shayla
Attending
Registered: Oct 11, 2008
Posts: 94
|
|
|
| #1 |
This is what Dr. Smith has to say about ESI's
1.. Chemically induced AA (CIAA):
This arises when chemicals are introduced into or around the subarachnoid space.
Ø Myelogram: oil-based (Pantopaque/Myodil) and water-based: Metrizamide, Dimer-X, Omnipaque, Amipaque. Procedure used as a diagnostic tool before availability of MRI scans, still in use occasionally. Oil-based dyes remain in the central nervous system as either a thin film or as encapsulated deposits, commonly in the lumbosacral region or in the base of the skull (basal cisterns).
Ø Epidural /intrathecal steroid injection: therapeutic measure commonly used in both acute and chronic back pain cases, including prolapsed discs. Benefit is questionable and temporary (up to 2-3 months). Risk of arachnoiditis is controversial; evidence of toxicity of the preservatives in the preparation points to a need to reappraise the continued clinical use of this procedure. Preservative-free solutions (Celeston Soluspan/Decadron) may confer lower risk, but this invasive treatment remains one in which risk may well outweigh benefit.
Ø Epidural anaesthetics: again, a controversial subject; use in healthy obstetric patients to minimise pain during labour may be unwise if there are suitable non-invasive alternatives; combined spinal/epidural procedures involve placement of the anaesthetic agent directly into the spinal fluid. Again, it is the preservatives which are likely to cause toxic damage to nerve roots, although the anaesthetic agents themselves may also directly affect nerves. The practice of regional anaesthetic techniques such as epidurals in conjunction with a general anaesthetic (used in paediatric operations) is a cause for considerable concern as the patient is unconscious and cannot therefore alert the doctor performing the procedure to pain due to inadvertent injection directly into nerve roots. Note also that in procedures of epidural steroid injections, it is common practice to combine this with local anaesthetic to confer immediate relief (steroid aiming to provide a more sustained relief over weeks): thus conferring "double jeopardy".
[Non-text portions of this message have been removed]
|
| |
shayla
Attending
Registered: Oct 11, 2008
Posts: 94
|
|
|
| #2 |
Here is an article written by Dr. Aldrete. I'm thinking he is for ESI's
TREATMENT
Unfortunately, there is no cure for arachnoiditis. In the acute inflammatory phase of ARC, the administration of systemic and intraspinal corticosteroids may prevent the evolution into the chronic phase. Pain may be treated with indomethacin, dipyrone or ibuprofen; in addition, d-penicillamine and colchicine are helpful. Oxybutynin usually improves urinary incontinence, and sildenafil citrate has been shown to correct most cases of impotence; however, the alterations of sexual function are much more complicated, with loss of libido and especially low back and lower extremity pain during and after intercourse. Muscle relaxants are indicated if muscle spasms are severe and not susceptible to treatment with physical therapy and reconditioning.
Once the proliferative phase starts, any intervention may exacerbate the pain path mechanisms; therefore, invasive procedures have to be selected if the risk/benefit ratio is favorable. Epidural steroids are helpful in producing temporary pain relief and reducing the extradural formation of fibrosis; so is the epidural and intrathecal infusion of analgesics. SC stimulation reduces pain temporarily in localized (mononeuronal) cases. Neuroplasty is contraindicated because it requires the injection of 10% hypertonic saline and hyaluronidase that produces arachnoiditis.
The surgical breakdown of adhesions, even when performed meticulously under the microscope carries a great risk because SC dysfunction may be aggravated; laminectomies, foraminotomies and spinal fusions would need to be absolutely indicated because of the potential danger of recurrent dural sac injury and entry of blood. Long-term opioid therapy is not to be taken lightly, especially with Schedule II "slow-release" preparations; the consequences of drug dependency are intangible, but very real, with serious behavioral alterations. Medications in Schedule III are preferred.
A variety of new therapeutic agents and interventional modalities are being proposed mostly for the symptomatic treatment of ARC; however, the most important therapy is prevention, since most of these cases are iatrogenically caused. Education of physicians, nurses, and technicians regarding the numerous causes of this disease is an essential initial step, followed by the information to the public in general, and to patients with spinal disease in particular, so as to warn them against accepting questionably effective procedures in desperation to have their pain relieved and to procure competent and responsible physicians in their care. Once an injurious event takes place, prompt action to define the precise diagnosis and to institute treatment is primordial. There is no place for hesitation since there is only a short window of opportunity during which chances to reverse the process are feasible. Once the proliferative phase begins, there is only symptomatic treatment.
|
| |
liamandmaria
Attending
Registered: Oct 15, 2008
Posts: 25
|
|
| March 11, 2009 at 06:32 PM |
|
| #3 |
i agreed with esi because i have arachnoiditis and know the pain it can cause. when you get to that frame of mind where you just can't take it anymore, an esi is a lot better than killing yourself. i'm serious. pain can ruin your life. it has done its best to ruin mine. |
| |
dandywalker
Attending
Registered: Oct 14, 2008
Posts: 30
|
|
| June 07, 2009 at 12:04 PM |
|
| #4 |
I agree with this treatment. Anyone who judges another person in severe pain, who hasn't walked a mile in their shoes, should zip it. If you are in that kind of pain and you feel this is the only way, who is someone who has never been in that much pain, to say it isn't right?
|
| |
