For many people, back pain flares up suddenly, sometimes causing a restless night’s sleep. This is known as acute back pain and can typically be treated with at-home care. Medical advice for acute back pain includes warm baths, applying ice or trying an over-the-counter pain reliever.
But another common condition is chronic back pain—when spinal discomfort lasts for at least 12 weeks and basic care doesn’t relieve the pain. When a person has chronic back pain, a doctor may recommend other treatments, such as prescription medications, physical therapy or injections.
Why Doctors Recommend Injections for Back Pain
Back pain management often requires a combination of therapies to treat current pain and help prevent future discomfort. Back injections are often part of a comprehensive treatment plan to relieve pain.
“Sometimes people get various injections in their back, whether it’s epidural or joint injections. Sometimes they get trigger point injections,” said Khalid Kurtom, MD, FAANS, FACS. “There are various methods, and they all can be undertaken simultaneously … it’s usually a multi-modality approach to treating these conditions.”
Back injections reduce inflammation, a persistent cause of pain. They can also reduce pain caused by inflamed or damaged nerves through therapeutic injections. Sometimes diagnostic injections help find the underlying cause of back pain so doctors can identify proper treatment.
Understanding Different Types of Back Injections
Back injections include epidural injections, trigger point injections, facet and sacroiliac joint injections, and nerve block injections. Each works in a slightly different way.
Epidural Injections
During an epidural injection, a steroid, a local anesthetic or both is injected into the epidural space that surrounds the membrane lining the spinal cord. You may have heard of epidural injections since they’re often used for women during labor. During that type of epidural, anesthesia is injected into the spinal nerves to numb the lower back and areas below it.
Epidural injections can also treat inflammation irritating the spinal nerves and causing back pain. In most cases, an anesthetic is injected along with a steroid. Lumbar epidural steroid injections typically provide only short-term, moderate pain relief.
Trigger Point Injections
Trigger point injections relieve pain caused by a trigger point—a knot in the muscle or fascia tissue of the lower back. Trigger points often develop as the result of stress caused by a poor ergonomic setup at work or physical inactivity. During this type of injection, the knot is typically injected with both an anesthetic and steroid to provide prompt pain relief.
Joint Injections
There are also two types of joint injections to treat back pain, leg pain and other related discomfort.
Facet joint injections treat pain caused by an injury or degenerative condition such as arthritis. These injections are placed in the small joints between the vertebrae in the back of the spine. Facet joint injections use a steroid to alleviate inflammation and pain in the neck, middle back or lower back, but can also help with pain that radiates into other areas of the body, such as the buttocks or shoulders.
Sacroiliac joint injections place steroids in the sacroiliac joints. This type of injection relieves pain in the lower back, buttocks and legs.
Nerve Blocks
During an injection called a nerve block, an anesthetic is injected into the area around a nerve in the back to numb the area and alleviate pain—but it wears off quickly. Nerve blocks can be used as a diagnostic tool as well as a therapeutic one.
Spinal Injections as Diagnostic Tools
During a diagnostic nerve block procedure called discography, a doctor injects dye into the spinal disc suspected of causing pain. If the disc is the culprit, the increased pressure from the dye will recreate the symptoms—and the dye will show damaged areas in a CT scan after the injection.
Other spinal injections can also be used as a diagnostic tool. An epidural spinal injection uses steroids, anesthetics or both. It can be placed in a specific nerve to determine if that nerve is the source of pain.
Diagnostic joint injections work similarly—a small amount of anesthetic is injected either into the joint itself or into a nerve near the joint. If the anesthetic effectively takes away the pain, then that joint may receive a steroid injection.
There’s also one other type of diagnostic back injection called provocation discography. Unlike the discography mentioned above, this doesn’t involve medication to relieve pain. Instead, a liquid is injected to pressurize the spinal disc and help a doctor distinguish between a healthy disc and one that’s causing pain. Provocation discography is used if doctors are considering surgery to relieve lower back pain.
What Happens During a Back Injection
All types of spinal injections are performed in a similar manner. Because the injections are placed in the intricate, complex spinal area, doctors use a type of X-ray known as fluoroscopy. Fluoroscopy allows doctors to continuously see inside the spine to ensure the injection is placed properly. Once the needle is in place, a dye is injected first. This dye moves into the body and is visible on the X-ray.
If the dye isn’t flowing into the correct location, your medical team will reposition the needle and reinject dye until it’s certain the needle is in the correct place to inject the medication.
Following a back injection, your doctor will advise whether you need to take special precautions or follow-up treatments.
Learn More
Listen to a podcast on degenerative spine disorders and learn more about back injections from Dr. Khalid Kurtom.
