Pain Management

Today I ventured over to the Wausau Bone and Joint clinic.  They have a very nice facility there.  My appointment was with Dr. Sahota to evaluate my pain and determine what treatment options were available to me. 

I spent a good amount of time talking with the medical assistant about my pain and how it has been limiting me in the past couple of weeks.  She assured me that Dr. Sahota had spoken with Dr. Messerly (who I had been seeing previously) and that she had already looked over all of the images that had been taken.  She asked me about my pain goals for the next 6 months.  I quickly told her that the only acceptable level of pain in 6 months time was 0!  This has already dragged on for too long.

When Dr. Sahota came in, she sat down and gave me the 60 second bio on how she came to be working in pain management.  She also let me know that while she wasn’t a runner, she was a mountain biker and she understood how hard it was for me to not be able to do what I love to do.

As soon as she started the exam, she noticed that my toes were almost purple.  (I wore sandals and the A/C was working overtime in the office.)  She asked if my toes were always that color.  I told her that I had Reynauds and that I was always cold, even in the summer.  She immediately suggested that we move to a room across the hall that had an electric heater.  Much warmer.  And my toes pinked right up!

She went through much the same exam that everyone else has done.  She tested my strength in my lower extremities.  She tested my reflexes and my ability to discern dull or sharp sensation.  She measured my range of motion and then had me lie down on the exam table to check which areas of my back elicited pain when she pressed against them.

She came to the determination that the it was the facet joints that were causing the pain.

Basically, they were compressing the nerves.

The treatment is going to take a while.  There are four components to the typical treatment.  The first step is a Medial Branch Block.  This is an injection that is done into the medial branch nerve.  Under X-ray guidance, she will inject a numbing medication into the nerve to see if it will offer any pain relief.  She will be injecting at three different spots on the right side—along L3, L4 and L5.  The hope is that I will get at least 75% pain relief from this type of procedure.  But, the relief is temporary-typically only a few hours. 

The procedure is repeated a second time, two weeks later.  The patient is not told what is being injected so that there are fewer chances for a placebo response.  And it probably keeps people from scouring the internet searching for answers from Dr. Google.

Two weeks after the second injection, I will have another office visit with Dr. Sahota and talk with her about the relief that I experienced after the injections.  Hopefully, I will be able to tell her that I got good relief and we can go on to the next step in the treatment…a Medial Branch Neurotomy, a couple weeks after the office visit appointment.

This procedure is ‘semi-permanent.’  Most patients have pain relief for 6 months to 2 years, or more.  Basically, she will (under X-ray guidance) use heat to ‘burn’ the part of the nerve that transmits pain signals to the pain.  Eventually, the nerve will regrow, but nerves grow slowly, and once they have been damaged, they don’t always grow back along the same pathways.

There is a little bit more info about both procedures here.

So after all this, I looked at her and asked her when I could run again.  She said I could run right now, if the pain didn’t stop me.  But seriously, she said that after the neurotomy, I could probably start running.  She didn’t think that I would be able to run the Twin Cities Marathon in October.  When I asked her about running the Madison Marathon with Tim in November, (at a slower pace, with walking breaks) she said ‘possibly.’  She said that if there was a fall half marathon, she felt I could be ready in time for a conservative effort there.

At this point I cried.  For two reasons.  I was mourning the loss of the Twin Cities Marathon.  And I was anticipating the possibility of being able to run again by the end of the summer.  There was more crying in the car after the appointment. 

I scheduled the first injection for June 23rd.  That was the earliest they could get me in because of the doctor’s schedule and because they need to get preauthorization from my insurance company.  The second injection is scheduled for two weeks after that. 

I will need a driver for these appointments and I’m hoping that my dad will be able to take me.  I don’t have an exact time for the procedure yet because any diabetic patients get to go first.  Can’t have them going for very long without food!  Bone and Joint will call me the Friday before to let me know what time to be there.

I won’t be able to eat anything before the injection.  I’ll have to check into the Surgery Center, since they consider this a procedure.  They will also require me to take a urine pregnancy test before the procedure because of the dye they use.  That would be the biggest surprise ever. 

The procedure itself doesn’t take a very long time, but they will give me some Valium to help reduce my anxiety and to help relax the muscles in my lower back.  Just another reason I need to have a driver to get me home.  Smile

In the meantime, I am to continue taking the Gabapentin as I have been.  I don’t want to take any more, so I’ll stay at the current dose in the hopes that it is actually tamping down the pain a little bit.  And, I can keep swimming.  I told her that my bike ride over the weekend caused me some pain.  She said I could try again in a few days, but that I should listen to my body and stop if it hurts.

So, I’ll keep you posted on things as it gets closer.

Has anyone else ever had this procedure?  Any ideas on recovery times?


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s