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Pain Management Injections

epidural injections

When the pain management injections are used?

Different Types Of Pain Management Injections are available for body injuries & pain. Steroid injections for neck & back pain are very common & safe to use. Pain management injections for chronic pain can be an effective form of treatment. Whether pain is the result of a fall, work injury, or motor vehicle accident, pain can crush the quality of a person’s life. Back pain can be particularly challenging to manage, especially when caused by herniated discs, impinged nerve roots, radiculopathy, or inflamed facet joints. In many cases, the steroid injections for back pain work like magic & patients start feeling better quickly. It really helps the doctors to perform the further treatment.

When first line treatments fail, local pain management injections are often recommended. These can relieve pain and make it easier for a patient to tolerate the type of physical therapy necessary to heal.

What is a Steroid Pain management Injection?

Steroid medications are well-established pain management tools. Their primary function is to reduce inflammation. This means less swelling, redness, and pain at the location of an injury. Steroids also prevent components of the immune system from “attacking” or causing further damage. For back, joint, or muscle injuries, pain is treated by directly injecting medication into the painful site.

There are several types of steroid mediations. You may have heard of a “cortisone shot”, or taken five day course of oral prednisone. While these can be used for treatment, injections with longer-acting dexamethasone or betamethasone are preferred. A local anesthetic is often combined with the steroid medication to enhance the pain relief effect.

Trigger Point Steroid Injections for pain

When chronic muscle pain is unresponsive to non-steroidal anti-inflammatories or muscle relaxants, a trigger point steroid injection may be helpful. A trigger point is a specific focus of spasm and pain within a muscle. It can develop as a result of acute trauma or from chronic micro-injuries. In severe cases, this pain can spread to other muscle groups.

For example, pain from a trigger point in the right shoulder may be felt near the spine or on the side of the neck. Following a whiplash injury, common symptoms include tension headaches, a stiff neck, reduced mobility and pain. In other scenarios, muscle twitching occurs.

Trigger point injections are performed by orthopedists, neurologists, pain management specialists, or primary care doctors who have received such training. Minimal equipment is needed, so the injection can be performed in an outpatient setting.

First, the exact location of the trigger point must be determined. This is done by palpating the muscle until the most painful area is located. It often resembles a “knot” within the muscle. The skin is then cleared with an antiseptic, and pressure is applied to reduce any muscle spasm. Once the trigger point becomes pliable, the needle is inserted. Giving feedback of pain that is experienced during this procedure insures that the needle is in the correct location.

Once the medication is injected into the trigger point, there is some initial pain relief. A local anesthetic is often combined with the steroid to enhance the effect. This same procedure is repeated for all other trigger points. Mild post-injection soreness is possible, but temporary. Relief from chronic muscle pain may last a few weeks or for several months.

Epidural Steroid Injections to reduce pain

When conservative treatments fail to relieve back pain, epidural steroid injections are often the next step. This modality is used to treat the pain of spinal nerve root compression, herniated discs, and arthritic changes from poorly healed vertebral fractures. For example, if a fall dislocates a lumbar intervertebral disc, lower back pain may radiate down the leg. Such injuries can become quite debilitating.

In order to perform an epidural injection, access to the internal structure of the spine is necessary. The vertebral bones protect the spinal cord and nerve roots, and the spinal cord itself is enclosed by a type of “sac” called the dura. The narrow space between the dura and ligamentum flavum is called the epidural space. This is where steroid injections occur.

Epidural injections are performed at surgical centers with anesthesia and imaging capabilities. Generally, interventional radiologists, neurologists, surgeons and pain management doctors perform this procedure. Prior to the appointment date, it is important to notify the doctor of your medications. Blood thinners and some over-the-counter mediations can increase the risk of bleeding. It also will be necessary for someone to accompany you to the appointment because a sedative will be administered.

Realtime imaging is done via fluoroscopy to allow visualization of the needle throughout the procedure. A “bellydown” or prone position is preferred for an easier access to the spine. The skin of the treatment area is cleaned with an antiseptic, and a local anesthetic is injected to numb the skin surface. With fluoroscopic guidance, the treatment needle is inserted through the skin, underlying muscle, and into the epidural space. A dye is injected first to confirm proper placement of the needle. If the location is correct, the steroid medication is injected into the epidural space. This directly treats any disc or spinal nerve root inflammation. If there are other painful dermatomes, this injection procedure is repeated at those vertebral levels.

Following the steroid injection, you will spend a short time in a recovery area. There may be some numbness which typically resolves within a few hours. Injection site soreness is common, so application of ice to the treatment area is recommended. Back pain relief from an epidural steroid injection can last from one week to a year. This can greatly improve tolerance of physical therapy and rehabilitation.

Facet Block pain killer Injections

Each spinal vertebra has projections of bone, called lamina, that extend from both sides. The lamina have facet joints that interconnect the 24 vertebrae above the sacrum. These joints give the spine smooth movement while bending forward, twisting at the waist, and arching backward.

Like the knee and elbow, facet joints consist of fluid, have an inner lining of cartilage, and are held together by connective tissue. When back trauma is sustained, these joints become inflamed and painful. Postural changes with intervertebral disc injuries exert excessive pressure onto the facet joints, adding to the pain and impaired mobility.

Facet joint injections are performed using a method similar to epidural injections. They too are done with the assistance of anesthesia and fluoroscopy. Instead of the epidural space, however, the needle is inserted into the problematic facet joint. A dye is first injected to ensure proper placement of the needle. Once this is confirmed, the steroid medication and anesthetic are injected into the joint space.

Prognosis of chronic pain

All of these treatment modalities may be a part of the overall treatment plan following an accident or injury. It is important to note that these injections are not a cure; they are only meant to assist in the healing process.

Steroid injections temporarily reduce pain which promotes success during physical therapy and rehabilitation. The response to a steroid injection varies. Some individuals remain pain-free for moths, while pain returns with a few weeks for others. Those who experience limited improvement may opt for a series of injections. Because each case is unique, it is best to customize your treatment plan with your doctor.

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