injection by radiologist vs. anesthesiologist

[quilter]

Is there any extra risk to having a CT-guided S2 block performed by an experienced diagnostic radiologist instead of under fluoro by a pain mgmt anesthesiologist? This is for my sacral/rectal pain, not the PN which is still much improved - separate issues. After many blind PN blocks, my first CT-guided PN blocks were performed at St. Joseph's by a radiologist as part of Dr. Hibner's initial eval in 2007. One of the most effective I've ever had.

I was having a shoulder arthrogram last week and the radiologist inquired why I'd requested extra padding under my sacrum. Explained about the sacral pain from the SCS and intolerance of hard X-ray/MRI tables. She asked if I'd heard about a radiologist at another facility who performs spinal injections under CT guidance. I met with him a few days later, discussed my case, and he requested a referral for ease of insurance payment. My pain anesthesiologist offered to perform such a block (under fluoro) 2 years ago, but I had to cancel due to illness. Since then he's not interested in doing one, though I'm still in pain from the SCS implant HE performed. Says I'd only get 1-2 day's benefit, no point since we know where the problem is. The radiologist told me he's heard similar complaints from patients about other local pain anesthesiologists, who aren't willing to try an injection unless it's for diagnostic purposes. He doesn't understand this attitude and is trying to help patients improve pain.

My anesthesiologist is now mostly at UCSF and only at my practice occasionally. His partner, who does my meds, refused a referral. Said that because this doc is a diagnostic radiologist he could inject me incorrectly and make things worse. She offered to refer me to another pain practice. They're basically refusing to provide what was once offered, and instead keep pushing for a pain pump trial. Not interested in another implanted device, at least not from this doctor.

So many patients on this forum have complained about anesthesiologists causing much worse pain after nerve blocks. Is this just a rivalry between specialties, or should I avoid the radiologist?

I need rotator cuff repair soon (full tear with separation), which will even further limit my sleeping position for 6+ weeks. Lying supine, even with padding, hurts the sacrum due to the SCS lead damage. I'd like to at least try a block. If it doesn't work or helps only briefly, at least I'll know and cross it off the options list. Would appreciate your opinions and experiences! Thanks!

[Violet M]

Hi Quilter,

I sent you an email but will post here also in case it is helpful to anyone else.

I'm not sure what the advantage is to having a CT guided injection at S2 rather than a fluoro guided. My understanding is that if the bone is what is used as the landmark for guiding the injection, then fluoro should be as accurate as CT because fluoro uses x-ray to visualize the bony landmark. The disadvantage of the CT guided would be the extra radiation which could increase your risk of cancer. The other concern with either injection would be if they are using steroids in the injection, there is a risk of arachnoiditis. Steroids are not FDA approved for epidural injections and while not common, there is always the risk of arachnoidits. The problem is the steroid would be the therapeutic part of the injection to reduce the inflammation so it's a catch 22 -- it can either help or hurt.

I don't think it's the physician's specialty so much that you should be concerned about but rather the experience of the person performing the procedure. Personally I might shy away from either one of them doing it because I've not heard of particularly good results from injections at the sacral nerve roots. I could be wrong because I'm not speaking from personal experience but rather from what I've read on the forums and know from one of my friends who developed arachnoiditis. It is worse than PN with not much available for treatment.

Violet