If you’re struggling with back pain, you owe it to yourself to consider these minimally invasive techniques to manage pain, according to Sheena Bhuva, M.D., a physician specializing in physical medicine and rehabilitation on the medical staff of Texas Health Center for Diagnostics and Surgery (THCDS) in Plano, TX.
“Many of our patients with back pain get good results and relief from pain with these injections, especially when they’re done in conjunction with physical therapy,” said Dr. Bhuva, “For some patients, it’s one of the best techniques for pain management.”
What can pain injections treat?
There are different types of pain management injections, each treating a specific kind of pain. Two key types are epidural steroid injections, which can help treat pain due to sciatica, and rhizotomies, which can help treat pain in the neck or low back.
Epidural Steroid Injections (ESI)
Epidural steroid injections, or ESIs, are excellent treatment options for acute or chronic pain due to sciatica, which causes radicular pain (numbness, tingling or pain in the arms or legs). For these epidural injections, the physician injects a steroid and lidocaine (a local anesthetic) around the pinched nerve.
“The goal is to help with the pain and decrease any irritation or inflammation in the affected nerve,” Dr. Bhuva said.
If the patient suffers from a herniated (bulging) disc or a bone spur, the injection won’t cure the herniation or remove the bone spur. However, the source of back pain isn’t always obvious from an MRI or CT scan. Inflammation, not always evident in imaging, may also play a significant role in causing pain; an injection can reduce that inflammation. Plus, even temporary relief can allow the patient and his or her physician to better manage the condition.
“If we can decrease the pain, the patient can be more functional and possibly able to tolerate physical therapy to help strengthen the muscles around the area, and thus, better support the spine, which can lead to more lasting relief,” Dr. Bhuva said.
For patients experiencing axial pain–pain in the neck or back–a rhizotomy, also known as a radiofrequency ablation, is another good option. To see if a patient is a candidate for this procedure, they need to undergo test injections called medial branch blocks (MBB). This procedure involves injecting a numbing agent near small medial branch nerves connected to a specific facet joint. Facet joints are small joints at each segment of the spine that provide stability and help guide motion; they can become painful due to arthritis of the spine, an acute injury, or mechanical stress to the back.
If the patient experiences significant pain relief lasting 4 to 5 hours after the procedure, then the facet joint is determined to be the source of the pain. A second, confirmatory MBB procedure is then performed. If the second procedure produces the same results, the patient meets the criteria for the rhizotomy, essentially burning the nerves to relieve pain.
In the rhizotomy, radiofrequency energy is used to partially destroy the nerves causing the pain. The goal is to interrupt the pain signal to the brain, while preserving other functions, such as normal sensation and muscle strength.
“The medial branch nerves sense pain from the facet joints,” Dr. Bhuva said. “These nerves don't go to the major muscles or make your legs move. Patients get long-term relief of their neck pain or back pain, averaging 8-12 months, and sometimes as long as two years.” When the nerves regenerate, the rhizotomy may be repeated.
Not Just Band-aids
Before pain injections are performed, the patient undergoes a physical exam and an MRI or CT scan of the spine. The physician examines the patient’s gait and asks what kinds of activities trigger the pain.
Dr. Bhuva noted many patients ask if pain injections are “just band-aids” in these initial consultations. She advises them that pain injections can offer more than just temporary relief.
“Injections help decease the pain and the inflammation,” she said. “Some patients have just one injection and don’t need another.” In some cases, injections give patients enough relief to undergo physical therapy, which can lead to more lasting relief.
Sometimes patients may get only partial relief; in those cases, a second or third injection may be recommended, or another type of injection may be tried, or the physician may change the level (location in the spine) where it’s injected.
The procedures themselves last about 10-15 minutes.
“We’re using an x-ray machine, so we can see exactly where we are going with needle,” Dr. Bhuva said. “I am talking to the patient throughout the procedure.”
Another advantage of pain injections: they offer a safer alternative to traditional pain medications. Injections can decrease or eliminate the need for opioids to manage pain. Opioids are very effective but can also lead to serious side effects. There is also a risk of addiction. (Patients should only take opioids under a doctor’s supervision.)
Services Offered at THCDS
Patients considering pain injections should find an experienced physician with specialized training in this area. Doctors on the medical staff at THCDS in Plano have performed thousands of these injections. Many patients not only choose THCDS for routine, non-surgical procedures including pain management procedures but also for surgical treatment of spinal disorders including endoscopic spine surgery, disc replacement surgery, discectomies and fusions. For more information about treatment options for back or neck pain, please contact our patient navigator at 972-543-1250.