I had 8 ESI's over 2.5 years. 7 were done by one old doc with no flouroscopy... never hurt... never made me worse... 5 of 7 produced relief for days or weeks. (remember that my pain was episodic, so I may have gotten better anyway.) The one caudal ESI I had with a young physiatrist (again, no flouroscopy), really set me off.
Upon going back to the old guy when I told him about ESI causing many days of severe pain, he said, "I bet he ran into bone and had to back up and try again." He was absolutely correct.
Mark
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