There are millions of people who suffer from debilitating low back pain and joint pain who live in misery every day. They wake up in pain, trudge through the day in pain, and go to bed in pain.
Most chronic pain sufferers have tried a host of medications including Tylenol, anti-inflammatories, stronger opioids or “narcotics” such as hydrocodone and oxycodone, and have also been through a course of physical therapy or perhaps acupuncture. Unfortunately, in many cases the above interventions aren’t successful and so patients resign to live a life of chronic pain when they do not have to.
Enter interventional pain management. In many cases, there are injections targeted at specific pain-generating structures that can help alleviate, and in some cases, completely eliminate their pain. For back pain, neck pain and sciatica, to name a few conditions, there are target specific xray-guided injections that include epidural steroid injections, facet joint injections, and sacroiliac joint injections. In the appropriate candidates and in the appropriately trained hands, these injections can greatly diminish pain and improve quality of life.
The injections are usually administered in the office, where an xray machine called a fluoroscope is used to visualize the appropriate landmarks and guide the needle(s) directly and safely to the pain source. The area of the skin and underlying soft tissues is first anesthetized or “numbed up” using lidocaine, similar to a novocaine injection at the dentist. Thereafter, a needle is advanced under direct visualization of the fluoroscope to the pain source, sometimes utilizing multiple camera views to achieve optimal needle placement. Finally, the medication is administered through the needle. This usually consists of a potent antiinflammatory, or cortisone-like medication, to reduce the local inflammation, as well as an anesthetic agent to numb the painful structures. Recovery after the injection is quick, and normally within minutes the patient may leave the office.
Epidural steroid injections typically take 1-3 days for the steroid to take effect. Facet and sacroliliac joint injections typically produce a more immediate pain reduction. Depending on the severity of the condition and the patient response, a follow-up injection or two may be necessary to achieve an adequate and acceptable level of pain control.
If a facet injection is shown to produce immediate and excellent pain relief, but the effect wears off rather quickly, a follow-up injection called a radiofrquency ablation will typically achieve much longer lasting effects. Radiofrequency ablation is a little-known treatment for arthritis related spine pain and may produce sustained pain relief of a year or even longer.
Pain injections in the hands of a well-trained physician, and in the appropriately chosen patient, can drastically improve lives. Injections may also help patients reduce or eliminate the usage of oral pain medications, which frequently have associated side effects, including sedation, nausea and constipation.
If you are suffering from chronic pain and have already tried medications and/or physical therapy, ask your doctor if pain injections might be appropriate for you.