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Epidural Corticosteroid Injection

Pain specialists have used epidural corticosteroid injection (ESI) for decades to treat back and neck pain. The procedure is further divided into cervical ESI, thoracic ESI and lumbar ESI (LESI) with the purpose of treating the pain originated from different spinal regions. By 1995, there were at least twelve so-called double-blind, placebo-controlled studies investigating the clinical efficacy of LESI for low back pain. Of these studies, only six yielded positive results, while the other studies did not support the use of LESI for low back pain. Actually several of these studies exhibited the critical flaw of treating “low back pain” as a single entity.

It is now realized that low back pain is a clinical syndrome that may be caused by a variety of pathologies in the lumbar spine and adjacent organs. It is not reasonable to treat low back pain with epidural corticosteroid injections regardless of the cause. More recent, well-designed, placebo-controlled studies have provided clinical evidence that LESI decreases lumbar radicular pain (nerve root pain) caused by lumbar disc herniation. The pain-relieving effect of LESI may last up to three months. Corticosteroids appear to speed the rate of recovery and return of function, allowing patients to reduce medication levels and increase activity while waiting for the natural improvement expected in most spinal disorders. Recent studies also support the use of LESI for pain relief in patients with spinal stenosis (narrowing of spinal canal).

Disc Herniation Pain

It is now believed that the pain in patients with disc herniation and associated radiculopathy is not simply due to mechanical compression, but is due to chemical inflammation of the nerve roots and nerve endings. Past the age of 60, more than 90 percent of the normal population has a variety of degenerative spine changes including disc herniation, spinal stenosis and foraminal stenosis. The majority of persons with these changes, however, do not have pain. Human discs contain high levels of phospholipase A2. This enzyme is responsible for the liberation of arachidonic acid from cell membranes, and has a theoretical inflammatory potential. It therefore appears that the primary function of a local corticosteroid injection is to suppress the function of phospholipase A2 and to decrease the inflammation around the nerve roots. It is reasonable to let patients have a trial of LESI before considering a surgical treatment for lumbar disc herniation. The procedure often prevents back surgeries. As long as pain is relieved and the patient is free of neurological deficits, a herniated disc should be left alone without further treatment.

Meet the FLPNR Team

  • YiLi Zhou, M.D., Ph.D
  • Hoang (Wayne) T. Vu, D.O.
  • Lourdes Varela–Batista, M.D.
  • Vinh-Loc Nguyen, P.A.
  • Kirstie Nicol, P.A.
  • Irene Aponte Moreno, N.P.
  • Sunny Park, N.P.
Neurologist in Ocala, FL Doctor of Osteopathic Medicine in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Nurse Practitioner in Ocala, FL Nurse Practitioner in Ocala, FL
Neurologist in Ocala, FL

YiLi Zhou, M.D., Ph.D.

Harvard-Trained, Board-Certified Pain Specialist and Neurologist.

Dr. Zhou graduated from Wenzhou Medical College, China in 1982 with training in both modern western medicine and traditional Chinese medicine. He had neurology fellowship training at Shanghai Medical School, specializing in EMG/NCV and evoked potential studies. He served as an attending neurologist in China.

Doctor of Osteopathic Medicine in Ocala, FL

Hoang (Wayne) T. Vu, D.O.

Dr. Zhou graduated from Wenzhou Medical College, China in 1982 with training in both modern western medicine and traditional Chinese medicine. He had neurology fellowship training at Shanghai Medical School, specializing in EMG/NCV and evoked potential studies. He served as an attending neurologist in China.

Physician in Ocala, FL

Lourdes Varela–Batista, M.D.

Dr. Varela is a fellowship trained pain specialist and board certified PMR expert. Her specialities include physical medicine and rehabilitation and interventional pain medicine. She received her undergraduate degree from University of Puerto Rico and completed her medical degree from New York Medica College. Dr. Varela completed her physical medicine and rehabilitation residency at University of Texas Health Science Center San Antonio.

Physician in Ocala, FL

Vinh-Loc Nguyen, P.A.

Vinh-Loc Nguyen is a NCCPA certified physician assistant and is licensed by the State of Florida Department of Health. He received his Bachelor of Science degree in microbiology and Bachelor of Arts Degree in economics from University of Florida in 1994. He had a successful career in the financial industry before returning to his true passion for medicine.

Physician in Ocala, FL

Kirstie Nicol, P.A.

Kirstie has been serving as a physician assistant at Florida Pain and Rehabilitation Center, Lake City since September 2016. She is board certified by the National Commission on Certification of Physician Assistants (NCCPA). She received her master of science in physician assistant studies, at Clarkson University in Potsdam, NY.

Nurse Practitioner in Ocala, FL

Irene Aponte Moreno, N.P.

Ms. Irene Aponte Moreno is an Adult-Gerontology certified Nurse Practitioner and licensed by the State of Florida Department of Health. In 2014, she received her Master of Science degree in Nursing from the University of South Alabama. She completed her Bachelor of Science degree in Nursing from Jacksonville State University in December of 2006. In 2003, she received an Associates of Arts degree from Southwestern Michigan College. She also completed an Associate degree in Informatics from the University Institute Antonio Jose de Sucre located in Lara State, Venezuela.

Nurse Practitioner in Ocala, FL

Sunny Park, N.P.

Ms. Sunny Park is an AANP and ANCC certified Advanced Registered Nurse Practitioner, licensed by the State of Florida Department of Health. She graduated with Summa Cum Laude with Bachelor of Arts in Drawing from Southern Illinois University in 1999. She pursued nursing career and graduated with Associate of Science in Nursing in 2007 and started working as a registered nurse in Cardiovascular ICU in St.Luke’s Medical Center. She continued with her education and graduated with Magna Cum Laude obtaining Bachelor of Science in Nursing in 2010 from Cardinal Stritch University. During her nursing education, she was awarded multiple scholarships including the Lamplight scholarship by Milwaukee Nurses Association.

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