Injections for Diagnosis and Pain Relief
The technique most commonly associated with pain medicine is the epidural steroid injection, or “epidural injection.” This is an example of what pain physicians call an interventional procedure, the use of needles to deliver medications to anesthetize nerves to relieve pain.
There are two categories of interventional techniques: those used to diagnose or identify the cause of pain and those intended to provide relief from pain.
Diagnosis is what we do to figure out what the problem is. To figure out what is causing pain, I can ask you about your pain—where it is, how it feels, what time of the day it occurs, what activities bring it on. I can order X-rays, CT scans, and MRI scans to peer inside the body and “see” what is causing your pain.
Unfortunately, traditional diagnostic techniques such as X-rays and MRI alone are not adequate for the task in most cases of chronic spinal pain or chronic pain that is felt to be of spinal origin. There are a number of shortfalls associated with these less invasive approaches. Even in experienced hands, the diagnosis of spine pain is hard to make without the use of diagnostic injections.
Diagnostic injections are performed to determine which injections for pain relief will be most effective.
For some conditions, diagnostic nerve blocks can be performed in order to use radiofrequency-generated heat or pulsed radiofrequency lesioning to temporarily disable the function of those nerves and provide pain relief for up to a year.
Injections for Pain Relief
Although there are as many injections for pain as there are different types of pain, injection therapy can be divided into a few basic elements:
1. Local anesthetic and steroid can be injected directly onto a nerve to shrink swelling and block the transmission of pain.
2. Local anesthetic and steroid can be injected into the epidural space to treat the effects of spinal pathology on the spinal cord or exiting nerve roots. This is the epidural steroid injection that many people get for back pain. It is also the epidural local anesthetic that pregnant women sometimes get to help relieve the pain of childbirth.
3. Local anesthetic and/or steroids can be injected into joints to relieve the mechanical pain associated with joint inflammation.