Injections

Lumbar Epidural Steroid Injection

A lumbar epidural steroid injection is a minimally invasive procedure for treating leg, buttock and lower back pain originating from the epidural space. The epidural space surrounds the dura, a membrane which protects the spinal cord and its nerves. The primary reasons for pain in this area are herniated or ruptured discs, stenosis, or sciatica all of which result in nerve compression. The pain may originate in any part of the lumbar region of the spine, including the coccyx, or tailbone, where it is referred to as caudal.

A lumbar epidural steroid injection is usually administered in an outpatient surgical setting under local anesthetic. After the local anesthetic has numbed the skin, a small needle is inserted into the epidural space with the assistance of an imaging technique known as fluoroscopy. Once the targeted area is pinpointed, the medications, which include an anesthetic and a corticosteroid, are injected.

injections

After a lumbar epidural steroid injection, most patients return to work the next day. They normally experience immediate pain relief for a few hours after the procedure as a result of the injected anesthetic, although there may be some irritation at the injection site. In a few days, the original pain may worsen again as the anesthetic wears off. This is completely normal. In about a week, the corticosteroids will take full effect, reducing inflammation and significantly reducing pain. Depending on the patient’s response, the doctor may administer as many as three epidural injections spaced several weeks apart.

The effectiveness of a lumbar epidural steroid injection varies. Some patients experience long-term, or sometimes even permanent, pain relief after one injection, requiring no further treatment. Others may require additional treatment a few weeks or months later. The exact effectiveness of a lumbar caudal epidural steroid injection depends on the individual patient’s condition.


Lumbar Facet-Joint Injections

Lumbar facet-joint injections are both a minimally invasive treatment for lower-back pain caused by inflamed facet joints, and a diagnostic tool to determine whether facet-joint inflammation is the source of the pain. Facet joints connect each vertebra to the vertebra above and below it. A facet-joint injection, administered either into the joint capsule or its surrounding tissue, combines a long-lasting corticosteroid with a local anesthetic. Although the anesthetic provides only very temporary pain relief, the corticosteroid reduces inflammation and can relieve pain for up to a few years. Enduring pain relief from the injection is diagnostically significant, indicating that the pain originates in the facet joint that received the injection.

Lumbar facet-joint injections can be repeated up to 3 times a year for those who experience successful but short-term pain relief. While this treatment is very helpful for certain patients, it is not effective in all cases.


Candidates For Lumbar Facet-Joint Injections

Patients with pain in the lower back, hips or buttocks, or radicular pain that radiates down the legs, are likely candidates for facet-joint injections. Facet-joint pain can be the result of injury, spinal stenosis, sciatica or osteoarthritis. Facet-joint injections may be administered after anti-inflammatory medications, a back brace or other conservative methods have failed to alleviate symptoms. Although lumbar facet-joint injections can be effective in relieving pain and determining its point of origin, they are not considered safe for a patient who is pregnant, or has an infection or chronic bleeding disorder.


The Lumbar Facet-Joint Injection Procedure

Prior to the administration of a facet-joint injection, the injection site is numbed with an anesthetic. The needle is then inserted, using fluoroscopy (an imaging technique) to ensure precise placement, through the back and directly into the facet joint. Once the needle is correctly positioned, a combination of anesthetic and corticosteroid is injected. This procedure takes less than 30 minutes to perform. The patient typically experiences immediate pain relief because of the anesthetic used in the injection, but measurable results of the corticosteroid may take several days to appear. Mild, temporary pain can occur at the injection site, but it can be managed by taking acetaminophen (Tylenol) and applying ice.

Recovery From Lumbar Facet-Joint Injections

After receiving a facet-joint injection, the patient is able to return home shortly thereafter, and resume regular activities the next day. The corticosteroid used in a facet-joint injection may take up to a week to fully relieve pain. During a follow-up visit in about a week, an evaluation is made of how effective the injection has been in lessening symptoms.

A patient is often encouraged to become involved in an exercise program that involves both stretching and strengthening exercises, which can enhance the effects of the facet-joint injection. Some patients experience long-term, sometimes even permanent, pain relief after one injection and require no further treatment; others may need additional treatment a few weeks or months later.


Risks Of Lumbar Facet-Joint Injections

Although considered safe, there are risks involved with facet-joint injections. In rare cases, they can cause infection, allergic reaction, bleeding or nerve damage.


Trigger-Point Injections

Trigger-point injections treat pain in areas that have developed trigger points, which are knots of muscle that form when muscles contract and but cannot relax. Trigger points are caused by injury to or overuse of the affected muscle; they can also be caused by stress and anxiety. They can irritate the nerves around them, which causes pain in other areas of the body. The chronic pain brought on by trigger points can also decrease the affected muscle’s range of motion.

Candidates For Trigger-Point InjectionsM

Trigger-point injections are typically used to treat pain in the neck, lower back, arms and legs. They can also be effective for tension headaches, temporomandibular joint (TMJ) pain or fibromyalgia, and for myofascial pain syndrome, a chronic pain condition in which trigger points develop in certain muscles, and cause pain when touched. Patients with this condition often experience deep, aching pain in the affected muscle that worsens over time, as well as muscle and joint stiffness, and difficulty sleeping. Symptoms can significantly affect a person’s quality of life, and should be addressed if they do not subside. Over time, patients with untreated myofascial pain syndrome can develop muscle weakness or fibromyalgia.

The Trigger-Point Injection Procedure

A needle containing a local anesthetic, and, sometimes, a corticosteroid to reduce inflammation, is inserted into the trigger point to make it inactive and, therefore, alleviate the pain. The procedure typically takes between 15 and 20 minutes, and is done in a doctor’s office. If necessary, multiple sites can receive trigger point injections in one appointment.

Risks Of Trigger-Point Injections

Trigger-point injections are considered safe, and have few side effects. The patient may feel sore around the injection site for up to 2 days, but applying ice usually helps. In most cases, normal activities can be resumed the next day. Trigger-point injections not only relieve pain, they loosen the muscles that are responsible for the pain, which facilitates the rehabilitation process.

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