Spinal injections can be helpful as diagnostic tools, and can also be used for therapeutic purposes. In the right patients, spinal injections can not only pinpoint the source of pain, but can also help to reduce the patient’s pain. There are several types of injections that may be used to relieve back and neck pain, depending on the patient’s needs.
Injections for Nerve Pain
Nerve pain can be caused by a variety of conditions, like bone spurs, herniated disc, or pinched nerves. Sometimes nerve irritation can produce pain, numbness, or tingling that radiates down the arms or legs. These injections can not only help to reduce pain and inflammation, they can also help to locate the irritated nerve. If the injection relieves the patient’s pain, it confirms the location of the irritated nerve. The injections often contain both an anesthetic for immediate pain relief and an anti-inflammatory for longer-lasting relief.
There are a few different approaches that can be taken for these injections. Your doctor will help to determine which will be best for you.
Epidural injections are administered in the epidural space of the spine, between the protective covering of the spinal cord (the dura) and the vertebrae, near the nerve causing pain. Epidural injections are often used in the lower back, but may be used in other parts of the neck and back as well.
Transforaminal injections are very similar to epidural injections. While both injections target the nerve causing pain, the injection is administered differently. An epidural injection is administered through the middle of the back or neck into the epidural space, whereas a transforaminal injection is administered off-center, at the side of the spine, in order to get closer placement to the nerve root. Like epidural injections, transforaminal injections can be administered in the upper, middle, and lower spine.
Selective Nerve Root Blocks
Selective nerve root blocks are also very similar to epidural and transforaminal injections, but specifically target the irritated nerve root and do not enter the epidural space. Selective nerve root blocks are administered directly over the irritated nerve. Selective nerve root blocks may also be used to locate the nerve that is causing pain. If the nerve root block relieves pain, it can confirm the location of the irritated nerve.
Injections for Facet Joint Pain
In some cases, the facet joints are the source of a patient’s pain, rather than the nerves. The facet joints are the paired joints of the spine. The bones are cushioned with cartilage and surrounded by a capsule. As we age, the cartilage can wear away and cause pain. Twisting injuries can also damage the facet joints.
Facet Joint Blocks
Facet joint blocks are placed within the facet joint capsule to confirm the source of pain and reduce inflammation. They contain a mixture of an anesthetic and an anti-inflammatory. Facet joint blocks can also help to confirm that the facet joint pain is the source of the patient’s back pain.
If the facet joint is confirmed to be the source of pain, but facet joint blocks do not provide long-lasting pain relief, a rhizotomy may be considered. During this procedure, a needle with an attached probe is inserted outside the facet joint. Radio waves are used to heat the probe, which is applied to the joint’s sensory nerve. This helps to prevent the nerve from transmitting pain signals to the brain.
It is important to note that while spinal injections may provide immediate relief with anesthesia, the pain may return as the anesthesia wears off. Anti-inflammatory medications may take some time to take effect, but can provide longer-lasting pain relief by reducing inflammation.
In my practice, I most often recommend transforaminal injections and selective nerve root blocks, but facet blocks and rhizotomies can be helpful for axial mechanical back pain. In the right patients, spinal injections can be quite helpful, particularly in identifying the source of pain.