Back Injections

Published: Jan 28, 2011
Back injections are often used by physicians as diagnostic tools to identify the source of back pain. Depending on the cause of the pain and a patient’s specific condition, a physician may also use back injections to temporally reduce inflammation and alleviate pain. During a back injection procedure, a local anesthetic combined with an anti-inflammatory medication such as corticosteroids, is injected directly to the source of back pain.

Common types of back injections include trigger point injections, facet injections, epidural injections, and selective nerve root block. These injections are often performed by anesthesiologists, neurologists, radiologists, orthopedists, or other pain management specialists at outpatient settings. During the procedure, fluoroscopy is generally used to assist the physician precisely pass the needle to the targeted area.

Types of Back Injections

Trigger point injections
A trigger point is a tight nodule or knot deep in the muscle. When pressed, a trigger point can cause pain at the spot and other symptoms at other parts of the body.

A trigger point injection is a procedure in which a physician injects a local anesthetic, alone or combined with a corticosteroid, which is a type of steroid that is closely related to cortisol produced by the body, directly to the trigger point to relieve pain and reduce inflammation. Trigger point injections are often used to treat back pain involving injured back muscles.

Facet joint injections
If a patient’s back pain is caused by conditions involving joint inflammation, anti-inflammatory medications such as corticosteroids may be injected into the troublesome joint to reduce inflammation and relieve pain. Facet joint injections may be used to relieve pain caused by spinal stenosis, herniated discs arthritis, sciatica, or spondylolisthesis, a condition in which one of the vertebra slips out of its natural position onto the one below it.

Epidural injections
If the pain is caused by irritated nerve roots or the spinal cord, corticosteroids and anesthetics may be injected into the spinal space, an area between the dural sac, a membrane encasing the spinal cord and the exiting nerve roots, and the wall of the spinal column. The corticosteroids help relieve pain by reducing the inflammation around the irritated nerve roots. Epidural injections have long been used for treating back pain. Today many physicians use epidural injections as an integrated part of management of back pain caused by herniated discs, spinal stenosis, spondylolisthesis, and other degenerative disc conditions.

Selective nerve root block
For back pain caused by one or more irritated nerve roots, a physician may inject a local anesthetic and/or anti-inflammatory medicine to the surrounding area of the irritated nerve(s) to relieve pain. Selective nerve root block is often used for patients with radicular pain that may be caused by conditions involving compressed nerve roots.

Efficiency and Limitations

Because anti-inflammatory medications are directly delivered to the source that generates pain, back injections relieve pain faster than oral medications. Back injections generally can produce sufficient pain relief right after the injections, but, unfortunately, the pain relief is only temporal. For long-term, or complete, pain relief, physicians often include other treatment options in their treatment program.

Because the medications used in the injections may weaken the bones and muscles and suppress the body’s natural hormone balance, these injections are not recommended for long-term or frequent use.

About Steroids and Corticosteroids

Steroids are a class of compounds sharing the same core chemical structure. There are many types of steroids. Corticosteroids, sex hormones, and cholesterols are all steroids. Despite the same core chemical structure, different types of steroids have very different effects because of their unique functional groups

It’s important to know that corticosteroids used in back injections are different from anabolic steroids, a type of sex hormones used by some athletes to increase muscle and bone growth and enhance athletic performance. Unlike anabolic steroids, corticosteroids do not increase muscle or bone growth.