Understanding the Types of Injections for Back Pain

Are you in need of pain relief for your neck or back issues? Does your back pain spread to your arms or legs? Has your doctor recommended spinal injections? Spinal cord injections may sound scary, but they are a quick and easy option for chronic pain relief. These injections are minimally invasive procedures used to reduce pain that is not relieved with more conservative approaches. Understanding the types of injections for back pain can go a long way in helping to alleviate fear so you can concentrate on getting better.

Pain reduces a patient’s quality of life and makes healing even harder. At MOSH, our specialists are trained in spine health and orthopedic pain relief. Whether you are dealing with chronic pain or an acute injury, our spine and back experts can help.

What Are Back Pain Spinal Injections?

Spinal injections are one way to provide neck and back pain relief directly to the source without invasive surgery. These shots for back pain are used in conjunction with other treatments, like a physical therapy exercise program. Physical therapists will provide exercises that will strengthen your supporting muscles and maintain spine and hip mobility and flexibility. Spinal injections are both diagnostic tools and treatment options.

Diagnostic Spinal Injections

Diagnostic spinal injections are used to discover the source of the pain and to confirm the proposed diagnosis. If the diagnostic injection of medicine stops the pain, the shot will be replaced by a therapeutic injection treatment. Types of diagnostic spinal injections include selective nerve root blocks (SNRB), facet joint injections, sacroiliac joint injections, and medial blocks.

Therapeutic Spinal Injections

Therapeutic types of spinal injections are used to relieve pain in the back, neck, and radiating arm and leg pain. Therapeutic injections, like epidural injections, are done after a diagnostic injection confirms the location of the problem. A therapeutic injection contains one or a combination of both of these medications:

  • Anti-Inflammatories include corticosteroid injections such as triamcinolone methylprednisolone, and betamethasone.
  • Pain-Relievers include anesthetics such as lidocaine, tetracaine, and bupivacaine. Lidocaine only lasts a few hours and is often used in diagnostic spine injections.

These medications are delivered directly to the pain source and last weeks to months, depending on the type of shot received and the status of your medical condition.

All spinal injections used for pain relief share the same goals:

  • To remove the pain barrier so that you can return to normal activities and participate in additional. treatments like physical therapy.
  • To prevent the use of narcotic pain medications, which can be dangerous.
  • To end patient suffering and allow for rest and healing.
  • To delay or avoid surgical interventions.

Pros and Cons of Spinal Injections for Pain Relief

In order to understand the types of injections for back pain and whether to consider using them, it helps to first understand the benefits and risks. Nearly every medical procedure has pros and cons. For back pain shots, these include:

Pros of Injections for Back Pain:

  • An increase in the patient’s quality of life
  • Increased mobility
  • Decreased or full alleviation of pain
  • Potential to restore function
  • More effective pain relief compared to oral and topical medications
  • Less invasive than surgery
  • Fewer side effects
  • Minimal recovery time
  • High success rates
  • May reduce the need for other types of treatment

Cons of Injections for Back Pain:

  • Pain relief is temporary
  • Too many injections may cause damage
  • Pain relief can vary for every patient
  • Some side effects
  • Higher cost for treatment, depending on insurance coverage
  • Infection at the injection site
  • Doesn’t treat the underlying medical condition
  • May not be available for every patient. Spinal injections are not recommended for people with skin infections near the injection site, blood disorders, allergies to contrast dye or the medication used. Steroids are also not recommended for diabetics with high blood sugar or people with high blood pressure.

What to Expect When Receiving an Injection for Back Pain

An X-ray-guided procedure called fluoroscopy will guide all types of injections for back pain. This ensures that the doctor is getting the medicine to the right area. During the fluoroscopy, dye is injected via a small syringe into the suspected origin of the pain to confirm proper placement. The needle placement is informed by the live “X-ray movie.” It is usually painless, and after your spinal injection is complete, you can usually go home the same day.

The steps to getting your shot will likely be as follows:

Step 1: Before the Procedure

You will have met with your doctor or specialist prior to the injections. They will take a patient history, perform a physical exam, and may send you for imaging tests. If they recommend a spinal injection, you may be asked to stop taking some medications like blood thinners.

Step 2: Preparation of the Injection Area

The procedure will usually take place in an imaging room, possibly with a CAT scan but usually in an X-ray room.

You will be given a local anesthetic (either a shot or a topical application) to numb the injection site area. You may also be given an oral or intravenous mild sedative. You need to stay awake so you can answer the doctor’s questions, but there will be no more pain than a flu shot.

Step 3: The Injection

Once the injection site area is numb, the doctor will inject dye into the suspected pain site using X-ray guidance (fluoroscopy).

When the doctor has the correct route to the pain source, the diagnostic or therapeutic back pain medication is injected. The whole procedure can take anywhere from 15 to 45 minutes. Afterward, you will be monitored for a short period, but you will be able to go home the same day.

