Spinal Injections For Back Pain
'Are They Worth The Risk?'
Many people view spinal injections for back pain as an ‘easy fix’ – a quick jab in the spine and the pain goes away. Unfortunately, the truth is far from this. The effects are typically short-term only and the risks can be substantial, so it pays to understand what you are doing before you make the decision.
When considering if you want a spinal injection for back pain, it is essential to know your epidural from your facet joint injection, and your Cortisone from your Lidocaine. Spinal injections are not without risk, but can also provide vital relief for some patients.
In this article, I will aim to go through the various types of injection and the pros and cons for you, to help with any future decision…
By Definition –
Spinal Injections for back pain consist generally of injections of steroids with or without or anaesthetic directly into, or immediately around your spine. They can provide very effective pain control for a short period of time, although they are certainly not a fix-all for pain relief.
What Is A Spinal Injection For Back Pain?
A spinal injection is literally an injection into or directly around the vertebrae that comprise your spine. Vertebrae are the main tubular bones that protect your spinal cord and the various nerves that need to travel up and down your body in safety.
In between your vertebrae, you’ll find what are known as intervertebral discs and facet joints. The discs are your spines ‘shock absorbers’, featuring between each of your vertebrae, while the facet joints connect your vertebrae together.
For a whole range of reasons, some perfectly harmless and others much more ominous, you can start to feel back pain. This may be short term or more continuous.
Typically, spinal injections for back pain are most likely to be considered if your back pain is crippling but with an obvious reason and likely to be short term. Pregnancy is an example of this, where an epidural injection with anaesthetic may be given to numb the pain.
Alternatively, if you suffer with chronic back pain (ie for more than 3 months), then various types of steroid injection may be administered. This can be done for a number reasons – including to help with your rehabilitation from an injury by removing back pain for a short period or simply as pain relief, although the risks of such injections may make the benefits less worthwhile.
Types Of Spinal Injection.
There are four basic types of injection –
– Epidural Injection.
This is any injection that targets the space around your spinal cord. These are the most common type for pregnant women with severe back pain.
– Nerve Root Injection.
This type of injection is designed to target specific nerves in your spine and block their messages of pain to your brain.
– Sacroiliac/ Facet Joint Injection.
Perhaps not surprisingly, these are injections given straight to the facet joints between your spinal vertebrae.
– Lumber Discogram (sometimes referred to as a ‘discography’).
This type of injection is delivered direct to the intervertebral discs that act as shock absorbers in your spine.
A ‘discography’ is actually only used for diagnostic purposes – to try and ascertain when the discs are that are causing you back pain.
Lumber discogram injections involve inserting a sterile liquid that puts pressure on the discs to induce pain where they are damaged, so that other treatments can be administered. To watch a short video on the procedure, please click here
What Will You Be Injected With?
Spinal injections for back pain consist of two basic components –
Commonly used steroids for back pain include hydrocortisone (pronounced ‘hi-dro-cor-tee-zone’), triamcinolone (pronounced ‘try-am-sin-o-lone’) or methylprednisolone (pronounced ‘meth-al-pred-niss-o-lone’).
These steroids are actually designed to reduce inflammation and swelling in your spine.
It is well accepted that the inflammation makes up a significant part of the pain you are feeling, so by reducing this swelling, you greatly reduce the discomfort felt.
In the case of nerve root (or ‘nerve-blocking’) injections, then the idea is to cut off your nerves signal to the brain altogether, again ending of discomfort of back pain.
Steroid injections are an artificial replacement for naturally occurring chemicals in the body – they are NOT the anabolic steroids you might associate with building artificially large muscles in the gym.
The most common anaesthetics used today are Lidocaine or Bupivacaine.
Anaesthetics are typically offered, because steroids can take up to a day or even longer to start reducing your pain levels. With an anaesthetic, you could be feeling the benefit in a matter of hours, or even faster.
Depending on your levels of pain, the type of injection you are having and the likely reason for your pain in the first place, doctors will decide whether to give you either –
A) A straightforward steroid injection (with no anaesthetic) or
B) A Combination of steroid and anaethsthetic to give you the longer term 3 month slow release of the steroid, combined with the faster release, but much shorter working period (typically around 7 days) of the anaesthetic.
In some cases, the anaesthetic will actually mostly be given to help with the pain of having a spinal injection, otherwise you may experience your pain getting worse, before it gets better.
