Epidural Steroid Injection
This is one of the most common procedures in pain management. An epidural steroid injection is performed to treat pain caused by disorders of the cervical, thoracic, and lumbar spines. Pain frequently radiates down the arms or legs. Disc herniation, spinal stenosis, and other causes for nerve root compression are the main indications for an epidural injection.
Facet Joint Injection and Medial Branch Block
Medial branch nerves transmit signals for pain generated by disorders of the facet joints of the spine. Medial branch blocks target these nerves in an attempt to alleviate the axial low back pain coming from the facet joints. These injections are used to treat cervical, thoracic, and lumbar facet joint disease.
When the medial branch blocks are successful in temporarily improving the facet joint pain, radiofrequency ablation (RFA) is administered in an attempt to provide at least 6-12 months of pain relief. With RFA, radio waves produce an electrical current that applies heat to the medial branch nerves and disrupts their ability to transmit pain signals for an extended period of time.
Sacroiliac Joint Injection
The sacroiliac (SI) joint is formed by the union of the sacrum at the base of the spine with the iliac wing of the pelvis. Pain typically is felt in the low back or posterior hip and it can refer down the leg to the knee. The sacroiliac joint injection is a corticosteroid injection into the SI joint.
Sacral Lateral Branch Blocks and RFA
When SI joint injections are only able to provide the patient with temporary relief, radiofrequency ablation can be a successful long-term solution for SI joint pain. The sacral lateral branch nerves that carry pain signals from the SI joint are the targets for RFA.
Trigger Point Injection
The paraspinal musculature can also be a common source of low back pain. Trigger point injections into the muscles are useful to relieve muscle spasms and produce pain relief. Brief massage is typically applied after the injection to aid in release of the muscle spasm.
Piriformis Muscle Injection
The piriformis muscle originates from the sacrum of the spine and inserts on the greater trochanter of the hip. The sciatic nerve runs beneath the piriformis muscle as it courses down the leg. Piriformis syndrome occurs when contracture of the muscle causes irritation of the sciatic nerve and radiating pain down the leg. With this injection, a combination of local anesthetic and corticosteroid is injected into the muscle to release the spasm and eliminate the sciatica.
A discogram is a diagnostic procedure to determine whether a disc that appears abnormal on CT or MRI scan is the source of back pain. Injection of liquid contrast dye into the abnormal disc may temporarily reproduce your pain symptoms if that disc is the pain generator. More than one disc is frequently injected to improve accuracy of the test.