Question
Can an epidural cause or trigger a L5-S1 back problem?  I had my daughter 8 years ago had an epidural, which took several attempts to finally place. Ever since that night I have had problems with my L4/5-S1. I have been on many pain/anti-inflammatory meds and nothing seems to help.  I have done physical therapy which helped maybe 5%.  My Dr's don't take me seriously and I was wondering how can I find out what caused this problem and how can I remedy it? What pain meds should I try and how can I make my Dr. prescribe them if they feel they are unnecessary?  Vicodin and Tramadol/Ultram do not work and those are the only meds the Dr. is willing to prescribe.  Have a referral into a pain specialist, neurologist, physical therapy and for X-rays not MRIs like I requested. Changing Drs is not a possibility due to location and insurance.  Please offer any advice possible. Thank you

Answer
Dear Amy,

Yes and epidural can initiate chronic back pain issues, and this should have been explained to you as part of the "informed consent" process before the epidural was placed.  Even though this happens in only a small percentage of cases, there are multiple reasons for this.  The dura (outer covering of the spinal cord) can be nicked, punctured, or irritated as well as the ligaments in that area that stabilize the spine.  All can result in pain which can become chronic, and in your case, multiple attempts to place the epidural is probably a contributing factor.

Now, there are many other issues that may be in play here such as abnormal joint function, inflammation of the joint capsules in the low back, and lying in a bed in the lithotomy position for birth places a lot of stress on the L4/L5/S1 segments of the spine, as well as the discs.  I am really surprised that you haven't been to a chiropractor yet...why not???  Research has proven multiple times over that chiropractic care is superior to medicine, physical therapy and acupuncture in reducing and correcting back pain.

Concerning pain medication, there are more powerful pain medications that can be prescribed, but all of them have addictive qualities as well as other issue...this is the reason why your docs are hesitant to prescribe them.  Moreover, if they can't verify what is causing your pain through functional orthopedic testing or imaging studies, they will probably not give you anything stronger.  The pain management specialist will want to perform more injections (either trigger point injections, facet injections, epidural injections, an possibly radiofrequency coagulation of the associated pain nerves in that area...to burn them off)...that is what pain management docs do in these cases.  The neurologist will likely be of no initial benefit because you do not seem to have nerve generated pain...radiating down the legs or around into the groin or thigh...however, they will perform additional testing and may order and MRI...which would be a great choice in this case.

Lastly...you mentioned changing doctors is not an option...this is always an option, and your insurance company cannot stop you from doing so.  Most policies will pay for out of network doctors even if it costs you more money.  If I could get you out of pain...what would you pay for that...what is that worth to you...would you pay $1000, even $5000 dollars to be pain free and back to normal???  8 years is a long time to have chronic pain, stay on medication, and going back to the same doctors which are not helping you.  So, I encourage you to look at other options, and other doctors.  Not to mention...chiropractic care is significantly more cost effective than medical care...also documented for years in multiple clinical and governmental research studies on back pain.  I would recommend that you give it a try, as well as the neurologist...also the chiro can order an MRI as well if it is clinically indicated.

Good luck Amy...I hope this helps.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net