Injections Specialist

What is a pain injection and why is it performed?

The purpose of the injection is to diagnose and treat the cause of pain.  The injection will be directed to specific areas of the body including muscles, joints, and nerves.  The duration of pain relief varies with each patient.  Sometimes, there will be no pain relief after the injection and this information can serve to narrow the true cause of pain.  The injection usually contains a local anesthetic along with a long acting steroid.  The local anesthetic medication provides a temporary numbing effect lasting from one to several hours.  The steroid medication begins to take effect anywhere from 2-14 days after the injection and then continues to be effective for an extended period of time.  A fluoroscopy machine is used during the injection procedure.  This machine allows visualization of the bony structures of the spine allowing for accurate and precise placement of the needle.  

What are the different types of pain injections?

1) Epidural steroid injection

An injection of steroid near a nerve or several nerves to reduce inflammation.  It is used to reduce pain from a pinched nerve or nerves resulting from a herniated disc or arthritis.  Pinched nerves in the low back typically produce pain from the low back radiating into the legs while pinched nerves in the neck produce pain from the neck radiating into the arms.  

2) Facet joint injection/medial branch block

An injection of steroid into the facet joint or next to the joint where the joint receives its nerve supply.  The joints of the spine are called facets.  Pain from the facet joints in the low back produce low back pain and can also involve the buttock/hip and upper leg.  Pain from the facet joints in the neck produce pain into the neck which can also involve the back of the head, shoulder blade, shoulders and midback.  For those patients who respond well to these injections, a procedure known as radiofrequency ablation may be a good option.  The procedure uses an electrical current produced by a radio wave to heat up the small nerves supplying the facet joints thereby reducing the pain signal coming from the facet joint.  

3) Sacroiliac (SI) joint injection

An injection of steroid into the sacroiliac joint.  The sacroiliac joint is the joint between the sacrum (the lowest part of the spine) and the ilium (the pelvic area).   Pain from the joint is referred to the low back and buttock area but can also involve the groin and the leg.  For patients who respond well to this injection, a radiofrequency ablation procedure can provide more long term pain relief.  The procedure uses an electric current produced by a radio wave to heat up the small nerves supplying the sacroiliac joint to reduce the pain signal coming from the joint.  

4) Joint injection (Hip/Shoulder)

An injection into the hip or shoulder joint to relieve pain resulting from arthritic inflammation.  Pain from the neck can be referred into the shoulder and likewise pain from the low back can refer to the hip.  An injection into the shoulder or hip can help to sort out whether the main pain generator is from the spine or the shoulder/hip joint.  

5) Trigger point injection

A trigger point is a tight “knot” or band of muscle that forms when a muscle will not relax.  A trigger point injection is an injection directly into the contracted muscle.  Trigger points may be caused by muscle tension conditions (myofascial pain syndrome), repetitive use injuries, spine conditions, post spinal surgery, or direct trauma.