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BACK AND NECK PAIN
For pain relief, injections can be more effective than an oral medication because they deliver medication directly to the anatomic location that is generating the pain. Typically, a steroid medication is injected to deliver a powerful anti-inflammatory solution directly to the area that is the source of pain. Depending on the type of injection, some forms of low back pain relief may be long lasting and some may be only temporary.
FACET JOINT ARTHRITIS
Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury, or mechanical stress to the back.
A cervical, thoracic or lumbar facet joint injection involves injecting a small amount of local anesthetic (numbing agent) and/or steroid medication, which can anesthetize the facet joints and block the pain. The pain relief from a facet joint injection is intended to help a patient better tolerate a physical therapy routine to rehabilitate his or her injury or back condition
A cervical herniated disc is diagnosed when the inner core of a disc in the neck herniates, or leaks out of the disc, and presses on an adjacent nerve root. It usually develops in the 30-to-50-year-old age group. While a cervical herniated disc may originate from some sort of trauma or neck injury, the symptoms commonly start spontaneously.
The arm pain from a cervical herniated disc results because the herniated disc material “pinches” or presses on a cervical nerve, causing pain to radiate along the nerve pathway down the arm. Along with the arm pain, numbness and tingling can be present down the arm and into the fingertips. Muscle weakness may also be present.
The discs in the cervical spine are not very large; however, there is also not a lot of space available for the nerves. This means that even a small cervical disc herniation may impinge on the nerve and cause significant pain. The arm pain is usually most severe as the nerve first becomes pinched.
- Injections. Cervical Epidural steroid injections or selective nerve root blocks can be helpful to reduce inflammation in cases of severe pain from a cervical herniated disc, and can be very effective if accompanied by a comprehensive rehabilitation program that may involve a number of the above treatments.
Injections of medication into the area near a nerve, or group of nerves, can be more effective than oral medication because the medication is delivered directly to the part of the body that is in pain. Medications injected may include steroids, local anesthetics, and opioids:
- Steroid injections may reduce the inflammation and irritation to that nerve and reduce pain.
- Local anesthetics may also break the cycle of pain and provide some relief of the patient’s chronic pain.
- Opioid injections also provide powerful, short-term pain relief.
By reducing irritation, the injections may help the affected nerve, or nerves, heal. Having a nerve block may also improve symptoms enough for the person to take a more active part in physical therapy.
Nerve blocks are used to target pain throughout the body, such as back, neck, head, shoulder, or leg pain. If back pain is the problem, an epidural pain block may be recommended. In an epidural nerve block, a corticosteroid medication is injected into the area around the spinal column known as the epidural space.
Nerve blocks are generally most effective when a small number of nerves-or a single nerve-is causing pain. Pain relief is usually immediate. The duration of pain relief varies with the individual, and some people have injections every few months. Pain blocks are typically administered in an outpatient procedure.
If you have knee osteoarthritis, doctors can offer a variety of treatments to relieve your symptoms. One option is to inject medication into your knee.
There are different types of injections, and they’re an important part of treating knee osteoarthritis for many people, says Roy Altman, MD, an osteoarthritis expert at UCLA. Injections can be especially helpful for people who haven’t gotten relief from NSAIDs like ibuprofen, or people who can’t take those drugs due to side effects. Osteoarthritis (OA) is a common form of arthritis that often affects the knees. It develops when the cartilage — the smooth covering that protects the bones in the joint — breaks down. The surface of the bones becomes damaged, causing pain, swelling, stiffness, and disability.
SACROILIAC JOINT DYSFUNCTION
Dysfunction in the sacroiliac joint, or SI joint, is thought to cause low back and/or leg pain. The leg pain can be particularly difficult, and may feel similar to sciatica or pain caused by a lumbar disc herniation.
While the primary reason for sacroiliac joint injections is to determine whether or not the sacroiliac joint is the cause of the patient’s pain, it is also useful in providing immediate pain relief. As part of the injection, an anesthetic (such as lidocaine or bipuvicaine, or novacaine) is typically injected along with an anti-inflammatory medication (such as a corticosteroid) to help reduce inflammation around the joint, which in turn will help alleviate the pain. The immediate pain relief can help the patient start with a physical therapy program and return to normal activity levels.
When the pain is severe or does not get better on its own, a more structured treatment approach, and possibly surgery, may be the best option for finding pain relief and preventing or minimizing future pain and/or dysfunction.
If the pain is severe, an epidural steroid injection can reduce inflammation. Unlike oral medications, an injection goes directly into the painful area around the sciatic nerve to address the inflammation that may be causing pain.
While the effects tend to be temporary (providing pain relief for as little as one week or up to a year), and it does not work for everyone, an epidural steroid injection can be effective in relieving acute sciatic pain. Importantly, it can provide sufficient relief to allow a patient to progress with a conditioning and exercise program.
Spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine to your arms and legs. Spinal stenosis occurs most often in the lower back and the neck.
While spinal stenosis may cause no signs or symptoms in some people, other people may experience pain, tingling, numbness, muscle weakness, and problems with normal bladder or bowel function.
Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.
Your nerve roots may become irritated and swollen at the spots where they are being pinched. Injecting a corticosteroid into the space around that constriction can help reduce the inflammation and relieve some of the pressure. However, steroid injections don’t work for everyone. And repeated steroid injections can weaken nearby bones and connective tissue, so only a few injections a year are suggested.
Injections are a treatment option for athletes whose joint or tendon injuries have not responded to conservative treatments and rest, but may not be severe enough to require surgical intervention. Like any treatment option, there are pros and cons, and not all physicians agree on the effectiveness of all injections available to treat sports injuries.
VERTEBRAL COMPRESSION FRACTURES
Vertebral augmentation is a category of surgical procedures that are used to stabilize a fractured vertebra with the goal of reducing the patient’s pain. These procedures are termed vertebroplasty, kyphoplasty, or radiofrequency vertebral augmentation.
Most people who undergo some type of vertebral augmentation have suffered a fracture in a spinal vertebra called a compression fracture. A compression fracture is usually caused by relatively minor trauma in patients with osteoporosis, a disease that leaves spinal vertebrae weak and brittle and prone to fracture. Fractures can also be caused by a spinal infection or tumor, or from more significant trauma to the spine.
Vertebral augmentation is a surgical procedure used to treat a compression fracture of the spine. There are many approaches to vertebral augmentation surgery, including vertebroplasty or kyphoplasty. The goal of this type of procedure is to stabilize the collapsed vertebra and bring pain relief to the patient.
Each year, worker injuries account for millions of dollars and countless hours of lost time that can never be recovered. It is the focus of numerous studies and efforts to both limit such injuries and appropriately return these workers to productive status on a timely basis. At Northwest Surgical Specialists that is exactly what we do.