It’s putting it mildly to say that persuading the conventional medical establishment to accept unconventional therapies is a challenge. Our pharmacologically based system doesn’t look too favorably on treatments that don’t involve drugs, surgeries, and medical devices. A case in point is transforaminal epidural steroid injections (TFESI).
Granted, the volume of evidence in support of this therapy is limited. But what evidence exists is very real. Even a recent study released by the American Academy of Neurology (AAN), an organization not normally friendly to alternative treatments, admits limited evidence in support of TFESI.
What They Looked At
A systematic review by AAN analyzed ninety studies that spanned sixteen years. Each of the studies was related to epidural steroid injections recommended for pain caused by radiculopathy (a pinched nerve), spinal cord compression, or spinal stenosis.
Their research determined that TFESI can provide short-term relief for 3 months or longer in the case of pinched nerves. It could also reduce disability in radiculopathy patients for 6 months or more.
The results were not as favorable for patients with spinal compression and spinal stenosis. In both cases, there was insufficient evidence to say that TFESI was an effective treatment. So where does all of this leave us? TFESI is probably appropriate for pinched nerves but no other back issues.
A Minimally Invasive Therapy
TFESI is a minimally invasive injection therapy, according to the pain medicine doctors at Texas-based LoneStarPainMedicine.com. Lone Star recommends TFESI primarily for pain relief related to compressed nerves in the spinal column.
The therapy relies on a medication that is essentially a combination of anesthetic and steroids. The anesthetic provides immediate relief while the steroids work on inflammation. Over time, the inflammation should be reduced enough to offer moderate pain relief.
The key to utilizing the therapy is correctly identifying the affected nerve. By identifying and bathing the nerve with medication, a pain medicine doctor can offer at least some relief.
Relief in Other Parts of the Body
TFESI is not intended as a pain-relieving therapy for other parts of the body. Nonetheless, pain relief elsewhere is a possibility. On their website, Lone Star Pain Medicine offers the example of a patient experiencing pain in the neck and shoulder because of a herniated disc pushing on a nearby nerve.
Treating the nerve with TFESI reduces inflammation. As a result, it is not just the patient’s back pain that is relieved. Corresponding pain radiating into the neck and shoulder are also reduced.
A Simple, Outpatient Procedure
To perform the procedure, a doctor first identifies the affected nerve using fluoroscopy. Once the nerve is identified, the patient lies face down on an exam table. A local anesthetic is applied to numb the skin.
From there, the doctor turns back to fluoroscopy to guide a needle through the skin and to the affected nerve. Medication is then injected. It bathes the nerve and immediately starts going to work.
A brief observation period normally follows this simple outpatient procedure. Within 20 to 30 minutes, the procedure is completed, and the patient is ready to go home. Some patients will experience temporary pain at the injection site. It could take a day or two before a patient’s back pain begins to subside.
Talk to Your Doctor About It
TFESI is definitely an alternative treatment for persistent lower back pain. While the evidence in support of it is limited, it is still there. It is still real. If you are suffering from back pain because of nerve compression, talk to your doctor about TFESI.
