Three Shots and You’re Out … of Pain!

Series of injections alleviates agony of pinched spinal nerves.

Patricia Dougherty had friends living in St. Augustine, and visiting them occasionally was all she needed to fall in love with the city. So, when she retired from her investment relations job in New York City, she knew exactly where to go. In Florida, Patricia enjoyed her retirement until a mishap occurred six months ago.

: Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated the pain in Patricia Dougherty’s low back radiating into her right leg using transforaminal epidural steroid injections (TFESI).

Patricia Dougherty

“It was very strange,” she recalls. “I was going to the gym three days a week, playing tennis and having a wonderful life. Then, I went to bed one night, woke up the next morning and could barely walk. I had no idea what happened. I didn’t know if I did something to my back in my sleep, or if it was something that had built up over time.

“I was in excruciating pain, and it radiated down my right leg and into my ankle. On a scale of one to ten, the pain hovered between an eight and a ten. I couldn’t do anything. Just walking around my house was painful, and I couldn’t stand for any length of time. At night, my ankle would throb, so I wasn’t getting much sleep either.

“At the beginning of the year, I was scheduled to start volunteering at the museum downtown, but I couldn’t do it because of the pain. I had to put those plans on hold. The only time I didn’t have pain was when I lay on the couch with my leg up. It was a very difficult time, not the way I planned on spending my retirement.”

Looking for answers, Patricia went to an orthopedic surgeon, who ordered x-rays and an MRI. He diagnosed a herniated disc. To treat it, the doctor gave Patricia several epidural injections into her back and sent her for physical therapy.

“The therapy helped a little,” she reports. “When I went back to the orthopedic doctor, I told him I had some relief, but it wasn’t enough. I still couldn’t function. He thought I might need another level of treatment, so he referred me to Dr. McGreevy.”

Kai McGreevy, MD, is a board-certified pain management specialist at McGreevy NeuroHealth. Dr. McGreevy has a variety of advanced therapies at his disposal to treat pain, especially that associated with nerve disorders. He suspected Patricia’s intense pain was caused by pressure on the spinal nerves at the site of the herniated disc.

“Patricia’s pain continued to get worse after conservative measures,” notes Dr. McGreevy. “Those included physical therapy, anti-inflammatory medications, heat and ice, and a home exercise program. Patricia’s pain worsened to the point where she was experiencing numbness and tingling in her leg. These facts pointed to nerve involvement.”

Distinctive Technique

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 with 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. That is what happened to Patricia, observes Dr. McGreevy.

“After an evaluation, Patricia’s orthopedic surgeon determined that she had degenerative disc disease and a herniation at one site on her spine,” he describes. “When I reviewed the MRI, I saw that the leaking disc material was threatening the nerve root at L4/5 in her lower back, and this was most likely the cause of her pain.

“I followed up with a nerve conduction study that confirmed Patricia had not only a chronic injury, but also an acute-on-chronic injury, meaning she has an ongoing and a recent injury to the surface of the nerve root. Something had to be done quickly to help repair that nerve root. Otherwise, it could lead to serious problems with movement in her right leg.”

To repair Patricia’s nerve root and relieve her pain, Dr. McGreevy suggested a series of three specialized injections called transforaminal epidural steroid injections. These minimally invasive injections are very 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,” informs the doctor. “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.

: Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated the pain in Patricia Dougherty’s low back radiating into her right leg using transforaminal epidural steroid injections (TFESI).

Patricia says the steroid injections worked great for her.

“Transforaminal is a technical approach to the target nerve. With the classic epidural, the labor or interlaminar epidural, the needle is positioned right at 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, however, enables the physician to safely position the needle slightly off midline so the area injected is closer to the site of the injury. This approach also minimizes the risk of a common complication of interlaminar epidurals called postdural puncture headaches. At the same time, it produces improved outcomes for patients with nerve root inflammation. Dr. McGreevy is specially trained in this approach.

Fading Memory

Now that Patricia has completed her transforaminal epidural steroid injections, she understands why the treatment is done as a series of three shots. Because she was patient and went through all three, she’s sleeping again and back to most of her activities.

“The results of the injections appear progressively,” she relates. “By the third shot, I had considerable relief. Now, I’m back to the gym three days a week, and I volunteer at the museum one day a week. I can now stand and walk for hours.

“I’m still afraid to play tennis, but that’s just me. Playing tennis was the last thing I did before this back thing happened, so psychologically, I’m not ready to get back to it.”

Patricia remembers when her pain level topped the scale of one to ten, but since her injection therapy, that memory is starting to fade. Her level of pain since completing the treatment barely registers on the scale.

“My pain now is between zero and one,” she says. “I might get a little pain, but that’s really only when I push myself too hard during exercise. Dr. McGreevy told me to be careful. I needed to get back to my normal routine slowly.

“When I start feeling good, I think I’m fine, then I get a little twinge and realize, Maybe I’m not one hundred percent yet, but I’m ninety-nine percent.”

Grateful for her recovery, Patricia lauds the pain management specialist and his staff for their knowledge and sensitivity. She says she knew she was in good hands during her initial appointment at McGreevy NeuroHealth, where she was wowed by Dr. McGreevy’s approach to her situation.

“I was so impressed by Dr. McGreevy’s thoughtfulness,” she states. “Not just thoughtful in being kind, but thoughtful in thinking through my issue, what other factors might be involved and what he could do about it. He approached my case in a very methodical, thoughtful way, and I appreciated that. Plus, he listened to me. I felt heard.”

Patricia also praises the staff at McGreevy NeuroHealth for making her visits positive and productive.

“The steroid injections worked great for me,” she shares. “I’ve already told a few of my friends with back issues about McGreevy NeuroHealth.

“Dr. McGreevy has a good staff around him. Everybody at McGreevy NeuroHealth knows what they’re doing and does it well. They also treat people well. They’re all very kind and understanding. The people who go to that office are in pain and need a little comfort, and the staff is very caring. I absolutely recommend them.”

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    • McGreevy Neuro Health

      Your neurological health is nothing to worry about when you visit McGreevy NeuroHealth, conveniently located between Saint Augustine and Jacksonville, Florida. Their facility hosts a qualified interventional pain physician who is also a board-ce... Read More

    • 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