“Oh! My back!” is a popular punch line for stand-up comics and in primetime sitcoms. For the many millions who suffer with it daily, chronic back pain is no laughing matter. Even mild back pain can interfere with the enjoyment of everyday life. Moderate activities like gardening, or simply keeping up with friends and family via email become uncomfortable for those in constant pain. Intense back pain can cause your entire life to come to a grinding halt. Forget about playing tennis, riding a bike, or working for any appreciable amount of time, with chronic back pain, you can barely get on the floor to play with your kids.
Fortunately, when more conservative approaches to pain management do not sufficiently manage the pain, many other effective treatments exist, such as injection therapy, to reduce and possibly eliminate chronic back pain. Physicians can use a number of different types of injections as well as several points of entry for the injections.
Some therapeutic injections deliver steroids, such as cortisone or a steroid mixture, directly to the source of the pain. Steroid injections can decrease the swelling and inflammation caused by trauma to the spinal nerve pain and, thereby, decrease pain. Others deliver opiates, a potentially addictive class of medication, to relieve the patient. Alternatively, injection therapy may consist of epidural steroid injections, spinal nerve blocks, or facet joint injections. Nerve block injections interrupt the pain signal from a spinal nerve to the brain, providing temporary pain relief. Still other types of injections are used as diagnostic tools to confirm or negate a spinal diagnosis.
Patients should never receive injection therapy unless under a doctor’s care. A medical professional with specialized knowledge of spinal anatomy and physiology will closely monitor the patient throughout any injection therapy process. Local anesthesia is typically administered to reduce patient discomfort. The various natures of injection therapies can confuse patients and some come with considerable controversy. To clear up the confusion, read this introduction to three primary categories of injection therapies.
Epidural Injection Therapy:
The traditional epidural injection technique involves the doctor manually feeling the patient’s spine in order to guide the placement of a needle between the spinal vertebrae. The physician injects the medication inside the bony column of the spine surrounding the ‘dura’—the medical term for the sac that houses the spinal cord and nerves. This may sound scary, but patients should know that the needle stays several centimeters from the spinal cord and can result in complications as minor as a headache.
Injections of medications, such as steroids or opiates, into the lumbar epidural space are frequently used for low back and related radicular leg pains. Physicians use epidural injections to treat a variety of painful back conditions, including sciatica, arthritis, degenerative disc problems, and spinal stenosis. When performed in the lumbar region it is a surprisingly simple technique.
Foraminal Injection Therapy:
With this, more advanced technique, doctors use X-ray fluoroscopy to guide the needle throughout foraminal injection treatments. The neural foramen, the region of the spinal cord where the affected spinal nerve root exits the spine, marks the injection point for foraminal injection therapy.
Physicians also use the foramen as the location for injections of a diagnostic nature to locate the source of the pain. X-ray technology provides an additional tool for your physician to deliver more precisely placed injections. That is why physicians also refer to foraminal injections as “Nerve Root Block”.
A more complex procedure than traditional epidural injections, patients undergoing foraminal injections receive IV as well as local anesthesia. While this may all sound mysterious, patients report only mild discomfort and generally find the procedure tolerable.
Facet Joint Injection Therapy:
The most common of these 3 therapies, facet injections are also the most controversial. Facet injections usually involve an injection of long-lasting cortisone directly into the “trigger point”—the joint itself that is causing pain. Facet joint injections target the back area of the bony spine to reduce pain caused by inflammation or irritation of the joint and surrounding areas as well as swelling of tissue around the joint space. Like the epidural, physicians use facet injections as a primary treatment to reduce pain.
For example, facet joint injections can provide relief of pain caused by an arthritic spine joint, arthritic joints in the hand or foot, repetitive motion injuries, or degenerative joint issues. Injections to facet joint typically take only a few minutes and take place in the doctor’s office. A debate continues in the medical community about the efficacy of facet joint injection therapy. Research findings have revealed contradictory and largely anecdotal results, so many experts hesitate to fully endorse the treatment.
New research data and treatment options for those enduring chronic pain, inflammation, and irritation become available all the time. As always, a two-way dynamic conversation between patient and physician will most likely result in the best chance for positive outcomes. And, if all else fails…laughing is always good medicine. We’ve got your back!
Image credits: Images courtesy of Science Lab Image Library