Pain Injections

Back injections may help treat two major back pain problems:

• Inflammation or damage to a nerve, usually in the neck or the low back. Sometimes called “radiculopathy,” this problem originates where the nerve exits the spine. Sharp pain shoots from the lower back down into one or both legs, or from the neck into the arm. A herniated disk can also cause radiculopathy.
• Spinal stenosis, which means that the spine has narrowed. This can happen because a herniated disk is pressing on the spine, or because a bone spur is jutting into that space, or, less commonly, if a tumor presses on the spine. Spinal stenosis compresses the nerves inside. This usually causes pain in the buttock or leg. You may or may not also have back pain. The pain from spinal stenosis may get worse when you’re active and ease up when you lean forward.

There are other situations and types of pin for which your doctor may also use injections. Also they use them to help find out what's causing the pain.

There are several kinds of injections, including nerve blocks, Epidural and Discography.

A “pain block” or “nerve block” is a common name for several procedures that use injections to treat, manage or diagnose many painful conditions.

The term “nerve block” can be confusing. In reality, these injections aren’t blocking any nerves at all. Instead they are injecting diluted solutions of cortisone or other medicines to relieve swelling and inflammation around the nerve.

Perhaps the best-known is an epidural. Many pregnant women receive an epidural during childbirth to allow them to be awake during delivery and ease the pain of labor and delivery.

Epidural means "around the spinal cord." These shots include a steroid medicine, also called corticosteroid, and usually an anesthetic medicine, too.

Their effects seem to only last a short time and offer modest pain relief. So these might not be something you’d get for long-term back pain. And if your back pain started suddenly, there are other treatments your doctor would probably consider first.

The epidural space is located inside the bones of the spine, but outside of the sack containing spinal fluid. By injecting medication into the epidural space, it can be delivered very close to nerves that are irritated by problems such as ruptured or degenerated discs, bone spurs, narrowing of the spine or nerve openings (stenosis), and other conditions.

The standard epidural block is performed by placing a needle between the bones in the middle of the spine, the lower back (lumbar) or into the neck area (cervical) and then injecting cortisone mixed with a diluted local anesthetic.

Today, most epidural injections are fluoroscopically guided, which means the physician is watching the injection using live X-ray or CT Scan, not doing the procedure “blind” by just feeling the needle.

While epidural injections are by far the most common, there are several other types of injections used in interventional pain, including:

• Facet joint. Injections of a steroid with local anesthetic into the facet joints in the spinal bones, or vertebrae, can help treat back pain resulting from arthritis or injury. Pain in the neck, middle back, lower back, buttocks, or upper legs can be controlled in this way.
• Sacroiliac joint. Injecting a steroid with local anesthetic medicine into the sacroiliac joint, the area between the pelvic bones in the lower back, can block pain in the buttocks, upper leg, and lower back.
• Suprascapular nerve block. This type of block can be useful for chronic pain involving the shoulder which does not respond to injections directly into arthritic joints. It can also be used to block shoulder pain that is severe enough to interfere with needed physical therapy.
• Occipital nerve block. Injection of a steroid with local anesthetic into the occipital nerves in the back of the head can help relieve pain from chronic headaches and types of neuralgia.

Although they can bring longed-for relief, therapeutic nerve blocks are not a cure for pain. Their effects may only last for a limited time. They are often part of a full program that may include oral medicines, exercise and stretching to help you recover from your injury.

If you are recovering from surgery, the block should last through the initial recovery stages. In other situations, make sure you understand when to call your healthcare provider about breakthrough pain.

Healthcare providers may use a nerve block as a tool to find out what is causing your pain and where it is coming from. By judging how you react to a temporary nerve block and how it affects your pain, your healthcare provider can better figure out the reason for your pain, where it is located, and how to best treat it.

Nerve blocks can be used to manage chronic (or long-term) pain, pain after surgery, severe acute (or short-term) pain. They ease pain by offering immediate relief. They can also offer longer-term relief, because some injections reduce irritation to the nerves and let them heal.

For people who have chronic pain, nerve blocks can help them function better in their daily lives, allowing them to go to work, exercise, and do daily tasks.

Temporary nerve blocks are often a short-term fix. The pain may return within as little as a few hours after the drugs wear off. Some people may need repeated or even long-term nerve block treatments to manage inflammation and pain.

Nerve blocks are often used during surgeries to ease pain and can also help relieve cancer-related pain as well as migraines and occipital neuralgia.

Done by a trained, qualified professional, nerve blocks are considered safe. However, like all procedures, nerve blocks do have some risks.

A nerve block can lead to bleeding and infection where the shot was given, the medicine may spill into other areas unexpectedly, and healthcare providers may hit the wrong nerve during surgery. However, compared with many procedures, nerve blocks appear to be quite safe.

Before the day of your procedure, a nurse will call to confirm the time you should arrive at the surgery center. This may vary slightly from the time you were originally given as other procedures scheduled before or after yours may have canceled or changed.

The nurse will review the medications you take and the medical conditions you might have. You probably have answered these questions before, but it is important that this information is checked and rechecked to be certain no errors are made.

Please follow your specific instructions, but there are some general preparations:

• You should not eat or drink for six hours before the procedure
• Your nurse or doctor will inform you which of your regular medications to take or avoid the day of your procedure
• You must arrange to have someone remain at the Surgery Center until you are discharged and to drive you home afterward. (Usually, you will be at the Surgery Center for two to three hours or less)

When you arrive at the Semmes Murphey Clinic Surgery Center, check in on the second floor with the receptionist to receive your armband and beeper. The beeper will indicate when it’s time to be taken to the pre-procedure area.

After check-in, you will change into a hospital gown. Another nurse will review the questions you were asked the day before. If an IV is required for your procedure, it will be started in your hand or forearm.

The doctor performing the procedure will come talk to you and answer any questions you have.

The procedure itself is performed in an X-ray room. After being positioned on the table the nurse will administer some sedation through your IV. The sedation will leave you feeling drowsy and relaxed, but you will not be “put to sleep” for these minor procedures. It’s not uncommon, though, for patients to not remember the procedure afterwards. Most interventional pain procedures take less than 20 minutes to perform.

After the pain block is complete, you will be sent to the recovery area for monitoring for 30 minutes or so to allow the effects of the sedation to wear off and to be certain you have no adverse effects from the procedure. Some patients will feel some numbness or weakness in their legs for 45 minutes or so after the procedure, but this is temporary.

Your driver may come join you in the recovery area. The nurse will go over discharge instructions and medications list with you and your driver. If you do not feel nauseated, the IV will be discontinued and you will be assisted to stand and take a few steps.

After your successful recovery, a nurse will give you discharge instructions and you will go home.

You will be here approximately two to three hours (or less) from the time you check-in until you are discharged.

When you arrive at your home, you don’t have to stay in bed, but you should limit yourself to quiet “around the house” activities for the rest of the day. You should not drive for at least six hours after the procedure since the effects of the sedative may slow your reaction times. Most patients resume normal activities and return to work the day after their procedure.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.