Johns Hopkins Health Alert
Injection Therapy for Persistent Low Back Pain: When, Where, Why?
This Health Alert is intended for readers interested in learning about the prevention, diagnosis, and management of back pain.
Injection therapy is a fairly conservative alternative for the treatment of nagging low back pain. Injections may be given for low back pain that is subacute (lasting longer than one month) or chronic (lasting for three months or more). The shots typically contain a combination of an anesthetic (to numb pain) and a corticosteroid (to reduce inflammation).
The site of the injection in the spine varies depending on the suspected source of the pain. Your healthcare provider may use fluoroscopy (a type of x-ray movie in real time) or a CT scanner to help direct the needle to the correct location in the spinal column. Common injection sites are the:
- Epidural space. An epidural injection with a corticosteroid is one of the most commonly used injection techniques. With this method, the steroid is injected directly into the epidural space (the area between the protective membrane of the spinal cord and the inner wall of the vertebrae).
- Facet joint. Medication is injected into facet joints if they are suspected of being inflamed. These joints, located between vertebrae, enable the spine to bend and twist. Facet joint injections are also used as diagnostic tools to help identify the exact location of back pain.
- Nerve root. Nerve roots emerge from the spinal column between vertebrae. Medication is injected over the area of the nerve thought to be inflamed.
- Trigger point. Trigger points are locations where touch or pressure elicits pain at specific areas in a muscle. Medication is then injected into these tender spots.
Injection therapy is not suitable if you are susceptible to excessive bleeding or are taking anticoagulants (drugs that reduce the formation of blood clots). In addition, people experiencing pain due to infection or certain forms of cancer should not receive injections with steroids, since these drugs can weaken the immune system.
So, do they work? Most studies show that injection therapy is no more effective than placebo for subacute or chronic back pain. For some people, however, treatment can provide short-term pain relief. This temporary effect may be sufficient to enable you to take part in a physical therapy or exercise program, which can help alleviate the stress and strain on your back and get you back on your feet once again.
Posted in Back Pain on September 3, 2010
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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