Back pain and neck pain are very common conditions. Back pain is often associated with pain in the legs (sciatica). Neck pain is often associated with arm pain or headaches. The pain may originate from any of the structures in the spine e.g. bones, ligaments, joints or discs. In many cases, there is no obvious cause. Most attacks of back pain resolve after a few days or weeks. Modern medical advice is to keep moving and take simple painkillers. However, if the pain is persistent an injection treatment may give some relief.
What injection treatments could be available to me?
The injections described here are all carried out in the operating theatre under x-ray guidance and with local anaesthesia or sedation. Your specialist may need imaging prior to carrying out any of the below procedures.
An epidural is an injection into an area of your back that surrounds the spinal cord. The procedure is usually performed to help reduce pain that is thought to arise from irritation of nerves in the spine e.g. sciatica. A local anaesthetic and slow release steroid drug is injected. This will bathe the nerve roots and minimise inflammation which may have an effect on your pain.
There is a small risk (approx. 1 in 100 patients) that the procedure will result in a severe headache, known as a ‘dural tap’. This may first be experienced several hours to days after the procedure. The headache is temporary and is relieved by lying down. It is important that you can contact the pain team should this occur.
Nerve Root Block
For management and diagnosis of back and neck pain. A nerve root block is an injection, most often a combination of local anaesthetic ( a numbing medicine) and steroid (an anti-inflammatory medicine), around the nerves that come from your spine. Inflammation around or compression of these nerve roots may produce pain in your arms and legs.
Imaging techniques, such as an MRI scan, can reveal small disc bulges and/or wear and tear in the spine with possible nerve irritation or inflammation. This can cause pain down the leg or arm in the area that the nerve supplies.
Sometimes the intervertebral discs lose their flexibility, elasticity and shock-absorbing characteristics, while the tough layer of ligaments that surrounds the intervertebral disc may weaken and no longer be able to contain the gel-like substance in the centre. This material may bulge through a tear in the disc (herniation) and can cause inflammation to the surrounding area and nerve roots. As the disc then degenerates it can lose height and as a consequence, close down the bony canal where the nerve root leaves the spinal column. This can cause pain if it touches the nerve.
Trigger Point Injection
A trigger point can be described as a painful or tight muscle. It can usually be easily felt under the skin and may twitch when touched. It may irritate the surrounding nerves and cause pain in that area of the body. A trigger point injection is an injection of local anaesthetic and slow release steroid directly into the painful or tight muscle. This injection is carried out without the use of x-ray.
Botox Trigger Point Injections
BOTOX® (botulinum toxin type-A) can be used to treat a number of painful conditions. This is highlighted by the recommendation for the use of BOTOX® in migraine by NICE (the National Institute for Health and Care Excellence). Resistant muscular pains are where BOTOX® is more often used. As with any treatment the use of BOTOX® has to be judged carefully for each patient and their particular individual circumstances.
Facet joint Injections
What are facet joints?
Facet joints are small, paired joints (left and right) located along the length of your spine that link the vertebrae together. If the joints are worn, traumatised, subject to repeated stress or inflamed they may give rise to pain. This can lead to stiffness, muscle weakness and loss of movement.
One way of finding out whether facet joints are the source of pain is to perform facet joint injections. This involves injecting local anaesthetic (to numb) and steroid (anti-inflammatory) around the small nerves to the facet joints under x-ray guidance to see if the pain is reduced.
What are the benefits of facet joint injections?
Facet joint injections aim to reduce pain by treating the inflammation around the joint. This will allow you to start increasing your exercise regime to strengthen the muscles and begin normal movement again.
Facet joint radiofrequency denervation
This procedure aims to modify the way pain is transmitted from the facet joints to the brain. The nerve is interrupted by heating it with an electrical current from a special device called a radiofrequency machine. This is usually done following facet joint injections, if only temporary relief was achieved. Facet joint denervation may provide you with longer lasting pain relief.
Sacroiliac Joint Injections
Sacroiliac joint injections may be used to diagnose and treat certain types of lower back pain. A mixture of local anaesthetic and steroid is used for the injection. This has the effect of reducing both the pain in the joint and any surrounding inflammation.
The sacrum is the large bony part at the bottom of the spine. It feels like one bone but is actually five bones that have grown together. The hip bone is called the ileum and the area where it joins the sacrum at the back is known as the sacroiliac joint.
Why do I need a sacroiliac injection?
A sacroiliac injection is administered in order to relieve pain which is thought to be coming from the sacroiliac joint.
Intravenous Regional blocks for CRPS
Why am I having an intravenous regional block?
This injection is performed in limbs where complex regional pain syndrome is present. This injection can help with pain, swelling, changes in colour and sensation to skin of the affected limb. You may have some or all of these symptoms.
What does the treatment involve?
Once in the operating theatre a team member will insert two small needles: the first into the painful limb and the second into the back of your hands. A cuff will then be applied to the affected limb (above the painful area) and inflated (stopping blood flow to the limb).
The drug is then injected into the limb. The cuff will remain inflated for around 20 minutes. You may experience some discomfort in your limb during this time due to the pressure of the cuff.
After the 20 minutes the cuff is deflated and you will be transferred back to your room to recover. The affected limb will feel heavy and numb but normal sensation will return after around 30 minutes. The whole process normally takes around 50 minutes.
Will the pain go away?
The treatment often produces immediate improvement in pain. However, the duration of pain relief can vary greatly and we recommend three treatments to achieve long-lasting pain relief.