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Doesn’t respond well to injections

Dear Dr. Roach: At 64, I was in very good health except for moderate hypertension, which was treated with lisinopril. I then had an incident lifting a heavy load, which injured my back. Long story short, three years of pain drove me to have an L4-L5 vertebrae back fusion. I am now 67, and in hindsight, surgery was a bad decision.

Since my surgery, every injection I have received from three pain-management doctors has been ineffective. These included painkillers to target nerves for radiofrequency nerve ablation; steroids at several spots above and below the fusion; and a recent epidural at L6 that was supposed to travel up my spine. The doctors said that relief would come within the hour or several days. These injections have never brought ANY relief. But they do, however, aggravate my pain for the next several days. I jokingly asked my current doctor if he is injecting me with saline solution.

Is my system impervious to the desired effect of these injections? My only limited relief is with hydrocodone tablets, which have other side effects (opioid-induced constipation). It’s sometimes as aggravating as the back pain. — R.S.

Answer: I don’t know why some people respond well to injections and others do not. Most experts do not keep attempting injections if the first one (or maybe few) are ineffective. However, some people have a good response, so it usually is worth a try. There isn’t outstanding evidence of benefit in trials (that is probably because there are quite a few people like you, who have gotten no benefit at all).

Your story is another reminder not to make the decision for back surgery lightly.

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