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Spinal injection relieves pain and restores function.

After more than 30 years as a truck mechanic, Syracuse, New York native David Lewis retired, but he still wields a wrench maintaining several rental properties in Palm Harbor. Recently, however, he started to experience severe pain and struggle at work when a long-time back issue intensified.
“I’ve had a bad back for years,” he relates. “I was in a car accident in 1979, and that’s what started it all. I had a lot of problems with my back, but I found a chiropractor who got me back on my feet.

Photo by Jordan Pysz.

David preps his bike for an upcoming road trip.

“Over the years, I injured my back a few more times, but I always just went to the chiropractor. About two years ago, my back got so bad, the chiropractor said he couldn’t help me anymore. I needed more care than he could give me. He recommended I get an MRI.”
Once David got the MRI, his doctor sent him to a surgeon for a consultation. The surgeon told David that despite the intense pain, his condition did not yet warrant surgery. The doctor suggested pain management and recommended Florida Pain Medicine. There, David met with Stephanie Epting, DO, a board-certified physical medicine and rehabilitation specialist.
“Dr. Epting was fantastic,” comments David. “Within just a short time, I knew she was very smart and knew what she was doing. She made me very comfortable, and she took time and explained everything. I’ve never had a doctor sit down and explain that much to me.”
After a thorough evaluation, Dr. Epting recommended an interlaminar epidural steroid injection to treat David’s pain. During this type of injection, Dr. Epting places pain-relieving steroid medication between the bones of the spine directly to the area where the pain is being generated. It is in that area that delicate spinal nerves are being pinched and irritated.
In 2017, David received his first injection, which gave him several months of relief. By January 2018, however, David’s back pain returned with a vengeance. It was excruciating, and the pain that radiated into his leg made many of his activities difficult to perform.
“My back pain was absolutely solid,” he describes. “It always hurt. It was hard for me to stand up, and I could hardly walk. It got to the point that I was walking with a cane just to hold myself upright.
“I couldn’t do anything. I couldn’t work. I couldn’t ride my motorcycle. Just getting up in the morning was extremely painful. They kept asking me how bad my pain was on a scale of one to ten, and I would say, It’s a fifty! I was miserable and in desperate need of help.”
David’s wife knew the problem was serious when David started taking the medications pills his doctor prescribed for the pain. The David she knew wouldn’t even take aspirin when he was sick.
“When you’re in that much pain, you’ll do almost anything,” he admits.
David returned to Florida Pain Medicine and explained his plight to
Dr. Epting. They agreed to do another injection, this time at a different spot in his back using a higher dose of steroids. Their goals were to restore David’s function, increase his independence and decrease his use of the medication.

Symptom-Based Strategy

At first, David’s back pain ran into his hip and thigh, so Dr. Epting aimed her injection at the spot on his spine where the nerves feeding that area are located. When the pain returned in January, it radiated into David’s lower leg, so Dr. Epting changed her strategy.
“Based on what David told me about his symptoms, as well as new MRI findings, I determined his pain was coming from a different source, a different level of his lumbar spine,” verifies Dr. Epting. “I repeated the interlaminar epidural injection, but this time, I placed the needle lower in his back, to the place corresponding to his pain.”
Dr. Epting notes that how soon after an injection people begin to feel pain relief varies.
“I generally tell my patients it can take anywhere from twenty-four to forty-eight hours before the steroids kick in,” she acknowledges.
The interlaminar epidural steroid injections are minimally invasive and performed in the office at Florida Pain Medicine. Physicians use fluoroscopy (continuous x-ray) to precisely guide the injections to the appropriate area of the spine. Patients remain awake during the procedure but have the option to take a light sedative beforehand to help them relax.
“Using a local anesthetic, I anesthetize the top of the skin,” informs
Dr. Epting. “Once the skin is anesthetized, a small welt is produced by the needle. As I inject and the needle goes deeper, I put in more anesthetic.”
While people scheduled for interlaminar injections can request medication to help them relax, it’s important that they are not completely sedated. Dr. Epting talks to her patients during their procedures and explains step-by-step what she is doing and what they can expect.

“I started to feel relief within a few hours of the procedure. I really couldn’t tell when the anesthesia wore off because I was pain free.”– David

“I want to eliminate the element of surprise during the process,” she says. “I let them know what I’m about to do. I’m drawing up the medication. I’m taking pictures now. You’re going to feel a pinch and burn on the count of three. They know everything that’s happening, and it gives them a sense of control.
“In my experience, this communication helps patients feel more prepared, and it takes away a lot of anxiety. With David, I described the entire procedure to him as I did it.”

Giving Back

It didn’t take 48 or even 24 hours for David to feel relief from his pain after his interlaminar steroid injection in January. Instead, he began to feel better that same day.
“I started to feel relief within a few hours of the procedure,” he marvels. “I really couldn’t tell when the anesthesia wore off because I was pain free. I never thought the injection would be that good and be effective that quickly, but what Dr. Epting did worked.”
With his pain abated, David is back to work without restrictions and has stopped taking the pain medication. He can walk normally, and has put the cane away. He’s returned to doing many of the activities he gave up due to his back pain flare-up.
“I haven’t used the cane in over two weeks,” he enthuses. “And I’m riding my motorcycle again. In fact, I’m going to make a run up to Homosassa and back, and I’m going to do it on the bike.
“I can pretty much do anything I want. I’m working to strengthen my back before I get too wound up. I know I’ll never be one hundred percent because of the condition of my back, but I’m almost there.
“Dr. Epting is definitely doing the injections right for me to not be in pain, not be taking any drugs and just be enjoying life,” he raves. “I’m happy. My wife’s happy because she was worried about me. I’m great now. I can’t say enough about Dr. Epting and Florida Pain Medicine.”

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    • Florida Pain Medicine

      At Florida Pain Medicine, your interventional pain and diagnoses experts, their mission is to help you “RESTORE FUNCTION & RELIVE LIFE.” Florida Pain Medicine offers complete, compassionate, and comprehensive pain care. They provide the la... Read More

    • Stephanie Epting, DO

      Stephanie Epting, DO, graduated from the University of Miami with a Bachelor’s degree in Microbiology and completed her medical degree at the Philadelphia College of Osteopathic Medicine. She completed her residency at the New York Univ... Read More