UK: Patients forced to live in agony

[Emma]

so now you have proved to everyone that you are indeed a dishonest fuck.. twice today you have said we/I was wrong but unable to say why! that's a dishonest fuck

You make shit up out of thin air and then have the nerve to call someone else "dishonest".

so tell me where I'm wrong,,

You seem to be laboring under the misconception that 'empirical' means there is no cause or diagnosis to justify the treatment.

 

[geauxtohell]

You make shit up out of thin air and then have the nerve to call someone else "dishonest".

so tell me where I'm wrong,,

You seem to be laboring under the misconception that 'empirical' means there is no cause or diagnosis to justify the treatment.

If we are going to make up terms, I'd call it "idiopathic treatment".

 

[WillowTree]

so tell me where I'm wrong,,

I've never heard the term "empiric treatment" used outside the context of antibiotics. In the term of antibiotics, empiric treatment is when someone presents with symptoms, and you start them on a broad course that covers a lot of bugs before you have positively stained something and narrow the spectrum.

I yet to hear someone incorporate the term "empiric" in the treatment of back pain.

Perhaps I am wrong, now the onus is on you to show me that I am.

I am more than happy to admit when I am wrong on something.

did you goggle using steriods empirically in the treatment of back pain?????

 

[WillowTree]

You make shit up out of thin air and then have the nerve to call someone else "dishonest".

so tell me where I'm wrong,,

You seem to be laboring under the misconception that 'empirical' means there is no cause or diagnosis to justify the treatment.

and you seem to be a dishonest fuck.

 

[geauxtohell]

so tell me where I'm wrong,,

I've never heard the term "empiric treatment" used outside the context of antibiotics. In the term of antibiotics, empiric treatment is when someone presents with symptoms, and you start them on a broad course that covers a lot of bugs before you have positively stained something and narrow the spectrum.

I yet to hear someone incorporate the term "empiric" in the treatment of back pain.

Perhaps I am wrong, now the onus is on you to show me that I am.

I am more than happy to admit when I am wrong on something.

did you goggle using steriods empirically in the treatment of back pain?????

Interestingly enough:

The use of intradiscal steroid therapy for lumbar ...[Spine (Phila Pa 1976). 2004] - PubMed Result

CONCLUSIONS: This study demonstrates that intradiscal steroid injections do not improve the clinical outcome in patients with discogenic back pain compared with placebo.

It appears that a study in 1976 demonstrated that steroid injections in the back offer no better results than saline. Which is probably why the practice of doing so is not familiar to people here.

The term "empiric" is used in the abstract, but it is from a British study (as is this article), so perhaps it has a different meaning over there.

I will concede that the term exists outside the realm of antibiotics, though.

 

[WillowTree]

I've never heard the term "empiric treatment" used outside the context of antibiotics. In the term of antibiotics, empiric treatment is when someone presents with symptoms, and you start them on a broad course that covers a lot of bugs before you have positively stained something and narrow the spectrum.

I yet to hear someone incorporate the term "empiric" in the treatment of back pain.

Perhaps I am wrong, now the onus is on you to show me that I am.

I am more than happy to admit when I am wrong on something.

did you goggle using steriods empirically in the treatment of back pain?????

Interestingly enough:

The use of intradiscal steroid therapy for lumbar ...[Spine (Phila Pa 1976). 2004] - PubMed Result

CONCLUSIONS: This study demonstrates that intradiscal steroid injections do not improve the clinical outcome in patients with discogenic back pain compared with placebo.

It appears that a study in 1976 demonstrated that steroid injections in the back offer no better results than saline. Which is probably why the practice of doing so is not familiar to people here.

The term "empiric" is used in the abstract, but it is from a British study (as is this article), so perhaps it has a different meaning over there.

I will concede that the term exists outside the realm of antibiotics, though.

there are lots of studies, about the use of steroids used empirically, and of course you realize that for every doctor who says it has no value there are those who say it does, and also in the treatment of low back pain steroids are not injected alone always,,often accompanied with an anesthetic agent and so you can see how a patient might obtain some relief. so if you have ever suffered chronic back pain you would not be happy if the treatment were denied you. would you?

 

[tigerbob]

You are such a Troll....

Isn't the Telegraph a respected newspaper?

The Telegraph is a fairly right wing newspaper, one that will take every opportunity to kick the current Labour government. The implication of the article is that there is a funding crisis in the NHS (there has never NOT been a funding crisis) and that the Government is responsible for this crisis.

