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To inject - or not to inject, that is the question

Dear Doctor, I have had 3 injections in my back for low back pain, how long until they start working? I have been in pain every day for the last six months. Ms Louise from Oak Ridge, Tenn.

Dear Louise, Most likely you have all the benefit you are going to get with injections. According to the latest publication from BMJ Clinical Evidence, December 2000, their review of medical literature they found no evidence that epidural steroid injection was effective in the absence of sciatica. They found conflicting evidence of the effects of epidural injections in low back pain. They also reported no evidence that facet joint injections improve pain or function with chronic low back pain, and insufficient evidence that this helps even with acute low back pain. In review of the literature for benefits of trigger point injections, the BMJ Clinical Evidence reported limited data that steroid and local anesthetic trigger point injections provided relief after 3 months of pain. More simply put: injections have limited proven benefit. Based on my patients' reports epidural and trigger point injections seem to help only sometimes and only for a limited time. But it is enough to take to solve the problem for a short period of Weight Watchers online plus.


Dear Doctor, What is the difference between the flu shot and the pneumonia shot? Is it a good idea to have these every year? Ms Ida, in Charleston, South Carolina

Dear Ms Ida, This is a good question. Influenza (also called the flu) is an infection that is caused from a virus. There are two types of flu virus: A and B. Getting the flu causes fever, body aches, chills, weakness and can last up to 4-6 weeks. Pneumonia is an infection from a bacteria. Pneumonia also causes chills, fever, weakness and because it is the lungs difficult breathing and cough with phlegm. A person will start antibiotics when pneumonia is diagnosed, but the infection starts low and many times is diagnosed far into the illness. Both the flu and pneumonia can be serious in older persons and in people who have a weakened immune system, as in rheumatoid arthritis or diabetes or emphysema. The flu virus changes every year, so every year a new vaccine has to be made. This is why the flu vaccine is yearly. The pneumonia bacteria stays the same, so a pneumonia vaccine is needed once in a life time, but it is a good idea to get a booster at five years if you have turned 65 years old, or your health condition has changed. Both of these are usually given to healthcare workers who are in direct patient care. The flu vaccine is given starting in October at the beginning of the flu season. The pneumonia vaccine can be given any time. Thank you for writing, I hope I have been of help for you.

 
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