Interventional Pain Management Injections
Injection techniques have obvious diagnostic and therapeutic value—they are extremely useful tools for precisely diagnosing and localizing the spinal pain generator(s). This is especially true in the setting of multilevel spine and joint disease and in situations where imaging or electromyographic tests show no obvious abnormalities.
The injections can be directed at specific target sites in and around the spine. Because of the precise needle localization needed and the technical difficulty of performing these procedures, the use of fluoroscopy and contrast dye are essential.
Sometimes diagnostically reproducing the pain trigger during these procedures facilitates accurate identification of the painful structure. Typically, non-affected nerve roots will not trigger a severe pain response when they are mechanically irritated by a spinal needle or contrast dye. In addition, when combined with a local anesthetic or corticosteroid solution, spinal injections can provide temporary pain relief.
Comparison of pain levels before and after the injections—by patient verbalization, pain procedure diaries, and visual analog scales (VAS)—helps the practitioner gauge the response to the anesthetic procedures. Afterwards, provocative maneuvers, such as assessment of spinal range of motion, straight leg raises, and ambulatory capabilities before and after the injections also may help us evaluate the contribution of that particular site as the actual painful source.
Indication for Procedures
These selective spinal and joint injections are indicated specifically for medically stable patients and are considered outpatient, minimally invasive, minor procedures. For patients with failed back surgical syndrome and for those considering operative interventions (eg, spinal fusion, microdiscectomy, or laminectomy and decompression), combining injection procedures with an accurate history and physical exam and appropriate imaging and/or electrophysiologic studies can help us and/or the spinal surgeon develop a more directed and efficient treatment program.
Spinal injections also can be used as an adjunct to rehabilitation and physical therapy, proving pain relief, increasing range of motion before and/or during the rehabilitative process, and allowing the patient to participate more fully in the therapy program.
Types of Injections
Although numerous interventional procedures are used to treat spinal-related pain conditions, a few of the most common types of diagnostic and therapeutic spinal injections are:
- Epidural Steroid injections of the cervical, thoracic, and lumbar spine
- Selective Nerve Root Injections
- Medial Branch Blocks for Facet originating pain
- Radio Frequency Ablation
- Sacroiliac Joint Injections
- Sympathetic Ganglion Nerve Injections
- Diagnostic Discogram Injections
- Intradiscal Injections
What conditions are injections used for?
- Herniated discs
- Spinal stenosis
- Spinal stenosis caused by rheumatoid arthritis
- Spine Arthritis
- Recurrent pain in an area of prior surgery
- Failed back surgery
What are the benefits of interventional pain management?
- It can eliminate/delay the need for surgery.
- It is frequently less expensive than surgery.