Roughly 8% of U.S. adults suffer from persistent or chronic back pain. That’s around 65 million people who are prevented from engaging in daily activities. Many are forced to miss days of work due to injury.
With rising healthcare costs, many back pain sufferers think that they are left without a real solution, until they try epidural injections.
An epidural injection is the infusion of robust anti-inflammatory medicine into the area around the spinal cord called the epidural space.
Not to be confused with epidural anesthesia that’s used to sedate the expecting mother during childbirth, epidural injections provide pain relief from back or leg pain.
Epidural injections are especially effective at treating lower back pain and radicular pain, but they can also be utilized for treating cervical pain, or neck pain. Relief can last anywhere from a few days up to a full year after treatment. This gives the patient time to recover from their injury by engaging in helpful rehab movements.
Back epidural injections are done either in a hospital or outpatient clinic. Regardless of the environment, modern epidural steroid injection procedures are conducted safety by trained specialists.
Types of Spinal Injections
Spinal injections are also known as lumbar epidural injections, and these can provide incredible pain relief for up to six months following treatment.
Here are some of the most common spinal injections for back pain sufferers:
Epidural steroid injections
This common treatment for lower back and leg pain isn’t anything new. Epidural steroid injections have been a key feature in rehabilitation regimens for many decades, and they continue to grow as a popular means of pain relief.
Most professionals agree that epidural steroid injections continue to be an effective mechanism in alleviating nerve pain and inflammation. These injections can also help patients get off oral medications they were using for pain relief and they can help postpone surgery.
Plus, if the patient is able to perform physical therapy and it’s effective, then there may no longer be a need for surgical intervention whatsoever.
The epidural injection site will vary depending on the patients’ needs. Most spinal injections specifically are performed as a portion of a more comprehensive treatment program, aiming to boost spinal mobility and cure the patient of chronic pain levels.
Facet joint injections
One of the least invasive procedures, a facet joint injection involves the injection of a small amount of local anesthetic that works to numb the facet joint and stimulate pain relief. These injections can provide relief for up to two months.
Facet joint injections are not particularly painful, with most patients feeling only a slight burning at the initial stages of the injection. You may feel minor tingling due to pressure around the injection site.
Success rates are high, with most studies indicating that around 92% of patients feel relief within 2-4 weeks.
If facet joint injections fail to alleviate pain, then the patient may want to explore a different type of injection like an epidural. In some situations the doctor may require additional testing, bone scans, or nerve studies. Patients may need follow-up injections over a six-month period to ensure consistent pain relief.
Facet joint injections differ from epidural injections. Even though both are utilized for pain relief, epidural injections are intended to treat different underlying conditions. Epidural injections are used primarily to treat back pain that transitions to the arms and legs, while facet injections are injected into the joints and intended to aid patients who suffer from degenerative conditions. Thus, the epidural injection site is different.
Through minor lifestyle adjustments and periodic facet joint injections, this pain can be managed and is attributable to a better quality of life.
Medial branch nerve blocks
This procedure involves the injection of an anesthetic across several levels of the spine near the medial nerves that are connected to a specific facet joint.
Medial branch nerve blocks can last anywhere from a few weeks to many months. The steroid used takes upwards of three days to show an effect on most people and this can peak within about two weeks.
A medial branch block is similar to a nerve block, except that the medication used is injected outside of the joint and closer to the nerves.
Because sedation isn’t needed following this procedure, patients will likely be able to walk and move around normally. However, it’s still recommended that the patient bring someone with them in case they are too impaired to drive.
For the procedure itself, the patient will lie face down on a table and their skin over the area is cleaned. Then a small anesthetic or numbing agent is applied which may slightly sting, but will properly prep the area for injection.
It’s a quick procedure, lasting no more than 15-20 minutes. Although there may be some minor discomfort due to the needle injection, the sedating medicine should quill this pain.
Depending on your physician’s recommendation, you may be able to receive a nerve block between roughly 3 to 6 times across a 12 month period.
