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What causes painful injection site on thigh after having epidural shots?

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Posted on Mon, 16 Mar 2015
Question: I had a radiofrequency done 7 weeks ago. I have severe degenerative disc disease in my lower back. I had the epidural shots and they were fine. then I had the radiofrequency done on my lower back on left and right side. My left side is fine. When I touch the injection site on the right side and right side and my right outer thigh, it is tender to touch. Why after 7 weeks is this bothering me like this? Is it a complication, a side effect? Any thoughts would be appreciated. Thanks
doctor
Answered by Dr. Vivek Chail (13 minutes later)
Brief Answer:
Possible irritation of lateral cutaneous nerve of thigh at its root

Detailed Answer:
Hi XXXXXX,
Thanks for writing in.

I have read through your query in detail.
The outer side of the thigh is supplied by lateral cutaneous nerve of thigh. This nerve has origins in the lower back and courses along and supplies the skin in the area on the outer thigh.

It looks like there is pain originating due to pressure over the nerve roots at the origin of the lateral cutaneous nerve of thigh or some where along the course of the nerve.

This could be a preexisting problem or due to irritation of the nerve roots after treatment.

It is important to know how you felt before the treatment and soon afterwards. This might require a specific repeat session of treatment after having a detail discussion with your doctors.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (17 minutes later)
Hi. thanks for the information. I did not have this problem before the radiofrequency. It started right after. Are you saying that maybe the trauma from the nerve burning might have caused this? would it be so tender and sore to touch at the injection site too? Also, I am not sure if I understood right, but did you mean having another radiofrequency would help? If not, what would help? This is driving me crazy as it has been 7 weeks already. Thanks in advance
doctor
Answered by Dr. Vivek Chail (6 hours later)
Brief Answer:
Please find details below

Detailed Answer:
Hi XXXXXX,
Thanks for writing back with an update.

Please find my observations below.
1. You might have undergone medial nerve branch radiofrequency neurotomy and like any other procedure, this is also not free from potential complications.

2. Pain can be present at the injection site which starts just after the radiofrequency procedure. This happens is few people and unfortunately you are having this. This pain can also be more than the initial pain in some patients.

3. The nerve do not get affected completely and still remain irritated and this causes pain including at the injection site.

4. Radiofrequency neurotomy might require repeat sessions for better pain relief. Radiofrequency neurotomy is a temporary solution and as such the patient might start feeling pain at the end of 9 months or more.

5. You need to get back to your doctor as it has been 7 weeks. The maximum time one can wait in anticipation of pain relief from this procedure is 4 weeks. Please consult your doctor and discuss if you require further sessions.

6. If your pain persists after repeated sessions then surgical treatment might work. However, I urge you to try more sessions before giving up.

Wishing you quick recovery.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (4 hours later)
Thanks so much for the follow up. Is there any way I could see what is really going on--like an xray, MRI etc. I am not sure if anything would show nerve type damage. Your #2 statement sounds to me that I might have had a complication. It is strange because it bothers me when I touch the injection site. Thanks!
doctor
Answered by Dr. Vivek Chail (59 minutes later)
Brief Answer:
Please find details below

Detailed Answer:
Hi XXXXXX,
Welcome and thanks for writing back with an update.

The X ray will not be of much use in your context. It does not show much details of soft tissues and therefore not a suitable investigation.

MRI will show soft tissues and nerves in detail but then unless there is any infection at the injection site, that can be suspected only after examining you clinically, other findings on MRI will not show any significant change.

I recommend that you have a word with your doctor who performed the procedure at the earliest.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (11 hours later)
Hi. I do have a follow up with my pain management doctor next week, and at that time I will address my concerns. But,in your dealings with this pain when I touch the injection site, does it ever go away or is it something I might have to deal with the rest of my life. I was just curious as to your thoughts and in your opinion, would another radiofrequency help matters at all or anything else? Just wanted to get an opinion before I see my doctor. Thanks so much. You have been very helpful
doctor
Answered by Dr. Vivek Chail (32 minutes later)
Brief Answer:
Your incompletely blocked nerve can be blocked totally in a repeat session

Detailed Answer:
Hi XXXXXX,
Welcome and thanks for writing back with an update.

Having seen radiofrequency procedures, in my opinion the pain at the injection site is most likely a result of incomplete controlled nerve destruction. This means the nerve in the region remained partially treated and this needs another round to make you feel better.

