Learn about epidurals, nerve blocks and other injection therapies for back pain.
Having back pain can be discouraging. Getting better often demands time and some discipline. You need to be diligent about following a self-care routine, and sometimes you need to try several methods before you feel better. Most of all, you need a lot of patience.
You may be thinking about injection therapy for your back pain, especially if the pain is severe or radiating down your leg (sciatica). It’s important to know more about this treatment before you make a decision.
What is injection therapy?
Injection therapy for back pain is delivery of medication directly to the nerves, joints or muscles in your back. It is used to reduce inflammation and relieve pain. Most injections for back pain contain a local anesthetic to ease pain temporarily, corticosteroid to reduce inflammation or a combination of the two. The anesthetic gives immediate relief but may last only hours. Corticosteroids typically take a few days to take full effect.
How effective is injection therapy?
This is where it gets complicated. Researchers have looked at studies and have not been able to find a clear answer. So far, what they have found is this: Sometimes it works, other times it does not. Although it is frustrating not to have a clear answer, you can weigh the possible benefits and risks of injection therapy with your doctor and together make a decision.
So what is the best course of action?
Work with your primary care doctor to find the best solution for your back pain. If he or she suggests starting with conservative measures, such as physical therapy, massage or other treatments, be sure to give those treatments a chance to work. Sometimes you need to try several different methods, or a combination of methods, before you find what works for you.
What you should know is that while back pain is different for each person, most people feel better within six weeks of starting conservative therapy.
What are the targets of injections?
Injection therapy can deliver medication directly to places in the back that are causing pain:
- Epidural space. Medication may be delivered into the epidural space, the area between the protective covering of the spinal cord and the vertebrae. This procedure may ease pain caused by a herniated disc (intervertebral disc). The intervertebral discs are “shock absorbers” in the spine. A disc is herniated when a piece bulges out of the vertebrae and causes pain. Once inside the epidural space, medication may reduce the production of substances that cause pain.
- Nerve roots. Nerve roots exit the spine between vertebrae. If a nerve is inflamed as it leaves the spinal cord, an injection of either a steroid or anesthetic may ease the pain.
- Facet joints. Facet joins are where the vertebrae connect to one another. They guide bending motion at each vertebra. These joints are not a frequent cause of back pain, but they can become irritated and inflamed.
- Sacroiliac joint. The sacroiliac joint is the connection between the lower spine and pelvic bone on each side. Inflammation of this joint can cause pain in the lower back and buttocks. More studies are needed to see if injections here can help with back pain.
- Trigger point. Trigger points are knots of muscle or knots that irritate the tissues around them and can cause pain in another part of the body, such as the leg.
What can I expect during the procedure?
Injection therapy is an outpatient procedure that takes about 15 to 30 minutes. Before your appointment, ask your doctor if you need to take your pain relieving medication the day of your procedure. Also ask if there are certain medications that you should not take before the procedure, like aspirin.
During the procedure:
- You lie on your stomach or your side and hold still.
- The doctor applies numbing medicine to your skin and then uses a needle to inject the medication directly to the part of the back causing the pain.
- A fluoroscope, or viewing x-ray machine, may be used to guide the needle to the right spot.
Be aware that this procedure can be painful. Afterwards, you may have a slight headache. Make sure a family member or friend is on hand to drive and help you get home.
If you don’t have any relief after the first injection, you probably will not benefit from more injections. And in fact, most doctors do not recommend repeated injections because damage to the back joint can occur.
Some people get a headache that goes away soon after this procedure, but severe side effects are rare. Call your doctor if you have any of the following after the procedure:
- Severe pain or headache
- Fever or chills
- Progressive weakness in arms or legs
- Trouble moving your bowels or bladder
- Redness or swelling around the injection site (infection)