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 Blocks. 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
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 those 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.
The injection procedure for an epidural includes the following steps:
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 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.
The medial branch block is often used as part of a 2-step diagnostic and treatment approach:
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.
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.
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.
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:
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.