By radiofrequency what we do is controlled nerve block and sometimes the nerve is not blocked enough to cut the pain impulses from reaching the brain where the impulses continue to be processed and pain is felt.

Considering that the nerve block on the right side has remained partially successful, another session might render it completely blocked.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (23 hours later)
Thanks! That makes a lot of sense. I am in hopes that this will eventually go away. If I do have to have another radiofrequency , I am assuming the injection site wont get worse when I touch it? Thanks again for all your help!
doctor
Answered by Dr. Vivek Chail (6 hours later)
Brief Answer:
Avoid touching the injection site for few days after second radiofrequency

Detailed Answer:
Hi XXXXXX,
Welcome and thanks for writing back with an update.

I do hope a second session will help treat your pain completely.
It certainly wont get worse, please avoid touching the injection site for few days after your second radiofrequency. You can also ask your doctor for ointment to be applied over the injection site to reduce toe pain following procedure.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (17 hours later)
Hi. on top of this, I have been having pain in my right groin. Sometimes its hard to walk. I dont think this is related to my back. Is it? I am thinking my hip. Thanks so much
doctor
Answered by Dr. Vivek Chail (1 hour later)
Brief Answer:
Nerve root irritation in back can cause hip and groin pain in the area

Detailed Answer:
Hi,
Thanks for writing back with an update.

The pain due to irritation of nerve roots of the lateral cutaneous nerve might be made worse by walking and standing but relieved by lying down with the hip flexed. It can also be felt at times in the groin and hip. Keeping in mind the tenderness over the right outer thing, all these symptoms might be due to nerve irritation at the back.

I wonder if your hip X rays show any changes that might be causing the pain. If your earlier hip X rays have been normal and this started after the radiofrequency session then the nerve root irritation is more likely.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Vivek Chail (11 hours later)
Hi. Thanks again for the info. Really appreciate it. So in your findings overall, radio frequency will help degenerative disease for the lower back. I am hoping this was the right way to go. If I have degeneration in my hip. what options do I have. thanks so much in advance
doctor
Answered by Dr. Vivek Chail (7 hours later)
Brief Answer:
Please find details below

Detailed Answer:
Hi XXXXXX,
Welcome and thanks for writing back with an update.

The hip is a ball and socket joint. In most people, the head of femur bone called the ball develops surface degenerative changes and the hip joint movements are made painful and difficult due to this.

Initial treatment of hip joint arthritis includes not allowing the affected side to bear weight, frequent rest and doing physiotherapy. If this does not help then the patient might get relief by taking pain relief medications and injections.

If there is severe degeneration causing limitation of movements at the hip joint then there are two types of surgery procedures, a hip joint resurfacing surgery where the affected ball of the hip joint is covered with a flap to protect and reduce friction during movements and the other method is by doing hip replacement surgery where the ball is replaced by a metallic ball and the socket is also resurfaced with a metal shell.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (48 hours later)
Hi. I went to pain mgt today. He gave me a shot by the injection site. I forget the name but it was a numbing and steroid shot. Right now my leg feels like it is sleeping a little. I could walk on it. He also said that my groin pain could be coming from my lower back too. Does this all make sense?. I am surprised my leg feels this way. Is that normal? Thanks in advance
doctor
Answered by Dr. Vivek Chail (1 hour later)
Brief Answer:
Things are more clear and nerve roots were causing your pain

Detailed Answer:
Hi XXXXXX,
Welcome and thanks for writing back with an update.

Good to know that your pain at the injection site has been attended to. The picture is more clear now and the nerve roots are origin of the pain. The groin pain also is coming from lower back. Hoping the effect of the injection continues for a longer period and keeps you comfortable. Things are going as expected but still I suggest you do not participate in heavy physical activities that might increase your pain.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Vivek Chail

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What causes painful injection site on thigh after having epidural shots?

Brief Answer: Possible irritation of lateral cutaneous nerve of thigh at its root Detailed Answer: Hi XXXXXX, Thanks for writing in. I have read through your query in detail. The outer side of the thigh is supplied by lateral cutaneous nerve of thigh. This nerve has origins in the lower back and courses along and supplies the skin in the area on the outer thigh. It looks like there is pain originating due to pressure over the nerve roots at the origin of the lateral cutaneous nerve of thigh or some where along the course of the nerve. This could be a preexisting problem or due to irritation of the nerve roots after treatment. It is important to know how you felt before the treatment and soon afterwards. This might require a specific repeat session of treatment after having a detail discussion with your doctors. Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek