Calmare Pain Treatment Device

This is NOT an advertisement. We make ZERO income from promoting or recommending the treatment option.  In fact I have not yet tried Calmare due to cost ($150 per session on average). I have an appointment scheduled with a Pain Treatment Center that uses the Calmare Device and hope it works!

Update Jan 31, 2011: I had one 45 minute treatment with the Calmare Pain Therapy system today. The treatment itself is not very painful. Once the surface electrodes are attached variable current is applied by the technician until you reach a point where you can feel the device but it is not causing you pain by itself. Electrodes are placed near your primary pain source but not on them. When current is applied it feels a lot like a pin prick. There is a small amount of electrical “twitching” which you may feel as well. The amount of sensation you receive is actually much less than from electronic acupuncture therapies. There is nothing that actually penetrates your skin. In short you shouldn’t have any fear of being hooked up to the device. Of course if you have a pacemaker you should tell your Doctor as that could be a problem.

Does it work? I don’t know yet. I do feel some relief in my neck area and my arms but it has only been a few hours, so I don’t know of the pain relief will “stick”. I also feel relief after heated ultrasound and massage. So who knows? Unfortunately I do not have the means to complete the standard 10 session protocol. However if you do… you should give this treatment option a serious run… it could prove life changing for you! For me? If I had the money I would continue on with treatment but sadly I don’t. Like most pain therapy there is a real cost – and it’s often expensive. At this point most insurance companies will not pay for the Calmare Pain Therapy.

While FDA Approved most insurance companies still consider this investigational and will NOT cover the cost (Isn’t that usually the case?).

For those of you who have “Tried Everything” this is another option.  I am NOT an expert on the Calmare Treatment, but I have read the material on how it works.

What makes Calmare Pain Treatment different is it is not intended to BLOCK pain signals, rather to retrain the brain into believing these signals are NOT pain (At least that is my understanding of the process – I hope to learn more soon).

Please watch the video and visit the Calmare Site to learn more.  I aplogize for the pop up window – But I believe this could be a Breakthrough for many pain patients; perhaps even the one drug free pain solution that actually works for you!

Company Website

Calmare Pain Treatment Company Website

Video about Calmare Pain Treatment

You’re in Pain and You want Relief Naturally

You’re in pain, and ibuprofen just won’t cut it. Nonsteroidal anti-inflammatory drugs, or NSAIDs, don’t agree with your stomach, and you’re wary of stronger meds.

Fortunately, you have alternatives — natural ones. From herbs that attack inflammation to techniques that leverage the brain’s remarkable healing powers, nature offers many treatments for conditions such as arthritis, fibromyalgia, and even muscle strains.

Here are eight natural remedies that may enhance or replace conventional antidotes, and leave you happier, healthier, and pain free.

Capsaicin: For Arthritis, Shingles, or Neuropathy

What the science says: An active component of chile pepper, capsaicin temporarily desensitizes pain-prone skin nerve receptors called C-fibers; soreness is diminished for 3 to 5 weeks while they regain sensation. Nearly 40 percent of arthritis patients reduced their pain by half after using a topical capsaicin cream for a month, and 60 percent of neuropathy patients achieved the same after 2 months, according to a University of Oxford study. Patients at the New England Center for Headache decreased their migraine and cluster headache intensity after applying capsaicin cream inside their nostrils.

How to try it: Capsaicin ointments and creams are sold in pharmacies and health stores. For arthritis or neuropathy, try 0.025 percent or 0.075 percent capsaicin cream one to four times daily; best results can take up to 2 weeks, says Philip Gregory, PharmD, a professor at Creighton University and editor of the Natural Medicines Comprehensive Database. But research on capsaicin and headaches remains limited — and don’t expect stronger versions anytime soon: “Current formulations are better suited for more acute problems, like a sore muscle or an arthritis flare-up, than everyday pain and stiffness,” Gregory says.

InflaThera or Zyflamend: For Arthritis

What the science says: Both supplement brands contain ginger, turmeric, and holy basil, all of which have anti-inflammatory properties. Turmeric (a curry ingredient) may be the best: A component, curcumin, eases inflammatory conditions like rheumatoid arthritis and psoriasis, according to the Methodist Research Institute in Indianapolis. Researchers are now testing Zyflamend in RA patients, but some experts are already sold: “Each herb has its own scientific database of evidence,” says James Dillard, MD, author of “The Chronic Pain Solution.”

How to try it: ProThera, InflaThera’s maker, will only sell to health care professionals, so your doctor has to order it for you; that said, it’s reportedly stronger (and slightly cheaper) than Zyflamend. InflaThera’s suggested dosage is twice daily with food. For the more readily accessible Zyflamend, take one capsule two or three times daily, but avoid it near bedtime — each pill contains 10 mg of caffeine (another version, Zyflamend PM, is reportedly less stimulating). Save money and try curcumin to start: Taking 500 mg four times daily, along with fish oil and a diet low in animal fat, can ease arthritis, says Jane Guiltinan, ND, immediate past president of the American Association of Naturopathic Physicians.

Arnica: For Acute Injury or Post Surgery Swelling

What the science says: This herb comes from a European flower; although its healing mechanism is still unknown, it does have natural anti-inflammatory properties. Taking oral homeopathic arnica after a tonsillectomy decreases pain, say British researchers, and German doctors found that it reduces surgery-related knee swelling.

How to try it: Use homeopathic arnica as an adjunct to ice, herbs, or conventional pain meds, suggests Guiltinan. Rub arnica ointment on bruises or strained muscles, or take it in the form of three lactose pellets under the tongue up to six times per day. Boiron is among the most reputable arnica manufacturers.

Aquamin: For Osteoarthritis

What the science says: This red seaweed supplement is rich in calcium and magnesium. A preliminary clinical study showed that the ingredients may reduce joint inflammation or even help build bone, says David O’Leary of Marigot, Aquamin’s Irish manufacturer. In a study of 70 volunteers published in Nutrition Journal, Aquamin users reduced arthritis pain by 20 percent in a month, and had less stiffness than patients taking a placebo.

How to try it: Marigot recommends 2,400 mg a day (two capsules) of Aquamin in tablet form, sold domestically in products such as Aquamin Sea Minerals and Cal-Sea-Um. A 60-pill jar of Swanson Vegetarian Aquamin Sea Minerals costs about $6 at swansonvitamins.com.

SAM-e (S adenosylmethionine): For Osteoarthritis

What the science says: SAM-e is made from a naturally occurring amino acid and sold as capsules. Doctors aren’t entirely sure why it tamps down pain, but it reduces inflammation and may increase the feel-good brain chemicals serotonin and dopamine.

Studies by the University of Maryland School of Nursing and the University of California, Irvine, showed that SAM-e was as effective as some NSAIDs in easing osteoarthritis aches; the California researchers found that SAM-e quashed pain by 50 percent after 2 months, though it took a few weeks to kick in. SAM-e produced no cardiovascular risks and fewer stomach problems than the conventional meds.

How to try it: Costco and CVS both carry it; a month’s supply costs $30 to $60. Guiltinan prescribes 400 to 1,600 mg daily, often with turmeric or fish oil. SAM-e can interact with other meds, especially MAO-inhibitor antidepressants, so it’s vital to talk with your doctor before taking it (and avoid SAM-e entirely if you have bipolar disorder).

Also, inspect the packaging before buying, advises Gregory: Make sure the product carries a USP or GMP quality seal, contains a stabilizing salt, has a far-off expiration date, and comes in foil blister packs — SAM-e can degrade rapidly in direct light.

Fish oil: For Joint Pain from Arthritis or Autoimmune Disorders

What the science says: Digested fish oil breaks down into hormonelike chemicals called prostaglandins, which reduce inflammation. In one study, about 40 percent of rheumatoid arthritis patients who took cod-liver oil every day were able to cut their NSAID use by more than a third, Scottish scientists recently reported. People with neck and back pain have fared even better: After about 10 weeks, nearly two-thirds were able to stop taking NSAIDs altogether in a University of Pittsburgh study.

How to try it: Taking 1,000 mg is proven to help your heart, but you should up the dose for pain. For osteoarthritis, try 2,000 to 4,000 mg daily; for rheumatoid arthritis and autoimmune diseases associated with joint pain (such as lupus), consider a much higher dose of upwards of 8,000 mg daily — but ask your doctor about such a large amount first, says Tanya Edwards, MD, medical director at the Cleveland Clinic’s Center for Integrative Medicine. (The same rule applies if you take BP or heart meds, as omega-3s can thin the blood.) Read the nutrition label carefully: The dosage refers to the amount of omega-3s in a capsule, not other ingredients. Nordic Naturals (nordicnaturals.com) and Carlson (carlsonlabs.com) are both reputable brands.

Methylsulfonyl-Methane (MSM): For Osteoarthritis

What the science says: MSM is derived from sulfur and may prevent joint and cartilage degeneration, say University of California, San Diego, scientists. People with osteoarthritis of the knee who took MSM had 25 percent less pain and 30 percent better physical function at the end of a 3-month trial at Southwest College of Naturopathic Medicine and Health Sciences. Indian researchers also found that MSM worked better when combined with glucosamine.

How to try it: Start with 1.5 to 3 g once daily and increase to 3 g twice daily for more severe pain, suggests Leslie Axelrod, ND, a professor of clinical sciences at Southwest. Patients in the Indian trial improved on dosages as low as 500 mg three times daily. Vendors of OptiMSM, the brand tested in Axelrod’s trial, can be found at optimsm.com.

Counting Out Loud: For Brief “Needle Stick” Pain

What the science says: Patients who counted backward from 100 out loud during an injection experienced and recalled less pain, according to a recent Japanese study. None of the 46 patients who counted complained afterward, and only one of them could remember pain from the injection at all (among the 46 who didn’t count, 19 said the injection hurt and 10 recalled what it felt like). Recitation might work by distracting the brain from processing the sensation, says study author Tomoko Higashi, MD, of Yokohama City University Medical Center in Kanagawa, Japan. The trick is probably only useful for short or acute periods, she says, adding: “The degree of pain reduction really depends on how well patients concentrate on counting.”

Stem Cells Diagram

Note: This Story was originally published by BBC News In November 2006

A patient’s own stem cells could soon be used to cure chronic back pain, say researchers.
The team from the University of Manchester hope their treatment will be available within three years.

They are perfecting a way to rebuild the soft shock-absorbing discs which separate the vertebrae in the spine.

Damage to these intervertebral discs (IVDs) is a common cause of debilitating low back pain which affects around 12 million in the UK. A treatment which effectively cured the problem could potentially save the UK economy as much as £5 billion a year.

The new therapy, developed by Dr Stephen Richardson, uses mesenchymal stem cells (MSCs) from adult bone marrow to regenerate spinal discs. MSCs are a class of stem cell which can grow into many different cell types, including bone, cartilage, fat and muscle.

Dr Richardson has succeeded in turning MSCs into the cells which make up the gel-like nucleus pulposus (NP) tissue separating the vertebrae. He plans to begin pre-clinical trials next year, with full patient trials to follow on.  Dr Richardson said: “Once we have extracted the bone marrow from the patient and have purified the MSCs, they will be grown in culture and our patented method of differentiation will be applied.

“They will then be embedded within a gel which can be implanted back into the patient.” No rejection

Since the stem cells are taken from the patient’s own body, there is no chance of them being rejected by the immune system.

The gel is based on a natural collagen similar to one already used for the treatment of cartilage defects.

It is implanted using an arthroscope, a thin tube device slipped through a small incision in the back. Dr Richardson said there was no reason why a patient should not return home on the same day as the procedure, or the day after.

He said: “Once implanted, the differentiated MSCs would produce a new NP tissue with the same properties as the original and would both treat the underlying cause of the disease and remove the painful symptoms.”

Currently, low back pain is treated with a combination of painkillers, physiotherapy or surgery. In severe cases tissue is removed to relieve the pain, or vertebrae fused together.

However, success is limited, and these techniques do not solve the root cause of the problem.

Dries Hettinga, research and information manager at the charity BackCare, said: “This is a really exciting area of research and although it is still early days, the initial results look very promising.”

by James J. Yue (Author), Rudolph Bertagnoli (Author), Paul C. McAfee (Author), Howard S. An (Author)

Book Link: Motion Preservation Surgery

This is the most authoritative text available at the time of this writing (August 2008).

* Publisher: Elsevier Health Sciences
* Pub. Date: June 2008

Product Description

New motion-preserving devices are revolutionizing spine surgery but the learning curve for these operations is steep, and great attention must be given to patient and device selection and the perfect execution of each procedure. Only one reference spells out exactly how to perform these new techniques and its peerless author team, comprised of key investigators involved in the devices’ actual clinical trials, is uniquely qualified to help you get the best results! These global leaders in this area discuss the advantages and disadvantages of the full range of non-fusion technologies and present the step-by-step, richly illustrated operative guidance you need to achieve optimal outcomes! 3 hours of surgical video on DVD demonstrate how to perform key procedures, and access to the complete contents of the book online enables you to reference it conveniently from any computer.

* Select the best device and approach for each patient!
* cervical total disc arthroplasty
* lumbar total disc arthroplasty
* lumbar partial disc replacement: nucleus replacement
* lumbar posterior dynamic stabilization: pedicle screw based
* lumbar posterior dynamic stabilization: interspinous based
* lumbar facet replacement
* Produce optimal outcomes with detailed advice on
* advantages and disadvantages of each option
* indications and contraindications
* patient selection
* interpretation of imaging studies
* surgical anatomy and biomechanics
* surgical techniques
* tips and pearls
* See how to perform each technique, thanks to
* step-by-step, full-color illustrations
* more than 3 hours of surgical videos on DVD, narrated by the experts!
* Access to the complete contents of the book online lets you perform rapid searches, follow links to Medline and PubMed abstracts, and more.

5 Painful Facts You Need to Know

First off, let’s set the record straight: Pain is normal. About 75 million U.S. residents endure chronic or recurrent pain. Migraines plague 25 million of us. One in six suffer arthritis.

The global pain industry peddles more than $50 billion in drugs a year. Yet for chronic pain sufferers, over-the-counter pills are typically little help, while morphine and other narcotics can be addictive sedatives.

An overview study published last month in the Journal of General Internal Medicine looked at multiple studies of pain and found “researchers don’t yet know how to determine which [treatment] is best for individual patients.” From studies of drugs to surgeries and alternative medicines, “We have found that there are huge gaps in our knowledge base,” said Dr. Matthew J. Bair, assistant professor of medicine at the Indiana University School of Medicine.

So what is pain and why do so many suffer so long?

Pain is felt when electrical signals are sent from nerve endings to your brain, which in turn can release painkillers called endorphins and generate reactions that range from instant and physical to long-term and emotional. Beyond that, scientific understanding gets painfully fuzzy.

Here’s what’s known:

Fact 1 – Scientist Don’t Understand Pain

When you’re in pain, you know it. But if scientists could fully grasp how pain works and why, they might be able to help you more. The American Academy of Pain Medicine defines pain as “an unpleasant sensation and emotional response to that sensation.” Some pain is the result of an obvious injury. Other times, it is caused by damaged nerves that are not so easy to pinpoint. “Pain is complex and defies our ability to establish a clear definition,” says Kathryn Weiner, director of the American Academy of Pain Management. “Pain is far more than neural transmission and sensory transduction. Pain is a complex mixture of emotions, culture, experience, spirit and sensation.”

Fact 2 – Chronic Pain Shrinks Brains

If you have chronic pain, you know how demoralizing and debilitating it can be, physically and mentally. It can prevent you from doing things and make you irritable for reasons nobody else understands. But that’s only half the story. People with chronic backaches have brains as much as 11 percent smaller than those of non-sufferers, scientists reported in 2004. They don’t know why. “It is possible it’s just the stress of having to live with the condition,” said study leader A. Vania Apkarian of Northwestern University. “The neurons become overactive or tired of the activity.”

Fact 3 – Migraines and Sex Go Together

It may not eliminate the phrase “Not tonight, honey …” but a 2006 study found that migraine sufferers had levels of sexual desire 20 percent higher than those suffering from tension headaches. The finding suggests sexual desire and migraines might be influenced by the same brain chemical, and getting a better handle on the link could lead to better treatments, at least for the pain portion of the equation.

Fact 4 – Women Feel More Pain

Any man who has watched a woman having a baby without using drugs would swear that women can tolerate anything. But the truth is, guys, it hurts more than you can imagine. Women have more nerve receptors than men. As an example, women have 34 nerve fibers per square centimeter of facial skin, while men average just 17. And in a 2005 study, women were found to report more pain throughout their lifetimes and, compared to men, they feel pain in more areas of their body and for longer durations.

Fact 5 – Some Animals Don’t Feel Our Pain

Animal research could offer clues to eventually relieve human suffering. Take the naked mole rat, a hairless and nearly blind subterranean creature. A study this year found it feels neither the pain of acid nor the sting of chili peppers. If researchers can figure out why, they might be on the road to new sorts of painkilling therapies for humans. In 2006, scientists found a pathway for the transmission of chronic pain in rats that they hope will translate into better understanding of human chronic pain. Lobsters feel no pain, even when boiled, scientists said in a 2005 report that is just one more salvo in a long-running debate.

What You Can Do

Meanwhile, exercise is a useful remedy for many types of chronic pain.

In an Italian study detailed in the May issue of the journal Cephalalgia, office workers did relaxation and posture exercises every two to three hours. Over an eight-month period, they kept diaries, which were then compared to those of a control group that did not change habits. In the end, the group that exercised reported that headaches and neck and shoulder pain decreased by more than 40 per cent, and their use of painkillers was cut in half.

“Physical activity is actually a natural pain reliever for most people suffering from arthritis,” concludes another study published in the Arthritis Care and Research journal in April. “Even minor lifestyle changes like taking a 10-minute walk three times a day can reduce the impact of arthritis on a person’s daily activities and help to prevent developing more painful arthritis,” said Dr. Patience White, chief public health officer of the Arthritis Foundation. “Physical activity can actually reduce pain naturally and decrease dependence on pain medications.”

Treatments I list on this page are those I have not investigated throughly. I have not tried these treatments, some mainstream, some alternative. I list them only so that those of you who are visiting the site may have additional access to possible therapies. it’s hard to say I’ve tried everything when there are so many therapies “Out there”. The real problem is not every therapy works for every person. So with that being said I give you this list.

Intrathecal Drug Delivery (Pain Pumps) – This is heavy duty, you do not want this… only the very worst cases may need this treatment.

Spinal Chord Stimulator -Surgically implanted pain treatment devices similar to Intrathecal except they deliver low voltage electrical stimulation instead of drugs.

Radiofrequency and Pulse Radiofrequency – Electromagnetic energy is delivered via a needle to treat nerves for pain.

Phoresis – High frequency sound waves are used to push a steroid medication through the skin. Lontophoresis uses a small machine to produce a mild electrical charge to carry the medicine through the skin.

Spinal Chord Stimulator -Surgically implanted paint

Therapeutic Ultrasound – I’m still learning about how this works. I’ve had both hot and cold Therapeutic Ultrasound and the hot felt great, but I don’t know the side effects if applied improperly. Most of the mainstream medical community would agree there is not real evidence to support this treatment.

Different Types of Massage Treatments

• Deep Tissue – Targets deep layers of muscles and connective tissue
• Rolfing - A specific form of deep tissue work
• Trigger Point Therapy – Addresses Adhesions in the muscles
• Swedish – most common, long smooth strokes and kneading, circular motions
• Shiatsu – Finger pressure on acupuncture meridians
• Thai
• Many many more

My point in this post is not to cover every single variation of massage, but to point out there are treatments that may address your specific problem areas.

Therapies like Deep Tissue Massage are designed for relieving muscle contraction and reducing pain. Not all massage therapists are alike, some do not understand how to do this properly – this is a form of medical massage, as opposed to just a relaxing massage to reduce stress. All massage work has benefits. Try several different modalities and see what works best for you. Be careful of the oils the therapist uses – I like grapeseed oil.- as some oils contain fragrances and are toxic to the chemically sensitive. You’re skin will absorb these chemicals.

The only downside to massage treatments is cost. I would go everyday if I could afford the expense, or better yet I’d have the therapist stop by my home. Give massage a try, it’s great!

Video About Massage Treatments

My Experience with Acupuncture

Works for some to help with pain. I tried Acupuncture with electrical therapy (At a Chiropractors Office” and it did nothing for me, but he person doing the work may not have been fully schooled as to the proper treatment.

I then found a true Oriental Acupuncture Specialist, and it made me realize the Chiropractor was clueless. The Doctor I saw for Acupuncture was born in China, Trained in China, and was actually a retired Orthopedic Surgeon in China. The number of needles he placed, the location of placement and the effects on my muscles were completely different from the “treatment” (Money bilking) I received from the Chiropractor. In my defense the Chiropractor came highly recommended by the Naturopathic Physician I was seeing at the time. But I should have been smart enough to know that they Guy had no clue what he was doing. Now I do. The benefits of hindsight.

In short, make sure your Acupuncturist is fully trained and licensed (Yes they have schools for Acupuncture).

I received some pain reduction and additional range of motion from my treatments (A series of 10 every couple of days). Unfortunately for me the treatments did not solve my chronic problems and due to the expense ($60 per treatment) vs. benefit I was forced to abandon further treatment.

Similar Modalities Like Gua Sha

Gua Sha is a healing technique used in Asia by practitioners of Traditional Medicine, in both the clinical setting and in homes, but little known in the West. It involves palpation and cutaneous stimulation where the skin is pressured, in strokes, by a round-edged instrument; that results in the appearance of small red petechiae called ‘sha’, that will fade in 2 to 3 days.

Raising Sha removes blood stagnation considered pathogenic, promoting normal circulation and metabolic processes.The patient experiences immediate relief from pain, stiffness, fever, chill, cough, nausea, and so on. Gua Sha is valuable in the prevention and treatment of acute infectious illness, upper respiratory and digestive problems, and many other acute or chronic disorders.

Gua Sha Video

Where the Steroids are Injected

The epidural space (or extradural space or peridural space) is a part of the human spine. It is the space inside the bony spinal canal, but outside the membrane called the dura mater (sometimes called the “dura”). In contact with the inner surface of the dura is another membrane called the arachnoid mater (“arachnoid”). The arachnoid encompasses the cerebrospinal fluid that surrounds the spinal cord.

Epidural Steroid Injections

An epidural injection, or epidural steroid injection, may be used to help reduce the pain caused by a herniated disc, degenerative disc disease, or spinal stenosis. These spinal disorders often affect the cervical (neck) and lumbar (lower back) areas of the spine.

The medicine used in the injection is usually a combination of a local anesthetic (e.g. bupivacaine) and a steroid (e.g. triamcinolone). The technique and risks of the procedure are similar to those for standard epidural analgesia. The effects of an epidural steroid injection vary, but permanent benefit is unlikely. The technique is believed to work by reducing the inflammation or swelling, or both, of the nerves in the epidural space.

Some patients who have some residual pain after the first injection may receive a second or third epidural steroid injection. Patients who do not receive any relief from the first injection are unlikely to benefit from a second injection.

Side Effects of Epidural Injections

Note: Yes I know that some of these side effects refer more to pregnant women than back pain, but the process is the same, it’s the injected drugs that differ.

In addition to blocking the nerves which carry pain, local anaesthetic drugs in the epidural space will block other types of nerves as well, in a dose-dependent manner. Depending on the drug and dose used, the effects may last only a few minutes or up to several hours. This results in three main effects:

• Loss of other modalities of sensation (including touch, and proprioception)
• Loss of muscle power
• Loss of function of the sympathetic nervous system, which controls blood pressure

Pain nerves are most sensitive to the effects of the epidural. This means that a good epidural can provide analgesia without affecting muscle power or other types of sensation. The larger the dose used, the more likely it is that the side-effects will be problematic.

For example, a laboring woman may have an epidural running during labor which is providing good analgesia without impairing her ability to move around in bed. She requires a Caesarean section, and is given a large dose of epidural bupivacaine. After a few minutes, she can no longer move her legs, or feel her abdomen. Her blood pressure is noted to be lower and she is given an intravenous infusion of ephedrine or phenylephrine to compensate. During the operation, she feels no pain.

Very large doses of epidural anaesthetic can cause paralysis of the intercostal muscles and diaphragm (which are responsible for breathing), and loss of sympathetic function to the heart itself, causing a profound drop in heart rate and blood pressure. This requires emergency treatment, and in severe cases may require airway support. This happens because the epidural is blocking the heart’s sympathetic nerves, as well as the phrenic nerves, which supply the diaphragm.

It is considered safe practice for all patients with epidurals to be confined to bed to prevent the risk of falls. The loss of the sensation of needing to urinate may require the placement of a urinary catheter for the duration of the epidural.

Opioid drugs in the epidural space are very safe (as well as effective). However, very large doses may cause troublesome itch, and rarely, delayed respiratory depression.

For patients with nerve root pain involving one or two roots, I believe that fluoroscopically guided foraminal injections will prove to be superior to the approaches that do not use x-ray guidance. Epidurals in general, but especially foraminal injections, do not appear to be as effective if the pain is caused by widespread degenerative or arthritic problems in the spine. – Steven Richeimer, MD