Whether the Telegraph is respected or not will depend on what someone thinks of their motives. Every media outlet has political bias of some form or other.

 

[WillowTree]

You are such a Troll....

Isn't the Telegraph a respected newspaper?

The Telegraph is a fairly right wing newspaper, one that will take every opportunity to kick the current Labour government. The implication of the article is that there is a funding crisis in the NHS (there has never NOT been a funding crisis) and that the Government is responsible for this crisis.

Whether the Telegraph is respected or not will depend on what someone thinks of their motives. Every media outlet has political bias of some form or other.

so how do you deal with the funding crisis? Is the article true or not true?

 

[geauxtohell]

did you goggle using steriods empirically in the treatment of back pain?????

Interestingly enough:

The use of intradiscal steroid therapy for lumbar ...[Spine (Phila Pa 1976). 2004] - PubMed Result

CONCLUSIONS: This study demonstrates that intradiscal steroid injections do not improve the clinical outcome in patients with discogenic back pain compared with placebo.

It appears that a study in 1976 demonstrated that steroid injections in the back offer no better results than saline. Which is probably why the practice of doing so is not familiar to people here.

The term "empiric" is used in the abstract, but it is from a British study (as is this article), so perhaps it has a different meaning over there.

I will concede that the term exists outside the realm of antibiotics, though.

there are lots of studies, about the use of steroids used empirically, and of course you realize that for every doctor who says it has no value there are those who say it does, and also in the treatment of low back pain steroids are not injected alone always,,often accompanied with an anesthetic agent and so you can see how a patient might obtain some relief. so if you have ever suffered chronic back pain you would not be happy if the treatment were denied you. would you?

Since I linked this from the NIH page, it appears that the consensus is that steroids, in fact, offer no therapeautic relief. Since this study is from 1976, that would appear to be the standard here. I have no idea if/why they still do it in the UK, but this could be one reason they are not funding it anymore. I wouldn't be happy if my Dr. were adhering to an old convention that was not supported by evidence based medicine. A lot of things that seem intuitive, are in fact not. In fact, a patient who feels they are being adequately treated by something that hasn't been shown to be effective implies a placebo effect is in place and that the patient's suffering might be "in their head" (for lack of a better term).

The practice that I witness as a student, is the treatment of pain with medications and narcotics. That is much cheaper, safer (arguably with opiates), and convenient than a spinal injection.

Perhaps not so strangely, the high powered opiate oral pain meds came out about the time this study did.

 

[Emma]

so tell me where I'm wrong,,

I've never heard the term "empiric treatment" used outside the context of antibiotics. In the term of antibiotics, empiric treatment is when someone presents with symptoms, and you start them on a broad course that covers a lot of bugs before you have positively stained something and narrow the spectrum.

I yet to hear someone incorporate the term "empiric" in the treatment of back pain.

Perhaps I am wrong, now the onus is on you to show me that I am.

I am more than happy to admit when I am wrong on something.

This person should go to a doc and demand an ESI for back pain and stipulate there are to be no diagnostics or exams to justify the treatment. See how far that gets her (him?).

 

[geauxtohell]

so tell me where I'm wrong,,

I've never heard the term "empiric treatment" used outside the context of antibiotics. In the term of antibiotics, empiric treatment is when someone presents with symptoms, and you start them on a broad course that covers a lot of bugs before you have positively stained something and narrow the spectrum.

I yet to hear someone incorporate the term "empiric" in the treatment of back pain.

Perhaps I am wrong, now the onus is on you to show me that I am.

I am more than happy to admit when I am wrong on something.

This person should go to a doc and demand an ESI for back pain and stipulate there are to be no diagnostics or exams to justify the treatment. See how far that gets her (him?).

I've just never heard of it. That doesn't mean it doesn't, but it's obviously not common.

At least not here.

 

[Emma]

did you goggle using steriods empirically in the treatment of back pain?????

Interestingly enough:

The use of intradiscal steroid therapy for lumbar ...[Spine (Phila Pa 1976). 2004] - PubMed Result

CONCLUSIONS: This study demonstrates that intradiscal steroid injections do not improve the clinical outcome in patients with discogenic back pain compared with placebo.

It appears that a study in 1976 demonstrated that steroid injections in the back offer no better results than saline. Which is probably why the practice of doing so is not familiar to people here.

The term "empiric" is used in the abstract, but it is from a British study (as is this article), so perhaps it has a different meaning over there.

