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.
Management of Pain
Pain is an unpleasant feeling or discomfort caused by injury, illness or emotional disorder. Pain management is mainly focused on alleviating your pain and enabling you to carry out day to day activities. Pain can be treated in a variety of ways and depends on the type of pain being experienced by the patient.
Advanced Pain Management Intervention
Advanced pain management techniques may be recommended for severe chronic pain. Pain may be temporary or persistent. Pain which lasts several months is called chronic pain.
Interventional Pain Management
Interventional pain management encompasses a variety of non-surgical and surgical treatments for reducing pain and improving quality of life. These treatments are used when acute or chronic pain interferes with activities of daily living and other treatment options have been unsuccessful in relieving pain.
Management of Complex Pain
Complex pain may be caused due to multiple factors that are not always clearly understood. It may be secondary to malignant (cancerous) or non-malignant conditions. A combination of different treatments is generally provided to relieve complex pain conditions.
Hip joint injections involve injecting medicine directly into the hip joint to diagnose the source of pain or treat pain due to conditions such as arthritis, injury or mechanical stress of the hip joint. Hip pain may be experienced in the hip, buttock, leg or lower back.
Epidural Steroid Injections
An epidural spinal injection is a non-surgical treatment option for relieving back pain. Your doctor usually suggests a non-surgical method to treat back pain, and epidural spinal injection is one of these preferences. In cases where you find no relief from this and other non-surgical methods, surgery is recommended.
Peripheral Joint Injections
Peripheral joint injections are injections administered into the joints of the limbs such as the shoulder, elbow, hip, knee, and joints of the hands and feet. They help diagnose and treat joint pain and inflammation and improve mobility. Peripheral joint injections are recommended when you have significant joint pain which does not respond to medications and you are not willing or able to undergo surgery.
Opioid, or narcotic, pain medications are beneficial in many ways. Patients with pain from terminal cancer benefit from their use. Patients benefit from their short-term use when recovering from an acute injury or following a painful surgical procedure. However, the long-term use of opioid medications for chronic, noncancer pain remains quite controversial.
Back pain or backache is the pain felt in the back that may originate from damage to the muscles, nerves, bones, joints or other structures in the spine. Back pain is one of the most common medical problems experienced by most people at some time in their life.
Common neck pain may occur from muscle strain or tension from everyday activities including poor posture, prolonged use of a computer and sleeping in an uncomfortable position.
Pain in the shoulder may suggest an injury, which is more common in athletes participating in sports such as swimming, tennis, pitching, and weightlifting. The injuries are caused due to the over usage or repetitive motion of the arms.
The elbow is a hinge joint made up of 3 bones – the humerus, radius, and ulna. The bones are held together by ligaments to provide stability to the joint. Damage to any of the structures that make up the elbow joint can cause elbow pain.
Hip pain, one of the common complaints, may not always be felt precisely over the hip joint rather in and around the hip joint. The cause for pain is multifactorial and the exact position of your hip pain suggests the probable cause or underlying condition causing it.
Knee pain is a common condition affecting individuals of various age groups. It not only affects movement but also impacts your quality of life. An injury or disease of the knee joint or any structure surrounding the knee can result in knee pain. A precise diagnosis of the underlying cause is important to develop an appropriate treatment plan.