Trigger Point Injections
Trigger point injections are used on painful or spasming muscles. These injections are used to calm and relax knotted muscles which can be impinging on nerves. These injections often include anesthetic and a corticosteroid (to reduce inflammation). Sometimes a dry needle will do the trick (which would be similar to acupuncture).
Epidural injection of Cortisone can reduce inflammation around the nerve root. The epidural space is located within the spinal canal which surrounds the spinal cord and spinal nerves (that splinter off). Epidural Injections are often known as a pain relief option for women during labor. Epidural injections to treat back pain are given in a much more precise location, based on where the spinal pathology lies. The medications used differs as well, with spinal epidural injections typically containing both a numbing medication and an anti-inflammatory medication. There are a number of different entry points of these injections. Since we are dealing with highly sensitive nerve structure, precise needle placement is required to assure safety. These injections are typically performed using real-time imaging guidance (fluoroscopy) or x-ray. This procedure can typically be done in an outpatient setting.
Numbing Medication Injections and Nerve Root Blocking
Fluoroscopy (or live x-ray) is used to help find the exact area for the injection. A Steroid is often injected in tandem with a numbing agent. Selective nerve root blockingis performed to help with pain or be an effective diagnostic procedure, helping locate the pain source from a particular nerve in your spine. This is often helpful with disk herniation pain.
Facet Joint Injections
Facet Joint Injections are helpful for some patients in reducing back pain caused from the facet joints. The facet joints are small, paired joints on the back of the spine (Add “facet Joint” photo). If the joint becomes inflamed or painful, an anesthetic (numbing) medication and a corticosteroid (strong anti-inflammatory medication) can be injected. The anesthetic can be helpful diagnostically, similar to selective root blocking to help determine if the facet joint injected is in fact the source of pain. These injections also require real-time imaging guidance (similar to the Epidural injections).
Radiofrequency Denervation Procedures
Radiofrequency denervation is a procedure in which a needle with a tiny radiofrequency emitting the end of it, is precisely placed (via imaging guidance) close to a nerve or small branch of a nerve that is carrying the pain signals. If the injection is properly placed, the probe at the end of the needle will “heat up” and cook or destroy the annoying nerve. There will be some collateral damage to surrounding soft tissues but his should heal completely in a week or two.
While the nerve blocking procedure can be thought of as temporarily “blocking” the nerve by which your pain signals are traveling, a radiofrequency denervation procedure is much more irreversible and invasive but will provide sustained pain relief.There is a chance that the damaged nerves could grow back (and cause pain) but this would happen very slowly. These procedures are reserved for pain symptoms that have been tested with local injections into (ie. Facet Joint Injections or Medial Branch Blocks) and specific location credibly diagnosed.
Discography is a investigative technique performed by injecting a contrast medium (dye) into a patients spinal disks. This test is specifically designed to see if degeneration (or abnormalities) in the disk is the cause of pain. One portion of the test is to see if a person experiences pain with these injection itself. While the second part to this test is a CT scan to see how the dye has spread through the disk. The more the dye spreads the more degeneration of that disk.