Klinikkauutisia

Edgar (vieras)

08.07.2012 02:18

the nerve is compress by 70%. She is in a lot of pain. She is in bed all the time becuase of the pain. The doctor wants her to have a surgery. She is affraid.Do you think etanercept will help?The nerve that is pinched will stayed pinched without pain?? Is that right?Thank you for your response.Unfortunately, I find it impossible to give advice. I work on these patients:Now initially I would offer daily B12 shots for 2 weeks given by p... näytä kokonaanatients themselves as it can reduce pain 20-35% probably not help someone tht severe though. A steroid epidural or selective nerve root block given pain specialist might be initial treatment. Etanercept would augment epidural if it failed to give enough relieve. For less severe cases I would:1) Deal with painful quadratus lumborum/psoas I pinch, from behind,around the back and get my fngers in front of quadratus lumborum. I pull it forward with my fingers until it releases some then I knuckle it until it comes out. If it is bad I inject the muscles much like a lumbar plexus block becuase I think these muscles might entrap these nerves some by their spasm.2) Deal with any Maignes' thoracolumbar problems by using an activator thumper/manipulator and massaging rotatories after by running fingers up and down until they let go.3) Deal with any sacral areas by local/steroid injection by Blomberg techniques. Also deal with SI joints a whole talk in self.4) Deal with any medial back iliac crest points by injecting 5% lidocaine repeatedly to numb5) Spend a great deal of time doing repeated transverse stretching to piriformis 15 20 min followed by knuckling out a session up to 3 X week. Some cases have gluteal muscles involved and I would similarly treat though I would needle as well (gluteal ones often come out when thoracolumbar level treated).6)When I was all finished these areas, it then became more apparent where the real pain was coming from Last few severe cases I had, involved the lowermost rib rubbing on the ilac crest and irritating nerve on the ilaic crest mid laterally. There are actually 3 nerves that cross there laterally and so it is easy to get neuropathic level pain from far lateral though they don't feel it there until you take out some of the other areas. There should be 2 fingers between iliac crest and ribs and when the quadratus lumborum is bad, it drags it right down to nothing. When sleeping on side, bottom hip sags and uppermost ribs collide with iliac crst same happens if they draw knees up at night so if they complain sleeping make it worse then wonder if it is this or a piriformis. It rubs when they walk and mimics spinal stenosis claudication (can't walk more that 1-3 blocks due to increased pains)7) If steroid epidurals don't last long enough, , intrathecal midazolam might keep it under control. I find Enbrel works better in conjunction with steroid epidurals though have a couple that get 2 of them every few months or so.8) There are cases I cannot help but are controlled on opioids and anti-neuropathic agentsSo you can see, the decision for surgery comes from a lack of response to conventional therapies. Some, however, go straight to surgery depending on their unique circumstances that have to be decided on a case to case basis. I have one patient with bad pains and pressure on a nerve roots settle with work on piriformis and lateral ilac crest injections -as well as realizing that some of the pain was actually coming from the hip joint either impingement or labral tear -waiting for dye enhanced MRI (doesn't always show it though). Needlle/massage gluteal muscles posteriorly and Cyriax hip mobilizations gave temporary respites.Of course ther are new innovations liked pulsed lower temperature radiofrequency to nerve spinal nerve ganglion at level which might help but I have no experience there. Ozone and botox injections have some benefits Good luck