ABOUT
Pain Management
Epidural Steroid Injections
The epidural space is between the dural sac (a membrane encasing the spinal cord, spinal fluid, and nerve roots) and the vertebral wall, inside the spinal canal but outside the nerve sac.
An epidural steroid injection (ESI) is an injection that delivers long-acting steroids directly into the epidural space. Steroids help to reduce pain by reducing inflammation around the nerves. Sometimes an anesthetic or saline is also used to help “flush out” inflammatory agents that may be irritating a nerve.
Treatments
Epidural steroid injections are typically used to treat pain radiating from the lower back into the legs or from the neck into the arms. Diagnoses most often considered for ESI include:
- Herniated Disc
- Stenosis
- Nerve Root Compression
- In some cases, Spondylolisthesis
Facet Injections
Facet joint pain arises from degenerative changes within the facet joint. These changes may cause inflammation. The mainstay of treatment is anti-inflammatory medication, physical therapy, chiropractic care, and activity modification. If these treatments fail to provide adequate pain relief, injections may be considered.
Facet injections may also be used as a diagnostic evaluation. If the pain decreases significantly after the injection, this helps to verify the joint as a pain generator. This can be helpful in planning future treatment. These injections can provide relief from pain for days or even years or, in some cases, permanently.
Sacroiliac Joint Injection
The Sacroiliac Joint is located between the sacrum (which supports the spine) and the ilium bones (which support the sacrum) of the pelvis. Being the link between the ilium bones and the sacrum, this joint is responsible for transferring the weight of the upper body to the lower extremities. Sacroiliac Joint (SI joint) pain arises from degenerative changes within the SI joint which may cause inflammation.
Diagnosing
SI joint injections may be used as a diagnostic evaluation. If the pain decreases significantly after the injection, this helps to verify the joint as a source of pain. Injections may provide temporary pain relief, or the pain may remain reduced for a long period of time.
Treatments
- Anti-inflammatory medication
- Physical therapy
- Chiropractic care
- Activity modification
- Injections
Trigger Point Injection
Back muscle spasms are an extremely common cause of acute and chronic neck and back pain. Muscles in the neck and back will often present themselves as “knots” and can be so uncomfortable that they restrict the range of motion. Trigger Point Injections help reduce the inflammation and irritation caused by these back muscle spasms.
Treatments
A trigger point is a particularly sensitive area in the muscle tissue (myofascial) that becomes painful when pressed or squeezed. Trigger Point Injections are used to reduce or eliminate back spasms by loosening the knots built up in the muscle tissue that may be causing pain.
By allowing the area to relax and release tension, Trigger Point Injections help stop the tearing and stretching of the tissue.
Medial Branch Block
The medial branch nerve block (the nerves carrying pain signals from the facet joint to the spinal cord) temporarily stops the nerve’s ability to carry pain signals to the brain, which in turn will determine if the facet joint(s) is the source of pain.
Medial branch nerves are the small nerves that carry pain signals to the brain from the facet joint in the spine. These nerves do not control any major muscles or carry any sensation to the arms or legs, so there is no danger of negatively affecting other pain-sensing processes with this injection.
This injection is a procedure in which a long-acting numbing agent is injected near small medial nerves connected to a specific facet joint (also called a zygapophysial joint or Z-joint) under live X-ray, known as fluoroscopy. Live X-ray helps in placing the needle and avoiding injury.
Selective Nerve Root Block
A Selective Nerve Root Block is similar to an epidural steroid injection but is more specific. Its purpose is to specifically block one or more spinal nerves to decrease pain and determine which nerve is related to your symptoms.
This is done by injecting an anesthetic and anti-inflammatory steroid into the space around the nerve for the nerve block.
Selective Nerve Root Block can be used to evaluate patients with:
- Radicular pain
- Stenosis
- Conditions that may result in nerve root compression