Medial branch blocks may also be used instead of a facet joint injection, especially if the patient can’t handle the particular steroid.
Radiofrequency ablation
Radiofrequency ablation, abbreviated to RFA, is a technique that shrinks down tumors and other potentially dangerous bodily growths.
With RFA, patients can correct a variety of ailments from venous insufficiency in the legs to chronic neck or back pain. Like a needle biopsy, the RFA involves placing the tip of a needle probe into the correct location of the body. The physician will utilize an ultrasound or similar imaging technology to hone in on the right spot.
Most patients are sent home the same day following their treatment, and they can resume normal activities in less than 24 hours. The success rate of an RFA procedure is upwards of 80%, and the procedure can be repeated if necessary.
It’s always important to discuss the treatment with your doctor so they can decide whether RFA is right for you. Side effects are very minimal but can include bleeding or infection at the site of the needle.
Sacroiliac joint injections
Sacroiliac joints sit next to the spine and connect the sacrum at both sides of the hip. The main purpose of a sacroiliac joint injection is to diagnose the source of pain and also to provide therapeutic relief.
The injection, also referred to as a sacroiliac joint block, is meant to diagnose lower back pain or other symptoms that may be attributed to sacroiliac joint dysfunction.
The two main types of sacroiliac joint injections are diagnostic and therapeutic. A diagnostic injection will confirm a diagnosis of sacroiliac joint dysfunction. This injection is executed under x-ray guidance to ensure accuracy.
Following the application of a numbing agent, patients are instructed to try and replicate the movement that causes pain.
These sacroiliac joint cortisone spinal injections may leave the patient sore for a few hours, but pain should begin to subside after that period.
Therapeutic sacroiliac joint injection shots also provide relief, except that the anti-inflammatory medication is used in the injection to reduce inflammation inside of the joint. These injections can be repeated up to three times a year and should be performed in tandem with the physical therapy process.
Do you find yourself standing or sitting for long periods? If so, you are a candidate for sacroiliac joint pain. Causes include arthritis, pregnancy, traumatic injury, and other infections.
If treatment is impossible without surgery, then a sacroiliac fusion may be required, but that’s ultimately at the discretion of the doctor. Sacroiliitis is non life-threatening but it is extremely uncomfortable and should be dealt with as soon as possible.
Sympathetic nerve blocks
A sympathetic nerve block is a type of injection designed to reduce pain. It can lessen a variety of problems related to leg or foot pain.
A lumbar sympathetic nerve block helps block the nerves sending pain signals to the brain. Healthcare providers may suggest this procedure for those with a variety of afflictions including reflex sympathetic dystrophy, diabetic neuropathy, ulcers, or frostbite.
Like the other procedures mentioned, you will lie on your stomach and receive sedation medicine to prepare yourself for the injection. Throughout the process your heart rate and blood pressure will be checked regularly and you may be required to wear a mask or nasal tubing.
Proceeding a lumbar sympathetic nerve block procedure, the patient will need to be watched by a physician for upwards of one hour. The patient shouldn’t plan on doing anything strenuous for the rest of the day.
Although the nerve block is similar to an epidural steroid injection, the latter is strictly used as a therapeutic intervention while the former may be either diagnostic or therapeutic.
Regenerative therapy injections
Regenerative injection therapy primarily targets the joints, and more specifically chronic pain from injuries that haven’t properly healed.
Targeted areas include joints, cartilage, tendons, muscles, and ligaments. A natural solution is injected that helps encourage the healing process, giving way to new tissue.
Athletes often opt for this therapy as a resource to help increase their movement and functionality. It can also lead to improved muscle strength, less overall pain, and provide a welcome alternative to surgery.
Some of the most common athletic injuries that regenerative therapy injections can cure include: ACL tears, tennis elbow, rotator cuff injuries, osteoarthritis, and damaged achilles tendons.
