Epidural steroid injections (ESIs) are a common treatment for lower back pain and can also provide relief for upper back and neck pain. An epidural space injection targets the source of discomfort by delivering powerful anti-inflammatory medication directly into the epidural space.
Back pain is one of the most common conditions for which steroid injections are prescribed. Risks are small but infrequent with minimally invasive procedures.
In this blog post, we’ll explore why injections for back pain are important, the different types of injections available, and what you can expect if you decide to go this route for pain relief.
Injections For Back Pain: 5 Vital Positions
When considering injections as a treatment option for back pain, it is crucial to know the different types available and their potential risks and complications. Below, we delve into the various injections commonly used for managing back pain and outline the associated risks.
Epidural Steroid Injections
Back pain is commonly treated with epidural steroid injections, especially when disc problems and nerve root irritation are involved. Corticosteroids are injected into the spine's epidural space to provide targeted relief. Direct injection of corticosteroids into the epidural space around the spinal cord and nerves is called epidural steroid injection.
These injections provide temporary relief from back pain radiating down the leg. This is usually recommended in cases of herniated discs and back pain accompanied by leg pain.
Risks And Complications:
- Infection: The risk of infection at the injection site is minimal, but it does exist.
- Bleeding: Some patients may experience minor bleeding, particularly if they are on blood-thinning medications.
- Nerve Damage: Accidental injury to nearby nerves is a potential risk, albeit uncommon.
- Temporary Blood Sugar Increase: For those with diabetes, epidural steroid injections may temporarily raise blood sugar levels.
Facet Joint Injections
Facet joint injections target pain stemming from the small joints located between vertebrae. These injections contain anesthetics and corticosteroids to reduce inflammation and alleviate discomfort. Lumbar facet injections treat arthritic pain in the spine's facet joints. Patients with mechanical lower back pain may find relief by using this procedure.
Risks And Complications:
- Allergic Reactions: Patients may suffer from allergic reactions to injections in rare circumstances.
- Temporary Pain Increase: Some individuals might experience a brief worsening of pain post-injection, which usually subsides within a few days.
- Tissue Damage: There's a minimal risk of unintentional injection into surrounding tissues or structures.
Sacroiliac Joint Injections
Injections in the sacroiliac joints treat pain and inflammation caused by dysfunction. These joints cause leg discomfort and back pain at the spine's base. Injections are indicated for people suffering from sacroiliac joint dysfunction. They may not be suitable for those with severe allergies or active infections.
Risks And Complications:
- Nerve Damage: Incorrect needle placement could lead to nerve damage, resulting in sensory or motor issues.
- Temporary Pain Increase: It's possible to experience temporary discomfort or a brief increase in pain following the injection.
- Localized Pain: Some patients may experience localized pain after getting an injection, but it usually subsides quickly.
- Allergic Reaction: While rare, there's a possibility of an allergic reaction to the injected medication or other substances used during the procedure.
- Incomplete Relief: Sacroiliac joint injections might not always provide complete or long-term relief from pain due to the complex nature of the condition.
Medial Branch Blocks
An anesthetic is injected near the small medial nerves connected to specific facet joints in the spine in a medial branch nerve block. This procedure often targets multiple levels of the spine during a single session. Temporary relief is provided by the anesthetic injection interrupting pain signals from the medial nerves.
Risks And Complications:
- Temporary Numbness or Weakness: In some cases, the injected anesthetic might cause temporary numbness or weakness in the treated area.
- Incomplete Pain Relief: The procedure might only provide the desired pain relief for some patients, as individual responses can vary.
- Localized Swelling or Bruising: Mild swelling or bruising might occur at the injection site, typically resolving independently.
- Rare Complications: Extremely rare complications could include dural puncture, allergic reactions to the substances, or inadvertent injection into unintended structures.
Your healthcare provider should discuss these potential risks and complications before performing a medial branch nerve block. Personalized guidance will ensure the procedure is appropriate for your condition and medical history.
Lateral Branch Blocks
The lateral branch block is often combined with radiofrequency ablation for chronic sacroiliac joint pain (sacroiliitis). Sacroiliac joints send pain signals to the brain and spinal cord through lateral branches. A temporary blockage of these branches can pinpoint the exact source of pain, followed by more lasting treatments like radiofrequency ablation.
Risks And Complications:
- Bleeding: Minor bleeding may occur at the injection site, but this is usually temporary.
- Allergic Reactions: While rare, individuals may experience allergic reactions to the injected medications, necessitating immediate medical attention.
- Nerve Damage: Nerve damage during the procedure can cause temporary or, in extremely rare cases, permanent neurological issues.
- Temporary Pain Flare-Up: It's possible to experience a temporary increase in pain immediately after the lateral branch block, which should subside within a day or two.
Knowing the potential risks and complications of various back pain injection treatments in collaboration with your healthcare provider is important. Consult a medical professional to determine which option is best for your condition.
The Procedure of Injections For Back Pain
The injection technique is a crucial part of the injections for back pain procedures. A skilled and experienced practitioner can increase these injections' effectiveness while minimizing the associated risks. Here are some key details you should know about injection technique:
Diagnosis
- Thorough Assessment: A comprehensive evaluation of the patient's medical history, symptoms, and imaging results is conducted to pinpoint the source of back pain.
- Diagnostic Imaging: X-rays, MRI scans, or CT scans might be employed to visualize the affected area, aiding in accurate diagnosis and treatment planning.
Preparation
Avoid taking anti-inflammatory medications such as Advil or aspirin for at least five days before an epidural spinal injection. Before your spine steroid injection, you can eat and drink as usual.
- Informed Consent: Patients are informed about the injection procedure, its potential benefits, risks, and alternatives, allowing them to make an informed decision.
- Preparation Guidelines: Before the injection, patients might be advised to temporarily discontinue certain medications, fast if necessary, and follow any specific instructions provided by the healthcare provider.
Injection Technique
- Patient Positioning: The patient assumes a lying position with a cushion beneath their stomach, facilitating lumbar spine flexion. This posture creates enhanced space for the needle to navigate during the injection procedure.
- Enhanced Lumbar Flexion: Placing a cushion under the stomach increases lumbar spine flexion, optimizing the trajectory for needle insertion and potentially improving the precision and comfort of the injection process.
- Guided Imaging: Fluoroscopy (real-time X-ray) or ultrasound is commonly used to guide the precise placement of the needle, ensuring accurate delivery of the medication to the targeted area.
Post-Injection Care
- Observation: After the injection, patients are monitored briefly to detect immediate adverse reactions. Expect mild soreness at the injection site(s) for 48 hours.
- Activity Modification: Depending on the type of injection, patients might receive instructions to avoid certain activities for a designated period to optimize the effectiveness of the treatment.
- Follow-Up: A follow-up appointment is typically scheduled to assess the patient's response to the injection and determine the need for further treatments.
A back injection involves meticulous diagnosis, preparation, skillful injection techniques, and post-injection care, improving the patient's quality of life.
Conclusion:
Injections for back pain can temporarily relieve people suffering from chronic or acute pain. While these injections may not be a cure-all for back pain, they can be an effective part of a comprehensive treatment plan. You should discuss these injections' potential risks and benefits with your doctor and determine if they are right for you.
To determine the cause of your back pain and develop an effective treatment plan, seek medical attention promptly. The right treatment can alleviate your pain so you can get back to living your life to the fullest.