Precise Approach

Epidural injections allay back pain from herniated discs.

During her working career, Elaine Johnson, 76, managed the production of a major corporation’s proposals for projects up for bidding. Merging data from multiple sources, editing text and inserting graphics on tight deadlines was stressful work.

Photo by Nerissa Johnson.

Elaine Johnson

A West Virginia native, Elaine is convinced that the stress of her job greatly contributed to a long-term issue with back pain, one that she long kept at bay through the use of a combination of therapies.

Over time, the pain intensified and eventually threatened to interrupt her laid-back retirement lifestyle, where she was content to relax with her husband, volunteer in the community and work in her garden.

“For at least twenty-five years, I experienced muscle spasms in my back,” Elaine divulges. “Twice a month, I went to a chiropractor and a massage therapist, and they pretty much kept the spasms down. But after I moved to Florida, my back got worse.

“The pain became excruciating. My back ached and throbbed, and it was unbearable. It was like a toothache, and to me, that’s one of the worst pains you can have. The pain throbbed, stopped for a couple of seconds, then throbbed again. And I never knew when it was going to start up.

“It hurt to do everything because of the throbbing. The pain kept me out of the garden and interfered with my sleep. Then, I didn’t want to get up in the morning because my back hurt so bad. The pain was really severe for about eight months, and during that time, I didn’t do much of anything except go to doctors.”

Among the doctors Elaine visited were a neurologist, a pain management specialist and an orthopedic surgeon. These physicians used several techniques in their attempt to relieve her pain, including physical therapy and injections to block the irritated nerves in her back. Unfortunately, their treatments didn’t provide the relief Elaine desired.

“I’d been to every physical therapist in the region,” Elaine remarks. “I even tried acupuncture, but nothing helped. The only medication I take on a regular basis is an antidepressant, and the neurologist switched it to one that’s good for pain, but that had no effect. At that point, my family doctor recommended Dr. McGreevy.”

Kai McGreevy, MD, is a board-certified neurologist and pain management specialist at McGreevy NeuroHealth, which has offices in Palm Coast and St. Augustine. Dr. McGreevy uses a wide range of advanced therapies to treat pain and many other conditions associated with nerve disorders. He uncovered the reason for Elaine’s excruciating back pain.

“When Elaine came in, she reported pain in the region of her thoracic spine, which is the mid back,” Dr. McGreevy discloses. “This area was tender to the touch, and her pain was made worse with coughing, sneezing and bearing down. She described the pain as an electric shooting sensation in the middle of her back that radiated around to her side.

“Elaine’s MRI showed disc herniation as the result of degenerative disc disease. Because she had already tried conservative measures, including physical therapy and over-the-counter anti-inflammatories, we recommended specialized injections called transforaminal epidural steroid injections to relieve the inflammation surrounding the spinal nerve roots exiting her damaged discs.”

Photo by Nerissa Johnson.

Elaine, shown here with Lucky, feels fortunate to have found Dr. McGreevy.

Slightly Off Center

The cushioning discs between the vertebrae of the human spine have a hard, outer layer and a soft, jelly-like, inner core. Over time or because of an injury, the outer layer can break open, or herniate. When this happens, some of the jelly-like material leaks out and puts pressure on nearby tissues, including nerves. That’s what happened to Elaine, Dr. McGreevy informs.

“Not only did Elaine’s MRI show her disc herniation, it also pointed me to the inflamed nerve roots exiting those discs that were the likely cause of her pain,” he notes. “I performed a nerve conduction study to confirm those were the nerves involved, then we moved on and began the series of injections.”

Transforaminal epidural steroid injections are specifically placed in the back by a trained specialist using fluoroscopic (continuous x-ray) guidance.

“In the injections, we use the combination of a nerve pain blocker and a steroid, which is a potent anti-inflammatory,”
Dr. McGreevy explains. “That combination offers pain relief as well as reduced swelling of the spinal nerves. This takes the pressure off the irritated nerve roots and provides relief, which can last for months.

“Transforaminal is a technical approach to the target nerve. With the classic epidural, the labor or interlaminar epidural, the needle is positioned right at the midline of the spine. The problem with that is the medicine doesn’t necessarily get to the site where the disc is encroaching upon the nerve root.”

The transforaminal approach enables the physician to safely position the needle slightly off midline so the area injected is closer to the site of the injury. It is a technique that produces improved outcomes for patients with nerve root inflammation that Dr. McGreevy is specially trained in.

“Transforaminal epidural steroid injections are performed under local anesthesia,” the doctor reports. “The injections are very comfortable, they take less than five minutes to perform and their results speak for themselves.”

Sudden Satisfaction

When Dr. McGreevy performed Elaine’s transforaminal epidural steroid injections, he explained that she might not gain relief from her pain right away, and he was right. Once they did take effect, though, the relief proved to be long-lasting.

“I received the nerve blocks two years ago in January,” Elaine recalls. “About three weeks later, I was driving along when all of a sudden I realized I wasn’t in pain anymore. I remember it well. It was February 12, 2017 when my back stopped hurting, and it hasn’t hurt since.

“It’s been more than two years, and I haven’t had any back pain. On a scale of one to ten, the pain was a ten before the injections. Now, it’s zero.”

“On a scale of one to ten, the pain was a ten before the injections. Now, it’s zero.” – Elaine

With zero pain, Elaine can sleep soundly at night and be active during the day. She credits her turnaround to Dr. McGreevy and his injections.

“Today, I feel really wonderful, and I’m out there gardening whenever I can,” she relates. “My massage therapist says I’m the healthiest seventy-six-year-old she knows.

“I absolutely recommend these injections to anybody with back pain, and I’ve endorsed Dr. McGreevy a number of times already. When people on Facebook ask about a neurologist or somebody for back pain, I recommend Dr. McGreevy and McGreevy NeuroHealth all the time. They’re wonderful!”

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    • Kai McGreevy, MD

      Kai McGreevy, MD, is board certified in neurology and pain medicine by the American Board of Psychiatry and Neurology. The American Board of Independent Medical Examiners also certifies him. His medical training includes completion of a neurolog... Read More