When nothing seems to help and back pain is excruciating, a variety of injections may be used as a last resort before – or to postpone – surgery. After a physical exam and appropriate diagnostic tests have pinpointed the source, injections of local anesthetic (such as lidocaine or marcaine), corticosteroids (such as cortisone or Depo-Medrol), and/or other drugs into the tissue around the af fected area or trigger points elsewhere in the body may be given to provide back pain relief.
The anesthetic blocks the pain’s transmission to the brain and in some cases immobilizes the troublesome tissue; the steroid reduces swelling and inflammation. Some injections are given in the doctor’s office, others in an outpatient surgical facility.
Injections usually provide a quick fix – however, for those with chronic back pain or a history of problems, injections are only a temporary relief.
They’re all ancillary to help with the pain. The key is restrengthening and exercising the muscles and relearning proper body mechanics. These are just tools to help reach that goal.
Epidural Injections
Epidural Injections
To relieve inflammation, swelling, and back pain that has a neurological source, this technique involves injecting a local anesthetic and/or an inflammation-reducing steroid into the epidural space, which is the space inside the spinal canal, between the outer membrane protecting the spinal cord and the ligament that supports it. Although the choice of drugs used depends on the area of the injection, in general, anesthetic is administered to quell back pain, and steroids given to reduce the swelling of the disk and any surrounding inflammation that might be pressing on a nerve. Rarely, narcotics or tranquilizing agents might also be used.
The procedure takes anywhere from fifteen to thirty minutes, and can be performed either in the doctor’s office or at an outpatient surgical facility. Although it can be done without the use of a fluoroscope (an X-ray that your doctor can view as he proceeds, akin to an X-ray TV), there are clear advantages to its use. The fluoroscope maximizes your benefit from the procedure.
One study showed that 30 percent of the epidural injections done by anesthesiologists are not even in the epidural space. Without a fluoroscope you can’t tell.
Epidural injections take effect in two to seven days, and are often given in a series of three shots – depending on success – at intervals one week apart. You might feel soreness around the site of the injection for a day or two.
Although this popular technique has been used for years and has been credited with long-lasting relief of pain – sometimes for months or even years at a time – a study in the New England Journal of Medicine reported only short-term improvement in leg pain for sciatica patients receiving epidural steroid injections, and found the technique appeared neither to help patients avoid surgery nor to aid their recovery in the long run.
Other studies report success rates of anywhere from 15 to 50 percent, with success dependent in many cases upon appropriateness of use.
Trigger-Point Injection Therapy
Trigger point injection therapy is another popular, if somewhat controversial, injection option for relieving back pain. Unlike epidural injections, the trigger point approach is used for musculoskeletal pain. Local anesthetic and/or steroid is injected into the fibers within a muscle to relieve muscle spasm, which has often resulted from soft tissue damage. Usually performed in the doctor’s office, it can take effect immediately or after as long as two days.
In Back Talk: How to Diagnose and Cure Low Back Pain and Sciatica, author Loren M. Fishman, M.D., mentions the use, in this type of injection therapy, of a medication called Botox (botulinum toxin type A), which comes from the same bacterium that causes botulism. Said to paralyze muscle in spasm and eradicate pain within ten to twenty days, the effects have been claimed to last for three to four months, often up to half a year. Dr. Fishman also notes that normal saline (sterile salt water) has been used in trigger-point injections to push apart compressed or constricted structures.
Other studies have found “dry needling” (injections without drugs) just as effective as those using anesthetic, or anesthetic and steroid, for some low back pain patients. One researcher theorized that achieving a local twitch response – an involuntary muscle movement – with the needle was the most important factor in success, an idea compatible with the intramuscular stimulation technique.
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