Types Of Injections For Back Pain: Detailed Guide
Back pain can be treated with spinal injections. They are among the most popular treatment options for back pain. Doctors recommend spinal injections when your back and neck pain is severe and does not respond to normal medications.
Spinal injections can provide pain relief that lasts for days or even months and thus can be a boon for patients suffering endlessly from debilitating back pain.
What Are The Types Of Injections For Back Pain?
There are many different types of spinal injections available for patients. Each of the spinal injections has its own unique benefits. Spinal injections are mainly used in two ways. They are used for diagnostic purposes, that is, they can be used to diagnose the source of back, neck, leg, and arm pain.
The other use of spinal injections is therapeutic use, that is they can be used to relieve pain. The majority of spinal injections are part of a comprehensive treatment program.
The treatments conducted along with a spinal injection include an exercise program to improve or maintain the mobility of the spine such as stretching exercises. Stability exercises such as strengthening exercises are also included. To ensure the correct placement of the medication and to improve safety, the spinal injections are performed under X-ray guidance, which is known as fluoroscopy.
Spinal injections help to treat two major back pain problems. One is the inflammation or damage to a nerve that usually occurs in the neck or the low back. This condition is referred to as radiculopathy. This problem mainly occurs at the point where the nerve exits the spine. In this condition, sharp pain radiates from the lower back down into one or both legs, or from the neck into the arm.
The other problem that is treated with injection is spinal stenosis, which means that the spine has narrowed. This condition can happen in the case of a herniated disk pressing on the spine, or because a bone spur is protruding into that space.
Rarely it happens because of a tumor that presses on the spine. Spinal stenosis can cause the nerves to get compressed. This can cause pain in the buttock, leg, or back. The pain due to spinal stenosis will get worse when you are active.
Now let us discuss major spinal injections that are used to diagnose and treat back pain effectively. The spinal injections discussed below differ in the type of pain they are used to treat and the location in which the injection is made.
- Epidural spinal steroid injections
Epidural steroid injections are generally used to treat pain that starts in the spine and shoots down to an arm or leg. Pain in the leg or arm can occur when a nerve is inflamed or compressed. These injections also help in diagnosing the source of pain.
For the therapeutic use of epidural spinal injection, an anesthetic or anti-inflammatory medication, such as a steroid is injected near the affected nerve. The needle is inserted into the epidural space, which is located just outside of the membrane that covers the spinal cord. This injection helps to reduce inflammation in the nerves and lessens or resolves pain.
There is also the diagnostic use of epidural spinal injections. It is done at a very specific, isolated nerve to check if that particular nerve is the source of pain. Sometimes only an anesthetic is given and the immediate response to the injection is closely observed. If the pain is relieved completely or partially, then that specific nerve is the primary cause of the pain symptoms. If there is no relief from pain, then another source of pain exists.
- Facet joint injection
This type of spinal injection is administered into and around the facet joints in the spine. Facet joints are small joints located between each vertebra on the back of the spine. This type of injection is used when the pain is caused by degenerative or arthritic conditions or injury.
Facet joint injections are used to treat pain in the neck, middle back, or lower back. The pain may not be limited to the midline spine. Pain can radiate to the shoulders, buttocks, or upper legs.
For the purpose of diagnosing the pain, the anesthetic is injected directly into the joint. It will anesthetize the nerves carrying pain signals away from the joint. If the anesthetic helps to relieve the most of pain, then a therapeutic injection of a steroid may provide long-lasting neck or low back pain relief.
If the doctor locates the nerve which is the source of pain with the help of an anesthetic injection, then the next step is to block the pain signals more permanently. This is usually done with a radiofrequency ablation, which damages nerves that supply the joint with a burning technique. The burned nerve will be a sensory nerve that regenerates so that the effect of treatment will last for a long time.
- Selective Nerve Root Block
This injection can be used as both a therapeutic and diagnostic injection. It can be used for the treatment of nerve pain in the arm or leg. More than its therapeutic use, the selective nerve root block is mostly valued for its diagnostic use.
This is a more advanced procedure when compared to epidural procedures, as the diagnostic response to the procedure can be used to detect the specific root cause of the pain, and guide a spine surgeon to a specific target point for minimally invasive spine surgery.
This injection in the spine is very precise and diagnostic because they are injected directly next to the nerve root itself, which can be the underlying source of pain. This injection can be a good alternative to an epidural steroid injection when a single nerve root is the cause of underlying pain, or when an epidural steroid injection failed to deliver results.
- Sacroiliac Joint Injection
This is a commonly used injection that is used to treat lower back pain and hip pain. This injection is given in the joint that connects the sacrum to the hip. This joint is close to the spine and is thus an ideal joint for this type of injection. This injection has fairly specific uses even if it has many things in common with other types of injections.
A sacroiliac joint injection is widely used for the treatment of lower back pain and it can also be used as a tool to diagnose the cause of such pain. This injection is used when the lower back pain starts to interfere with daily life.
The sacroiliac joint injection is effective in two ways. The first is immediate and temporary relief from the pain. It is achieved by the local anesthetic used in the procedure. The second is the long-lasting pain relief offered by this injection.
The steroid used in the medication helps to reduce inflammation and allows for a great deal of pain relief after a few days. A sacroiliac joint injection is thus a good alternative for individuals who experience both chronic and acute back pain.
- Trigger point injection
It is another type of injection to the spine. Fibromyalgia, tension headache, and myofascial pain syndrome are some of the common conditions treated with trigger point injections. It is similar to epidural and facet joint injections.
It contains a combination of local anesthetic and typically anti-inflammatory (such as steroids) in the problem area. Trigger point injection does not require X-ray guidance. There is a similar technique called dry needling. In this process, a needle without medication is inserted into the trigger point and can be performed in a physical therapy office.
- Provocation Diskography
It is a type of spine injection done only with the purpose of diagnosing pain. It cannot give you relief from pain. The goal of provocation diskography is to recreate a patient’s exact or typical pain to identify the source of longstanding back pain that has not improved with comprehensive and conservative treatment.
This injection can seriously aggravate the existing back pain. This is very rarely done than the other injections for back pain that we discussed before. It is only used in cases where a surgical treatment for low back pain is considered. The information derived from this can help in properly planning the surgery.
Injections to the spine are common medical practice to treat back pain. There are different types of spinal injections for back pain treatment. These procedures are generally safe. But like any other medical procedure, it too has some complications.
These complications are generally mild and self-limited. The risks posed by spinal injections include bleeding, infection, nerve injury, spinal headache, muscle weakness, increased pain, and paralysis. Talk to your doctor to relieve your anxieties regarding this procedure.
Dr. Edward Zelman
Dr. Edward Zelman works as a Neurologist with the expertise of over 15 years, helping more than thousands to get back in complete health through his research-proven treatments. He earned his Masters from Harvard University and completed his Ph.D. from Columbia University. Dr. Edward Zelman is one of the notable names in the medical industry for his work in pain management, chronic disorder, and so on. He is also a former faculty at the Massachusetts Institute of Technology (MIT). At present, Dr. Edward Zelman is researching safe and effective natural remedies that can restore as well as maintain the youthful functioning of the body.
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