Zion Pain Management

FREQUENTLY ASKED QUESTIONS

Question: If I am having a procedure, what happens and how long does the whole process take?
Answer: If you are having sedation, you will need to abstain from food and drink for 4 hours prior to the procedure.  After you check in, we will obtain a set of vitals, place an IV for sedation, have you sign a consent form, and answer any remaining questions you may have. You will then be taken back to the OR  for the procedure.  Some procedures take more time than others, but the whole process including the procedure lasts roughly one hour.  During your recovery we take another set of vitals, remove the IV, offer you some juice, and then, when you are stable, we discharge you to your family or friends with some instructions and a follow-up appointment.

Question: Does it hurt?
Answer: Injections are not painful, although you may feel some pressure. Other, more invasive  procedures can be somewhat uncomfortable without sedation, but with sedation they are not a problem. 

Question: What will I be given to help me relax?
Answer: We will give you Versed to help you relax and Fentanyl to prevent any pain from the procedure.

Question: Do I have to have sedation?
Answer: No. You may choose not to have sedation, but in most cases the sedation makes the experience more pleasant for you.

Question: How soon following a procedure can I drive?
Answer: Five hours, if you choose to have sedation. If you had no sedation, you may drive as soon as the numbness from the injection has worn off.

Question: When can I eat following a procedure?
Answer: You should have nothing to eat or drink for at least 4 hours prior to your procedure, if you are having sedation. After the procedure you may resume your normal diet at any time.

Question: What medications should I stop taking before a procedure?
Answer: You should stop taking all blood thinners 4 days prior to the procedure. You should continue taking your blood pressure medications. If you are on an antibiotic, you must reschedule your appointment after you have finished the antibiotic and the infection has completely cleared up.

Question: How soon after the procedure may I return to my normal activities?
Answer: You may return to work the following day, but you should limit your physical activity for several days.

Question: How long does it take for an injection to work?
Answer: Allow up to 72 hours for the steroid to reduce the inflammation. Once it is reduced the pain will subside.

Question: Should I use heat or ice following my injection?
Answer: You may use ice for the first 24 hours after the injection and heat after that. Leave the ice or heat on the affected area for no more than 20 minutes at a time and then remove it for at least 20 minutes.

Question: How often can I have a steroidal injection?
Answer: As a general rule, you may have no more than three injections within a six-month period at least two weeks apart.

Question: What if I just had surgery or am going to have surgery within the next two weeks?
Answer: We would need to reschedule your appointment six weeks out from your surgery and be certain that all incisions had healed completely.

Question: How will steroid affect other wounds that I may have?
Answer: Steroid slows the healing process, lowers the immune system and makes the body more prone to infection. If the wounds are open or still have stitches, you will have to wait until they are healed completely before having a steroid injection.

Question: If I am diabetic, will the steroid affect my blood sugar?
Answer: Yes, the steroid will elevate your blood sugar for up to a month. You may need to contact your primary care physician to adjust your insulin or oral medications during that time.

Question: What would cause me to have muscle cramps following an injection?
Answer: Steroids can lower your potassium levels, and that can result in muscle cramps. To treat this you need to increase your potassium intake by eating fresh fruits such as bananas, apricots, grapefruit, oranges and tomatoes. Dried fruits and fruit juices are also high in potassium.

Question: What can cause me to have weakness in my legs following an injection in my back?
Answer:  Along with the steroid, a local anesthetic is injected into your back. Sometimes, as the local anesthetic spreads, it not only numbs the sensory nerve to give you pain relief, but it  also numbs a motor nerve as well. Numbing does not damage the motor nerve, but it may cause weakness that lasts about 5 hours, after which the legs should return to normal strength.

Question: Why is it that my pain may be in one area, but my injection may be placed in another area?
Answer: Spinal nerves originate in the spine and spread to all the extremities. When the spinal nerves are injured the pain radiates along the nerve pathway and can manifest itself in other areas of the body. The injection is made at the source of the pain and not necessarily where you feel it.

Question: How will the doctor be able to know where the needle is placed, if I don’t bring my MRI film to the appointment?
Answer: The doctor does the injection under fluoroscopic (live x-ray) guidance. This allows him to watch the needle as he advances it. Once the needle is in place, the doctor injects a contrast dye to verify the placement and then he injects the medication. By following this procedure the risks of complication are greatly reduced.

Question: What if I don’t get complete pain relief after my first injection?
Answer: It could mean several things. First, the inflammation may be so severe that several injections are required. Second, more than one pain source may be contributing to the pain that you feel. Third, the injury may require surgical repair in order to get full pain relief.

Question: I have noticed that when I have an injection sometimes the pain I feel in other parts of my body—like in my joints—is also reduced. Is that related to the injection?
Answer: Yes, the steroid is an anti-inflammatory, and, because it is placed near your spine, it may be absorbed and have a systemic effect, which means that it may reduce inflammation elsewhere in the body.

Question: I am on opioid medication and must schedule a medication appointment every month, even though my meds are working fine and I’m having no problems; why is that?
Answer: By law we are required to see all patients once a month who are on opiates or opioids. If a patient has been on the same medication regimen for six months with no complications, we may consider seeing him or her every other month.