Low back pain is the most common disease in the United States. While most low back pain is caused by muscle spasms and can be treated with a few weeks of rest and over the counter anti-inflammatory medications (NSAIDs), some people have more persistent symptoms and can be related to degenerative changes in the spine. These degenerative changes commonly are caused by the narrowing of the spinal canal and compression of the nerves resulting in back and leg pain, as well as weakness and numbness in some cases.
The initial treatment of a degenerative spine is rest and anti-inflammatories. The goal is to return to a reasonable level of activity as soon as possible, limiting immobility to two days or less. However, if these initial home remedies do not work, therapy and injections can be useful.
What is a Spinal Injection?
A spinal injection involves placing a needle around the spine and injecting a medication that can relieve the pain. The injection is performed by a pain physician, physiatrist, anesthesiologist or radiologist. Unlike some injections that can be placed in an orthopedic office, spine injections are deep and around the nerves, so they must be placed using a special x-ray, called fluoroscopy, at a hospital or surgery center. The injection usually contains a steroid and an anesthetic which is thought to relieve the pain by reducing the inflammation. A recent trial in the New England Journal of Medicine in 2014 compared injections using a steroid and injections with just an anesthetic. The trial found no differences six weeks following the injection. This argues that the effect from injections may not truly be anti-inflammatory.
Numerous techniques for injecting the medications also exist. These can be caudal blocks (injecting at the bottom of the spine and allowing the medication to migrate upwards), interlaminar injections (injecting focally between the bones), transforaminal injections (injecting focally around one nerve) and facet injections (injecting in the joints of the spine). Depending on the suspected cause of pain, transforaminal injections are thought to be most effective in relieving pain.
How Long Will an Injection Last?
Injections are thought to be a temporary treatment of pain. No matter what the cause of the pain (disc herniation, narrowing of the spinal canal, bone spurs, slippage of the bones, etc.), the injection does not resolve the primary problem. As such, some people consider an injection a “band-aid,” but this is not exactly true either. Even though the injection does not change the structural problem causing the pain and it is not meant to provide long-term pain relief, the injection can temporarily relieve pain while the body fixes itself. However, if the body does not heal itself, other treatments such as surgery are recommended. Overall, injections do not alter the need for surgery in the long-term.
At Rocky Mountain Brain & Spine Institute, we can help you find a path towards relief. Contact us today to schedule your initial appointment.
