercises may lessen discomfort and pain. Moist heat can be useful.
If your symptoms are not improving with the above measures, then Epidural steroid injection is indicated. Generally, these injections will provide a significant improvement in the symptoms for over few months.
As like any other invasive procedure, Cervical Epidural steroid injections are also associated with few risks and complications (though the incidence is very less & infrequent) like non-specific headache, transient lightheadedness, nerve root injury, epidural hematoma, subdural hematoma, stiff neck, hypotension, respiratory insufficiency, epidural abscess, cord infarction and cerebellar infarction etc. All these complications may not occur in each and every individual but they have to be considered in your case owing to the comorbid conditions you have and your age factor. So, the risk-benefit ratio has to be taken into account in your case.
So, I suggest you to consult your treating doctor and discuss the issues.
Hope I have addressed your query. Happy to help further
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So I assume that a chiropractor is not the answer.. Not that I tried one.. I never trusted their approach just in case it was critical...I don't want them to cause any more problems.
Actually I think the physical therapist caused harm just under the front upper rib..by massaging that area. It is very touchy now.. It didn't hurt before he was massaging it. So I stopped going to PT and canceled the last two.
My orthopedic doc gave me Vicodin for the pain, but it doesn't work for me..Just dulls everything BUT NOT the pain.. Weird. I have Percocet given for another purpose, but I wonder how that would work? I really am nervous as I don't want to become addicted to pills. But the pain is getting to me.
I am wearing my soft collar 4 times a day. It helps.. Doesn't take the pain completely away, but relieves the strain.
Oy, this is one of the worst things I have gone thru. I can hardly sleep. XXXXXXX
The last 3 years have been challenging, but this one is very stressful and incurs the most pain to deal with.I am trying all non invasive things before I go for the epidural.
By the way, taking Tylenol has raised my BP, as well as not sleeping well.. That has something to do with it..
Any more suggestions.
Thank you.
Actually I think the physical therapist caused harm just under the front upper rib..by massaging that area. It is very touchy now.. It didn't hurt before he was massaging it. So I stopped going to PT and canceled the last two.
My orthopedic doc gave me Vicodin for the pain, but it doesn't work for me..Just dulls everything BUT NOT the pain.. Weird. I have Percocet given for another purpose, but I wonder how that would work? I really am nervous as I don't want to become addicted to pills. But the pain is getting to me.
I am wearing my soft collar 4 times a day. It helps.. Doesn't take the pain completely away, but relieves the strain.
Oy, this is one of the worst things I have gone thru. I can hardly sleep. XXXXXXX
The last 3 years have been challenging, but this one is very stressful and incurs the most pain to deal with.I am trying all non invasive things before I go for the epidural.
By the way, taking Tylenol has raised my BP, as well as not sleeping well.. That has something to do with it..
Any more suggestions.
Thank you.
Brief Answer:
Results of Noninvasive treatment are short lived.
Detailed Answer:
Hi, Nice to hear from you.
I understand your concern regarding the ailment. As rightly said by you, there is no harm in trying all Noninvasive resources for pain relief before going for an Epidural, but you have to accept the fact that any form of noninvasive treatment for Cervical disc disease with radiculopathy offers only short term symptomatic relief. Even the Epidural injections are not going to provide long lasting relief.
So, if you are looking for a permanent solution, then surgical decompression is the only choice.
Hope I have justified your query. Good day
Results of Noninvasive treatment are short lived.
Detailed Answer:
Hi, Nice to hear from you.
I understand your concern regarding the ailment. As rightly said by you, there is no harm in trying all Noninvasive resources for pain relief before going for an Epidural, but you have to accept the fact that any form of noninvasive treatment for Cervical disc disease with radiculopathy offers only short term symptomatic relief. Even the Epidural injections are not going to provide long lasting relief.
So, if you are looking for a permanent solution, then surgical decompression is the only choice.
Hope I have justified your query. Good day
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Dr. K. Naga Ravi Prasad
Orthopaedic Surgeon, Joint Replacement
Practicing since :1996
Answered : 2148 Questions
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