Two of the main types of regenerative therapy include prolotherapy and platelet rich plasma. Both work to stimulate the body’s natural healing process leading to a natural recovery, but platelet rich plasma (PRP) contains about six times the concentration of a person’s own platelets which can accelerate the tissue repair and regeneration process.
Spinal Injections vs Surgery
Spinal injections and spinal cord surgery are two valuable methods of relief for those with back pain. When deciding which method to pursue, the decision comes down to a patient and their doctor. Let’s go over some of the differences they may consider.
As far as which one is better, it really comes down to the effects of steroid injections on the individual. A few questions to ask include:
- Do injections work for an extended period of time or does pain linger?
- Is the individual physically unable to handle injections?
If the patient has tried injections but still feels pain many weeks after, it could be a sign that they need surgery.
Types of Epidurals
There are several types of epidurals, ranging from single-injections to more involved injections using a catheter.
Epidural anesthesia vs epidural steroid injection
Epidural anesthesia is commonly given to expecting mothers before they give birth, and it can also apply to specific types of surgeries. Conversely, an epidural steroid injection delivers anti-inflammatory medicine into the space outside of the sac of fluid near the spinal cord.
Interlaminar epidural steroid injection
Interlaminar epidural injections are procedures that deliver the injected substance into the epidural space by directing the needle between laminae of two vertebrae. It doesn’t take very long for the procedure to occur and side effects tend to be rare.
Caudal epidural steroid injections
This is a specific type of epidural steroid injection into the lower back. The shot is injected with a steroid medication that reduces inflammation and eases lower back pain.
Known side effects of caudal epidural steroid injections (CESI) are headaches, back pain, and drastic increases in blood sugar levels, but most patients are feeling better in minutes. Although it’s standard for clinics to monitor movement right after the injection, most patients will be able to perform normal functions quickly.
Cervical epidural steroid injections
Cervical epidural steroid injections are utilized to inject anti-inflammatory medicine into the epidural space around spinal nerves in the neck area.
Cervical radiculopathy is a chronic pain that is caused by spinal nerve root inflammation. It can manifest itself in a herniated disk, degenerative disk, or spinal stenosis. These injections are a very common therapeutic for specific causes of chronic neck pain.
Transforaminal epidural steroid injections
These injections are administered via the insertion of a needle between the spinal cord and spine. They are especially useful in treating sciatica or common back problems—via sciatica epidural steroid injections, for example).
Here are some additional use cases involving an epidural:
Epidural using a catheter
A catheter is inserted into the epidural space in the patient’s spinal column, allowing the physician to administer multiple injections of medication. This method is recommended for longer procedures and is intended to provide pain relief over the course of many days.
Epidural with PCA
Patient-controlled analgesia allows patients to determine the level of pain relief they can receive. A physician would program the PCA pump to give the patient a prescribed pain reliever at specific intervals. Although this is controlled by the patient, it is closely monitored to ensure safety.
Epidural needle sizes
Epidural needles come in multiple varieties and sizes. A higher gauge needle is thinner, while lower gauge needles (like a 16G) denote thinner epidural needles.
Thinner needles typically perform better when it comes to complications.
Epidural Preparation
Getting ready for an epidural injection is usually straightforward, and will ultimately be laid out by your doctor. The standard protocol is for the patient to avoid eating or drinking for at least eight hours prior to their scheduled procedure.
If the patient is currently taking any medications at the time of their injection, they should immediately notify their doctor. These could cause interference with blood thinners and result in excessive bleeding.
In most situations, patients will be advised not to take any anti-inflammatory medications for multiple days prior to an epidural injection.
The physician in charge of the epidural will communicate with the patient’s primary physician regarding their medication situation.
Trusting The Best in Epidural Technology
The process of receiving an epidural injection has never been simpler thanks to advancements in modern technology like the CompuFlo Instrument.
Thanks to objective detection of pressure changes, physicians are made aware of a patient’s tolerance and handling of the injection within a matter of seconds. This results in fewer complications, lower costs, and a higher effectiveness rate.
Clinicians are able to navigate the epidural space with precision, resulting in a safer experience for all.