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Question is related to treatment for back pain, facet joint…

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Question is related to treatment...
Question is related to treatment for back pain, facet joint injections at l4-l3, moderate bilateral arthritis/
Hello, I have facet injections a week ago and feel they have helped to reduce pain, probably about 50 percent. Doc says 50 percent reduction is the amount needed to get insurance toauthorize further treatment for this problem. I think my pain doc will give me the option to do the injections again or do radio-frequency ablation. I can research both of these treatments on my own, but I have a very specific question to ask you, the expert.
The facet arthritis is causing problems with bowel movements and frequent urination, the disc at that level is very healthy and full of fluid This,to me, is more important to address then the actual pain. (However, I understand they can go hand in hand). Of the two treatments I may be able to pick from, which has shown more clinical evidence to help with the symptoms I just mentioned. You can assume I understand the basics of both of these techniques and the injections can be for both diagnostic and therapeutic purposes.
Also, why would a pain management specialist elect to treat the interior of the facet joint and not treat around the exterior of the facet joints (could the exterior of the facet joint be causing the bowel issues?). What questions should I be asking? I am trying to get this done before the end of the year because I have already reached my insurance out of pocket maximums...Thank you
Submitted: 8 months ago.Category: Medical
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Answered in 55 minutes by:
11/18/2017
Doctor: Dr. Bob, Medical Doctor replied 8 months ago
Dr. Bob
Dr. Bob, Medical Doctor
Category: Medical
Satisfied Customers: 5,762
Experience: 20 Years in Internal Medicine, Neurology and Sports Medicine
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Have you had an MRI? Is there any evidence of spinal stenosis or neuroforaminal stenosis?

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Customer reply replied 8 months ago
have done MRI, Both pain specialist (MD) and orthopedic spine specialist agree this is moderate to severe facet joint arthritis bilaterally but no stenosis, the disc at this level has been reported to be very healthy, I was hoping the injections/RA would help me to stay active and keep my back strong....
Doctor: Dr. Bob, Medical Doctor replied 8 months ago

The facet joints are outside the spinal canal. If there are no proliferative changes resulting in spinal or neuroforaminal stenosis then the spinal nerves are not involved. If the spinal nerves are not involved, this should have no direct effect on your bowel or bladder function. Pain itself can sometimes indirectly affect these functions, as can pain medications, but they would not be at risk of damage or permanent injury. That said, facet injections have a much longer history and significantly more clinical evidence of effectiveness than RFA does.

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Customer reply replied 8 months ago
Ok thank you, ***** ***** please comment on the difference between direct facet injections and injections in the immediate area surrounding the facets? Why would a specialist choose one vs the other with bilateral facet arthritis? (I think I understand the reasoning for RFA following the diagnostic procedures).
Customer reply replied 8 months ago
medial branch vs. facet)
Doctor: Dr. Bob, Medical Doctor replied 8 months ago

If you've narrowed down the source of the back pain to a facet, or a couple facets, you want to inject the medication as close to the source (the arthropathy) as possible. Numbing a single nerve in the region may be less effective if there are branches of other nerves involved as well. Think of a larger joint like the knee. There is no substitute for getting the numbing and anti-ingflammatory agents directly into the joint, as opposed to numbing up the area around the joint and hoping you get all the involved nerves.

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Customer reply replied 7 months ago
Hi, I am sorry you havent got your credit for your work. I logged in and noticed I didnt rate you but the system wont let me do so....
Doctor: Dr. Bob, Medical Doctor replied 7 months ago

Thank you for checking in. Did you have your injection? How did it go?

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Doctor: Dr. Bob, Medical Doctor replied 7 months ago

You can rate me at any time now. I appreciate it.

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