Invasive techniques in pain management involve invasion (or insertion) of instruments and devices into the body. However, this type of pain management is quite distinct from surgery as it involves the most minimal of invasiveness and effect to tissue. There are a multitude of invasive pain management therapies that may be used used to treat neck and back pain. An epidural injection places anti-inflammatory medicine into the epidural space of your spine to reduce nerve inflammation. By stopping or limiting nerve inflammation we may promote healing, and speed up mother nature, thereby reducing your pain.
Athough not always helpful, epidural injections reduce pain and improve symptoms in most people within 3-7 days. They may provide permanent relief or provide a period of pain relief that will allow other treatments like physical therapy to be more effective.
Injections are a direct delivery of steroids or anesthetic to nerve, joint or epidural space. Injections into the facet, peripheral nerve, "trigger point"; and other locations are also known as "blocks";. These may provide relief of pain (often temporary) and can be used to confirm diagnosis. Epidural injections provide temporary relief for severe back pain.
Epidural Steroid injections can be administered either in a transforaminal or an interlaminar fashion under fluoroscopic image guidance. Transforaminal injections allow for a more precise placement of medication at the site of disc or nerve root inflammation. Interlaminar injections allow for a greater spread of medication to a particular area in the epidural space. During the performance of an epidural injection procedure several medications are utilized. These include a contrast agent to confirm proper flow of medication prior to injecting any therapeutic medications, a local anesthetic (to provide comfort, diagnostic information, and to assist controlling inflammation), and a corticosteroid (the primary medication responsible for controlling nerve root swelling, inflammation, and pain).
Facet joint injections can be performed either diagnostically or for therapeutic purposes. Diagnostic injections to the facet joints can be performed in two ways. One way is by placing anesthetic into a given facet joint (intra-articular injection). The second way is by placing the same anesthetic along the nerves which supply sensation to the facet joint. These nerves are known as the medial branches (hence the procedure is called a “medial branch block’).
Similar to diagnosing and treating facet joint pain, injections to the sacroiliac joint can be performed for diagnostic or therapeutic purposes. Diagnostic injections are performed with anesthetic placed into the sacroiliac joint under fluoroscopic guidance. During the life of the injection anesthetic, the patient’s level of pain relief is recorded. Similar to the case with facet joint pain, the only reliable means of confirming the sacroiliac joint as a true pain generator (“Sacroliiac joint syndrome”) is to perform a diagnostic injection. Therapeutic injections to the sacroiliac joint are performed in a similar fashion but with the injection of corticosteroid to address painful inflammation or degeneration. Such injections can accurately performed only with the use of fluoroscopic guidance.