Pain Injections

Pain Injections

Pain Injections Overview:

There are a lot of options, and thus a lot of choices and decisions, when it comes to choosing pain injections. Epidural Steroid Injections. Medial Branch Nerve BlP6140235ocks. Radiofrequency Neurotomy. Prolotherapy. It can be confusing. Each have their own purposes, risks, benefits, and side-effects. Knowing how each works gives you an advantage against your pain

Types of Injections:

Cervical, Thoracic and Lumbar Interlaminar Epidural Injections:

An epidural injection delivers steroids into the epidural space around spinal nerve roots to relieve pain – back pain, leg pain, or other pain – caused by irritated spinal nerves. The steroid used in the epidural steroid injection reduces the inflammation of thoseEpidural3-300x200 nerves, which is often the source of the pain. It is important to note that an epidural steroid injection should not be considered a cure for back pain or leg pain: rather, the goal is to help patients get enough pain relief in order to be able to progress with their rehabilitation program.

Epidural Steroid Injection Procedure:

The injection procedure for an epidural includes the following steps:

  • An IV is started so that medicine can be given for relaxation if desired.
  • The patient lies face down on an X-ray table and the skin is well cleaned with an antiseptic.
  • The area where the epidural needle will be inserted is numbed with a local anesthetic.
  • Fluoroscopy (a guided X-ray procedure where the doctor can watch the placement and movement of the needle) will be used to direct a small needle into the epidural space. The patient will feel some pressure during this part. Fluoroscopy is important in this procedure to help ensure correct placement of the medications.
  • A contrast dye is injected to confirm that the medicine spreads to the affected nerve(s) in the epidural space.
  • A combination of numbing medicine (an anesthetic) and time released anti-inflammatory medicine (a steroid) is injected.

Epidural Injection Results and Follow-up:

Following the epidural injection, some partial numbness from the anesthetic may occur in the patient’s arms or legs. Any partial numbness usually subsides after a few hours. Any remaining pain needs to be reported to the physician, and ideally the patient should keep a “pain diary” to record the pain relief experienced over the next week. After the pain diary is returned to the treating physician, the physician should be kept informed of the results in order to plan future tests and/or treatment if needed.

Medial Branch Nerve Blocks:

Medial branch nerves are small nerves that feed out from the facet joints in the spine and carry pain signals from the facet joints to the brain.injcn

The medial branch block is often used as part of a 2-step diagnostic and treatment approach:

  1. Role of a Medial Branch Block
    A medial branch nerve block is a procedure in which an anesthetic is injected near small medial nerves connected to a specific facet joint. Typically several levels of the spine are injected in one procedure.

If the patient experiences marked pain relief immediately after the injection, then the facet joint is determined to be the source of the patient’s pain.

  1.   Role of a Medial Branch Radiofrequency Neurotomy (Ablation)
    In cases where a medial branch nerve block has confirmed that a patient’s pain originates from a facet joint, a radiofrequency neurotomy can be considered for longer term pain relief.

 Facet Joint Injections

At times, a medial branch block is tried after the patient has already been treated with one or more facet joint injections, although this is not always the case.

Sacroiliac Joint Injection:

A sacroiliac (SI) joint injection – also called a sacroiliac joint block – is primarily used either to diagnose or treat low back pain and/or sciatica symptoms associated with sacroiliac joint dysfunction.

The purpose of a sacroiliac joint injection is two-fold: to diagnose the source of a patient’s pain, and to provide therapeutic pain relief. At times, these are separated and a patient will undergo a purely diagnostic or therapeutic injection, although often the two are combined into one injection.

  1. Diagnosis
    A diagnostic SI joint injection is used to confirm a suspected diagnosis of sacroiliac joint dysfunction. This is done by numbing the sacroiliac joint with local anesthetic (e.g. lidocaine). The injection is performed under fluoroscopy (X-ray guidance) for accuracy. Once the needle has entered the sacroiliac joint, contrast is injected into the joint to ensure proper needle placement and proper spread of medication. The numbing medication is then injected into the joint.
  2. Pain Relief
    A therapeutic SI joint injection is done to provide relief of the pain associated with sacroiliac joint dysfunction. The injection is performed using the same technique as a diagnostic SI joint injection, except that anti-inflammatory medication (corticosteroid) is included in the injection to provide pain relief by reducing inflammation within the joint.

The Sacroiliac Joint Injection Procedure

The Sacroiliac Joint injection procedure is usually performed in an operating room or a dedicated procedure room. The entire procedure usually takes only minutes, and the patient goes home the same day.

The following outlines the typical injection procedure:

  • After informed consent has been obtained, the patient lies face down on his or her stomach on the radiography table. A pillow might be placed under the hips for patient comfort.
  • The patient’s vitals (e.g. pulse rate and blood pressure) are monitored throughout the procedure.
  • Depending on the physician and the patient’s preference, an intravenous line may be inserted to deliver medication to help the patient relax.
  • To maintain sterility, the skin overlying the sacroiliac joint injection is cleansed using an iodine based solution (e.g. Povidine-Iodine) or an alcohol-based antiseptic (e.g. chlorhexidine 0.5% in 70% alcohol). Sterile gloves are used throughout the entire injection procedure.
  • For the patient’s comfort, the needle insertion site is often numbed using local anesthetic. Once the needle enters the sacroiliac joint under fluoroscopy guidance, contrast – ‘dye’ that shows up under X-ray – is injected to verify needle placement within the sacroiliac joint and to verify spread of solution within the joint.
  • Once the needle has been guided into the joint successfully, diagnostic and/or therapeutic medications are injected into the joint.

Selective Nerve Root Blocks (SNRB) and Facet Joint Injections:

Another common injection, a selective nerve root block (SNRB), is primarily used to diagnose the specific source of nerve root pain and, secondarily, for therapeutic relief of low back pain and/or leg pain.

When a nerve root becomes compressed and inflamed, it can produce back and/or leg pain. Occasionally, an imaging study (e.g. MRI) may not clearly show which nerve is causing the pain and an SNRB injection is performed to assist in isolating the source of pain. In addition to its diagnostic function, this type of injection for pain management can also be used as a treatment for a far lateral disc herniation (a disc that ruptures outside the spinal canal).

In an SNRB, the nerve is approached at the level where it exits the foramen (the hole between the vertebral bodies). The injection is done both with a steroid (an anti-inflammatory medication) and lidocaine (a numbing agent). Fluoroscopy (live X-ray) is used to ensure the medication is delivered to the correct location. If the patient’s pain goes away after the injection, it can be inferred that the back pain generator is the specific nerve root that has just been injected. Following the injection, the steroid also helps reduce inflammation around the nerve root.