Physical therapy and injection therapy are the two most common tools used by a spine center to help patients recover from back or neck pain — without surgery. A physician who fails to use these nonsurgical options may only be increasing the need for surgery. Spine surgery should be the last option to explore.While physical therapy is the safest treatment option, sometimes intense pain prevents a patient from entering physical therapy. Injections can often relieve pain long enough to begin therapy. There are many different injections that can be used including epidural steroid injections, facet injections and trigger point injections which can stimulate healing of weak or damaged connective tissues. Injections can also act as a diagnostic tool by providing a spine specialist with key information and insight into the possible causes of your back or neck pain symptoms.
It is important to remember that injection therapy serves as a means to an end. While passive things like massage or pills may feel good, they don’t change anything with the structure of your back. Physical therapy and customized exercises make the back and neck muscles stronger, more flexible and resistant to future strain and pain.
By inserting pain-relieving medication into the injury site or pain generator, joint pain and/or inflammation surrounding a nerve root can be relieved long enough for a patient to begin working with a physical therapist. Injections essentially act as a bridge on the path of your return to activity.
How do injections work?
When physicians choose to use injection therapy, their ultimate goal is to relieve pain long enough to enable the patient to begin physical therapy.
Relief from such injections can last anywhere from a few weeks to a few months and sometimes longer, especially if therapy is used simultaneously to strengthen muscles in the back. In other cases, an injection may bring patients minimal or no pain relief.
The injection procedure
During an injection procedure you may lay on your stomach to enable the X-ray to visualize your spine. Local anesthetic may be injected into the skin and underlying tissues to reduce discomfort.
Once the anesthetic sets in, the epidural needle is inserted into the epidural space, with the vertebrae serving as “landmarks.” The physician will use a special X-ray image from a C-arm fluoroscopic device to make sure the needle is positioned correctly.
The corticosteroid injection may include a saline solution and/or a local anesthetic. Its dosage, volume and components will vary according to the doctor’s assessment of each individual patient.
Once the needle enters the epidural space, a syringe containing corticosteroid solution is connected to it. After ensuring the needle is in the correct place, the solution is slowly injected. During this time, you will be able to communicate with the doctor, and the most common sensation reported is one which resembles the feeling of “pins and needles.”
What are the risks involved?
There are risks involved in any operation or injection procedure. In the case of epidural steroid injections, these risks are minimal. There are a variety of possible side effects and complications, most of which relate to the way in which the injection is administered rather than the actual steroid itself.
The most common side effect of epidural steroid injections is a temporary surge in pain, but this only occurs about one percent of the time and most likely relates to the volume of the injected substance. Headaches are another potential complication, with an incidence of just one percent. These headaches may be linked to the unintended puncture of the innermost membrane that surrounds the spinal cord. In most cases, the headache will subside within a few hours and rarely lasts more than a day.
How many injections will I need?
You are unlikely to benefit from repeated epidural steroid injections if the first or second do not provide relief. You should not receive more than three injections if none of them have helped. Additional epidural injections usually are not indicated if your pain symptoms are increased after an injection. Even if the injections do provide relief, only in exceptional cases will more than three be recommended over a three-month period. Other injection techniques may prove helpful even if the initial approach is not clearly beneficial.
NO PHYSICIAN REFERRAL IS NEEDED UNLESS REQUIRED BY YOUR INSURANCE
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