It is recommended that you have a ride home because of the sedative and in case you experience some mild leg weakness.

Step 4: After The Injection

You will probably be able to resume your pre-pain activities the day after your procedure. You may experience some soreness at the injection site that can be treated with over-the-counter (OTC) medications like aspirin.

It’s helpful to keep a log of your pain for a couple of weeks after the procedure. You’ll have to schedule a follow-up visit with your doctor, and the log will be helpful in monitoring your progress. Be sure to follow all your doctor’s orders before and after your spinal cord injection procedure.

6 Common Spinal Injections for Back Pain

Learning and understanding the types of injections for back pain is important so the patient can make informed decisions. Spinal injections for pain are low risk, minimally invasive, virtually painless, and done as an outpatient procedure. Here are six of the most common injections for back pain.

Epidural Steroid Injection (ESI)

ESI injections are a mix of pain-relieving and anti-inflammatory steroid medicine used to calm irritated nerves and reduce the pressure-causing pain. They are injected via one needle into the epidural space of the spine between the vertebrae and the protective sac enclosing the spinal nerves. An epidural steroid injection is not the same as epidural anesthesia given for childbirth. ESI pain relief varies and can last weeks to months.

There are three types of ESIs:

  1. Lumbar ESI: The shot is given in the lumbar area of the spine. This area consists of five vertebrae found after the thoracic vertebra and before the sacrum (bottom of the spine). It is used to treat radiating chronic pain, known as lumbar radiculopathy (radicular pain). This pain is often felt in the lower back and down the legs, hips, and feet.
  2. Cervical ESI: This injection is delivered to the epidural space between one of the seven vertebrates of the neck. Like the lumbar ESI, it is used to treat chronic pain originating from the cervical spine. 40% to 84% of ESI recipients felt temporary relief from neck pain.
  3. Caudal ESI: This injection goes into the epidural space of your lower back. It is used to treat pain from sciatica, herniated discs, degenerative disk diseases, spinal stenosis, and spondylosis (osteoarthritis).

Facet Joint Injections

Facet joints are hinge-like joints between the vertebrae of the spine that allow movements like bending and stretching. Facet joint injections (sometimes called facet joint blocks) can be either diagnostic or therapeutic. When injected with pain-relieving medicine, a facet joint injection can last for a long time with almost immediate pain relief.

Facet joint injections can be used to treat pain from sciatica, spinal osteoarthritis, whiplash, sports-related injuries, and general back pain management.

Selective Root Nerve Blocks (SRNBs)

SRNBs, sometimes referred to as a nerve block, are used as both a diagnostic and treatment tool. When used to treat pain, an anesthetic (or anesthetic with steroid) is injected near the nerve as it exits the spinal column. SRNBs can last six months to a year.

Selective root nerve blocks can provide pain relief for conditions like spinal stenosis, sciatica, bone spurs, scoliosis, herniated discs, low back pain, or nerve compressions.

Medial Branch Nerve Blocks

A medial branch nerve block involves injecting anesthetic and steroid medications into the medial nerve that runs through the facet joints. This injection is used most often as a diagnostic tool to locate facet joint damage. If a medial branch nerve block is successful, radiofrequency ablation is sometimes recommended as a treatment. Medial branch nerve blocks can also be used as an effective pain management for degenerative discs and facet joint inflammation by blocking the pain signal from specific nerves.

Sacroiliac Joint Blocks

The sacroiliac (SI) joint functions like a facet joint linking the pelvis and the lower spine. SI injections can be used to confirm a diagnosis or as a treatment option. For pain relief, injections usually include steroids and an anesthetic.

SI injections can be used to alleviate pain from rheumatoid arthritis, degenerative diseases, ankylosing spondylitis, sacroiliitis, osteoarthritis, trauma, or pregnancy. It can also be used for radiating discomfort into the buttocks, groin, leg, and lower back.

Regenerative Injection Therapy (RIT)

Regenerative injections involve harvesting the patient’s own cells from another part of the body and injecting them into the damaged area. The cells can be stem cells from bone marrow or platelet-rich plasma (PRP). These regenerative injections are used to aid our body’s natural healing abilities and aid in the regrowth of damaged tissue, which can help reduce pain for weeks to months.

RIT can be used for chronic pain due to tissue damage. It can be used in other areas besides the spine for medical conditions like torn ACLs, golfer’s elbow, Achilles tendonitis, and other sports injuries.

Now that you understand the different types of injections for back pain, you can consider these treatment options before having surgery. At MOSH, we have teams of expert specialists ready to diagnose and treat your orthopedic pain and injuries. Don’t let back and neck pain slow you down. Call us today at 414-817-5800 or email us and see how we can get you back to the life you love.

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