I will concede that the term exists outside the realm of antibiotics, though.

there are lots of studies, about the use of steroids used empirically, and of course you realize that for every doctor who says it has no value there are those who say it does, and also in the treatment of low back pain steroids are not injected alone always,,often accompanied with an anesthetic agent and so you can see how a patient might obtain some relief. so if you have ever suffered chronic back pain you would not be happy if the treatment were denied you. would you?

The local anesthetic is to relieve the localized pain of the injection itself.

And I'd be thrilled to know I have a doc who won't prescribe/perform ESI without indication, taking the time to examine and perform diagnostics to determine the cause and to rule out other conditions that could be causing the pain; who actually makes a diagnosis, chooses the best available options for treatment, and weighs the risk vs the benefits of those treatments.

 

[Emma]

Since I linked this from the NIH page, it appears that the consensus is that steroids, in fact, offer no therapeautic relief.

Temporary and effective in only about 50% of the cases and with risk (although uncommon) of significant side effects. Which leads me back to the point I've made all along. Once the cause of the pain is diagnosed (through determining the exact cause and / or ruling-out others), then the physician can weigh the risks vs benefits of this particular treatment and decide if it is appropriate. Any doc who would recommend ESI without doing that first is a dangerous fool.

 

[WillowTree]

Interestingly enough:

The use of intradiscal steroid therapy for lumbar ...[Spine (Phila Pa 1976). 2004] - PubMed Result



It appears that a study in 1976 demonstrated that steroid injections in the back offer no better results than saline. Which is probably why the practice of doing so is not familiar to people here.

The term "empiric" is used in the abstract, but it is from a British study (as is this article), so perhaps it has a different meaning over there.

I will concede that the term exists outside the realm of antibiotics, though.

there are lots of studies, about the use of steroids used empirically, and of course you realize that for every doctor who says it has no value there are those who say it does, and also in the treatment of low back pain steroids are not injected alone always,,often accompanied with an anesthetic agent and so you can see how a patient might obtain some relief. so if you have ever suffered chronic back pain you would not be happy if the treatment were denied you. would you?

The local anesthetic is to relieve the localized pain of the injection itself.

And I'd be thrilled to know I have a doc who won't prescribe/perform ESI without indication, taking the time to examine and perform diagnostics to determine the cause and to rule out other conditions that could be causing the pain; who actually makes a diagnosis, chooses the best available options for treatment, and weighs the risk vs the benefits of those treatments.

 

[geauxtohell]

Or you could address the point.

 

[WillowTree]

Or you could address the point.

The local anesthetic is to relieve the localized pain of the injection itself.

proof she is talking out of her azz! =====

 

[geauxtohell]

Or you could address the point.

The local anesthetic is to relieve the localized pain of the injection itself.

proof she is talking out of her azz! =====

Say what you will, but when pressed on this issue, you tend to resort to the most base type of posting. You've even insisted we do your research for you, which we've done, only to be answered with idiotic smilies.

 

[WillowTree]

Or you could address the point.

The local anesthetic is to relieve the localized pain of the injection itself.

proof she is talking out of her azz! =====

Say what you will, but when pressed on this issue, you tend to resort to the most base type of posting. You've even insisted we do your research for you, which we've done, only to be answered with idiotic smilies.

so you agree with her statement? it's used to relieve the localized pain of the injection itself? is that what I am to infer?

 

[geauxtohell]

proof she is talking out of her azz! =====

Say what you will, but when pressed on this issue, you tend to resort to the most base type of posting. You've even insisted we do your research for you, which we've done, only to be answered with idiotic smilies.

so you agree with her statement? it's used to relieve the localized pain of the injection itself? is that what I am to infer?

About the "local anesthetic"?

Absolutely. Local anesthetic (i.e. lidocaine) is used to relieve localized pain (small areas).

That's why it's called "LOCAL ANESTHETIC".

She didn't claim the local anesthetic is for the anti-inflammatory effect or the spine. That's what the steroids are used for.

You appear to have misunderstood her post.

 

[Emma]

What is actually injected?

The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication (triamcinolone – Aristocort® or methylprednisolone – Depo-medrol®, Celestone-Soluspan).

What should I expect after the injection?

Immediately after the injection, you may feel your legs slightly heavy and may be numb. Also, you may notice that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a "sore back" for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation form the steroid itself. You should start noticing pain relief starting the 3rd day or so.

How long the effect of the medication last?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 3 to 5 days and its effect can last for several days to a few months.

http://www.reddinganesthesia.com/ESB.htm

And you were saying?