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Epidural injections of steroid medications to relieve inflammation and pain are helpful more often than they are not, but they can be inflammatory and painful in themselves.  

No pain treatment works completely for everyone all the time, and epidurals are not an exception. (The doctor usually gives lidocaine to numb the area where the epidural is going to be applied. The lidocaine shot can burn and sting, but this typically only lasts a few seconds.)

From 5 to 10 percent of people won't get any pain relief at all. Another 15 to 20 percent of injection recipients will get partial pain relief. But up to 75 percent will get complete pain relief at least for a few months. It may take a couple of weeks for the shot to "kick in."

About 98 percent of the time, an epidural at least doesn't make pain worse. However, if a doctor strikes a nerve, there can be intense, "electrical," burning pain that can start in the middle of the procedure and can persist for a long while. Six months to a year of debilitating, hard to treat pain is possible. The doctor may give hydrocodone (Vicodin) or oxycodone (Oxy), which have the serious side effect of risk of addiction, or try treating the pain with old-style antidepressants like amitriptyline (Elavil), which is very inexpensive and works surprisingly well, or pregabalin (Lyrica), which is much more expensive and doesn't.

What about spinal cord stimulators?

There have been about 380 studies of spinal cord stimulators for chronic lower back pain and persistent limb pain after surgery. Generally, you'll get better results if you see a pain specialist at a clinic that does a high volume of procedures using the stimulator device. There are many variations of these devices (there's not just one device and there's not just one company) and your doctor will have to guide you through the choices of the device that works best for your pain.

The simple fact is, spinal cord stimulators don't work for everyone:

  • The longer you wait to start pain treatment, the less likely it is to work for you.
  • Smokers do not get as much pain relief as non-smokers. You may have to weigh the choice between the problems associated with quitting smoking and how much pain limits your daily life.
  • Foot pain responds better to spinal cord stimulators than leg pain, and leg pain responds better than back pain.
  • Pain relief is usually partial, not total.

And only about 60 percent of people respond to spinal cord stimulation enough to be happy with the procedure. Still, most people find it's worth a try.

What about alternative therapies? Acupuncture is reliably better than no treatment at all, but some people won't respond to acupuncture, either. Oddly enough, the skill level of the acupuncturist doesn't appreciably change the results. Clinical trials involving "sham" acupuncture, in which needles were inserted into the "wrong" acupuncture points, worked as well as classical acupuncture.

Massage therapy may relieve pain, although it won't strengthen the back. If you can't lift heavy objects before you have massage therapy, you won't be able to life heavy objects after you have massage therapy, either. However, massage may make activities like walking or bicycling less painful.

Bee venom pharamacopuncture (inserting bee venom at acupuncture points) occasionally is exactly what is needed to relieve chronic back pain. It's not easy to find a practitioner who is trained and licensed in the technique (usually this would be an MD who has studied acupuncture) and it won't be covered by insurance. Results usually take about three treatments and three weeks. 

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