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eLearning Series:
Relieve My Back Pain NOW!
( 23 pages )
BACK
PAIN: INJECTIONS
Injections
Spinal
injections have been used to as an alternative to surgery
in treating back pain since the early
1900s. Studies
have shown
injections to be effective in up to 50% of
patients. They are typically given after medication and
physical treatments
have
been utilized, but before surgery. Injections
tend to be more effective than oral pain medication
because they
deliver
medicine
right to the source of the pain.
Sacroiliac
(SI) joint blocks are injections used to treat low back
pain. The sacroiliac
joints
are located
next
to the spine
and connect the sacrum to the pelvis. Painful
joints cause pain in the lower back, buttocks,
abdomen,
groin, and legs.
SI joint blocks work in three ways: 1) they
are used to determine if the SI joint is
the source
of back
pain (if
the injection
makes the pain better, that’s where the pain
is coming from), 2) the numbing medication
used in
the block
gives temporary
relief so the patient can have chiropractic
or other physical treatments immediately
after the
block is
administered, and 3) a time-release steroid
gives extended pain relief
by reducing
inflammation.
During an SI block,
the patient lies on his stomach and live x-ray, known as
fluoroscopic
guidance,
is used to
allow the
doctor to see the joints. The skin is sterilized
and numbed. The doctor then inserts a very
small needle
into the joint
and injects it with lidocaine (a numbing
agent) and a steroid (an anti-inflammatory).
After
treatment the legs
sometimes
feel numb or weak for a few hours. Side
effects are
rare and include allergic reaction, infection,
excessive bleeding,
nerve
damage, and chemical meningitis.
Thoracic
Facet joints are small joints about the size of a thumbnail
and are located
in
pairs along
the back
of
the spine.
If they become irritated, middle back
pain occurs. Thoracic facet joint injections
have the same
purpose as SI joint
injections, are performed in exactly
the same manner, and have the same
side effects. The only difference is
they treat middle back pain instead of lower
back pain.
Epidural steroidal
injections are similar to SI and thoracic facet join injections,
except
the
cortosteroid
is injected
into the spinal canal surrounding the
spinal cord. They are used to treat
chronic
and
not acute low
back pain.
This procedure
has the same side effects of other
injections. Relief generally lasts anywhere from
one week to one year.
Selective nerve
root blocks (SNRB) are used primarily as a diagnostic
tool and
secondarily
as treatment
for pain.
Back
pain can occur when nerve roots become
compressed and inflamed. While MRIs
can be used to show
which nerves
are causing
the pain, they don’t always work
successfully. In cases when
this happens, an SNRB injection can
be performed in order to isolate
the source of the pain. SNRBs are
also used to treat disc that rupture outside
of the
spinal canal, or
far lateral
herniated
discs. The procedure is the same
for other types
of injections. As with other injections,
SNRBs should not be performed
more than three times per year. SNRBs
are considered more difficult
to perform than other types of injections
and should be done only by a physician
experienced in them.
Facet rhizotomy
may be recommended if three facet blocks have been performed
but more
pain relief
is needed.
Facet rhizotomy
injections disable the sensory
nerves that lead to the facet joint, thereby
providing
pain relief.
The
procedure
for facet
rhizotomy injections is different
from that of other injections.
A needle
with
a probe
is inserted
just
outside the joint,
is heated with radio waves, and
applied to the sensory nerve. This disables
the nerve
and keeps
it from
sending pain signals
to the brain.
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