Wednesday 8 May 2013

Pain Management

I had an appointment with an anaesthetist on Tuesday, regarding a pain management program.  I took along the diagnosis from the spinal surgeon, which suggests 3 different injections; a right-sided pars block, l5-s1 facet joint injection, and a caudal epidural. 

The anaesthetist agreed with the diagnosis that I have disc degeneration disease (DDD) of the L5-S1 disc, but believes that if I have all 3 of those injections we will not actually find out what my pain causality is.  The DDD in my MRI is very clear, with the thinner and dark lumbar disc very much evident even to my untrained eye.  I also have a disc bulge, which at the moment is not too large, but could (and will likely) worsen in time.  He did however also point out a few other anomalies in my facet joints, differences in muscle mass, and also put forward a suggestion that my DDD could potentially have caused impingement syndrome, which as I understand it, is that the collapsed disc is sitting on, or interfering with, a nerve around my Sacroiliac joint (SIJ).  This could be the cause of the acute pain and muscle strength fatigue and failure as I run.  He advised that this was only another theory, and it was also difficult to treat. Possible long term management include an even higher orthotic in my left shoe to try and lengthen my left leg and easy any pressure on the my right side SIJ. 

He suggested rhizolysis could be a potential treatment.  This is an unpleasant sounding treatment where a probe is inserted into the spine, guided by x-ray until it is in contact with the nerve causing the problem.  The probe is then heated, to essentially kill the nerve signals, shutting off the pain.  There are of course other nerves in the area that carry muscle movement signals, so you have to be very certain you have the right nerve which only kills the pain signals.  I have read around and this treatment is partially or fully successful in 60-70% of patients. I believe that the procedure is carried out using a couple of doses of local anaesthetic into the area so the probe can be heated with manageable pain.

For now all of those treatment options are potentially months away.  For now, he has suggested I have a series of steroid injections to try and isolate what is causing my pain.  The first injections will be on 28th may into my right side SIJ.

Regardless of my long term future running, which admittedly looks somewhat bleak at the moment, I have been researching road bikes.  Even if I am somehow able to bring the pain under control, I will have to change my training structure.  I want to be able to run ultramarathon’s but I would realistically have to train for them by predominantly cross training long distances on a road bike to retain my endurance, and also doing more strength and flexibility work.  This may allow me to still run short distances in training, and I hope, still participate in some long distance events as a runner.

I’m going to try a run a 3.5 mile fell race this evening.  The first time I have tried to run that far for weeks and weeks.  It’s very hilly too, but I figure it can’t really do he a lot of harm.  I may be dreadfully unfit at the moment, so it will do something for that at least.