Doctors advise the use of injections when other medications have been ineffective. Injections supply medicine directly into the required area, hence making them very effective. In addition, the medicine usually stays put (as a pose to oral treatments which must travel through several body systems before reaching the site of pain). Nevertheless this treatment is more aggressive. The ability of the person administering the injections is vital because he or she needs to target the precise point in the nervous or musculoskeletal system. Injections are usually done to outpatients. Specialists including radiologists, anesthesiologists, pain physicians, physiatrists, and neurosurgeons will generally do the procedure. There are different medications as well as different points of injection. You should appreciate that injections are not designed to be stand-alone procedures; instead they should fit into an overall treatment plan. The subsections provide information on some of the more common injection treatments.
You should realise that you have a muscular trigger point because you can easily feel it. Push onto one of these knotted up muscles and it feels painful as well as radiating out to other parts of your back. Hence the name “trigger,” as they cause pain elsewhere.
The initial treatment for trigger points is usually a massage or other hands-on techniques. If pain still persists after a few weeks of that treatment, an injection may be advised. A local anaesthetic, saline solution or Botox may be injected to alleviate the muscle knot. More than three injections into the same trigger point can cause permanent muscle damage and so are not advised.
The joints in between your vertebrae are called facet joints; you can find more information about them here. Just like other joints in the body, they are at risk to wear and tear as well as diseases such as osteoarthritis which result in inflammation and thus pain. The medicine injected into a facet joint is often a mixture of a steroid with an anaesthetic.
Occasionally, injections are required for sacroiliac (SI) joint pain. The SI joint is where your sacrum meets your hip bones and is a common source of back pain. These injections require the use of radiological fluoroscopy, essentially an elaborate X-ray which allows physicians to see images of your bones in real time as the needle is injected. Sometimes dye is injected in the area surrounding the nerve to show that the medication is flowing in the right area.
Epidural Steroid Injections
For suffers of sharp, shooting pain, such as from sciatica, this may be advised. The injection usually works best when used within the initial month of pain. Studies show if you wait much longer, it’s not as effective.
A steroid is introduced into the epidural space surrounding the spinal canal. A specialist must be specifically trained in order to conduct this procedure. Injecting medication into this area has an effect on a number of nerves. The sciatic nerve is comprised of several nerves which have roots in the lower back; this injection can be particularly valuable when dealing with sciatic pain.
Just like facet-joint injections, this procedure is conducted under fluoroscopy. Patients can feel better initially due to the numbing effect of the anaesthetic, but it generally takes several days to feel the full effect of an epidural steroid. Injections usually last for around six months, and patients often need another dose or two before the natural healing process of the body has taken place. Other times, the injection may only last a few days.
Epidural injections influence a broader range of nerves, whereas nerve-root blocks target particular nerves. Apart from these differences the procedures are very similar in use of technology and medication. When injecting a nerve-root block, the specialist first injects an anaesthetic to see if the appropriate nerve has been reached. They place the needle carefully at the site where the nerve exits the spine. The nerve is not directly injected; instead, the needle enters the space surrounding the nerve. If the anaesthetic alleviates the pain, the right nerve has been located and steroid is next injected into the site. Occasionally, selective nerve-root blocks are used to aid diagnose which nerve is problematic and to help direct future treatments such as surgery for specific nerve-root decompression. It can require numerous attempts to locate the correct nerve, but the process isn’t lengthy. It takes only about 10 minutes or so to test each injected nerve root.
Nerve-root blocks can be more effective because the exact nerve involved in the pain has been found and treated. Most of the time, this procedure is used to treat nerve pain and sciatica.