This is because jabbing a needle into an area of great pain with a substance that may take two days before it starts to work can cause considerable pain in the meantime.
In certain circumstances, for even faster pain relief, doctors may use high-strength opioids such as morphine instead of Lidocaine or Bupivacaine. This can provide even faster pain relief to the area.
Fluoroscopy Guided Spinal Injections.
One of the options open to your clinician is to have your spinal injection guided with the use of x-ray.
In such a case, a radiologist will maneuver the needle into the pinpoint area of the spine required using a rolling x-ray and will then inject a substance known as ‘contrast’ to highlight the needle’s position in relation to your spine.
Once the perfect position is attained, then the injection of anaesthetic and steroid can be administered.
The big advantage of a fluoroscopy guided spinal injection is that it largely takes away the risk of missing the target, something that is estimated to occur in up to 30% of non-guided injections.
How Long Do Spinal Injections Last?
In general, they aim to be effective for up to 3 months at a time, although pain is highly subjective and so this will vary from person to person.
What Are The Risks With Spinal Injections In The Back?
One of the leading hospitals in England, Guys and St Thomas NHS, put the risk of infection from spinal injections at 1 in 100.
However, there are a number of points to be made with that – firstly some hospitals are likely to be considerably worse depending on their standards and cleanliness. Secondly, if you think that some people might have 5 or 6 injections over 3 years, that brings the odds down for them of getting an injection to 1 in 20.
Spinal Nerve Injury.
Again it is estimated that around 1 in 100 people are likely to be effected. Spinal injury can happen for many reasons. I can declare a personal interest here because my wife actually sustained a permanent back injury when an epidural administered while giving birth went wrong.
It is likely that the injection point of the needle damaged another nerve in her spine and that has caused her permanent low-level back pain.
Any procedure that involves sticking a sharp needle in to a mass of nerves, tendons and spinal cord has the chance of going wrong.
As with any injection, there is always the chance of substantial bleeding. This is particularly true if you are an anti-coagulant or any other medication that might thin your blood.
If the inserted needle accidently catches your spinal cord, it is likely to lead to a leakage of spinal fluid. While the body is great at repairing itself, and will do again here over a period of 7 days or more, you find yourself with a dull, throbbing headache in the meantime.
As with any medicine or indeed any foreign chemical introduced into your body, there is always a small chance that you will suffer an allergic reaction.
This is unlikely and should reveal itself almost immediately – which is handy because it means help is normally still at hand. If not, you just go straight back to the hospital for immediate treatment.
Increased Pain Around The Site Of Your Injection.
This is especially likely if you don’t have a combination of steroid and anaesthetic. As mentioned earlier, if you are stabbing an area that is already very painful, then it is likely that at least in the short term, you may make it worse.
Effects Of The Steroid.
There are a host of minor side effects associated with taking steroids, however you take them (by tablet or injection). These include sickness, diarrhoea, blood sugar surges, hot flushes, nausea and weak muscles.
Benefits Of Spinal Injections
In comparison to traditional pain medications, spinal injections are made directly to the affected area and can therefore deliver a much more concentrated dose of painkiller.
This nonsurgical therapy can therefore represent a more effective option if you suffer persistent back pain that other treatments haven’t been able to treat.
The benefits of achieving pain relief are then the increased range of mobility, better quality of life and better posture. The better posture may even mean that you reduce other pains such as sore ankles, knees or hips that may actually be caused by a bad back that has been affecting your walking style etc.
Can Anyone Have A Spinal Injection?
No. Ultimately, your suitability for spinal injections in the back will be decided by your doctor. They will be looking for certain ‘red flags’ that would indicate an area of concern that may be enough to rule you out for steroid injections.
These include –
- A previous allergy to steroids or local anaesthetic
- A skin infection at or near the likely site of insertion by the needle.
- An already present ‘systemic infection’ such as a chest infection.
- Poor control from yourself of a current medical condition such as high blood pressure or diabetes
- A bleeding disorder (EDLS) or if you are already taking medicines to thin your blood (DOACs or NSAIDs etc).
Are There Any Alternatives?
Absolutely! We have considered 33 other potential options for ‘How To Treat Lower Back Pain’, the most popular being hot/ cold therapy and use of a TENS (Transcutaneous Electrical Nerve Stimulation) machine.
The Final Word –
Spinal injections offer a very realistic alternative for chronic or extreme pain sufferers. They are however not without considerable risk.
On the one hand, the pain relief that they offer can be both almost instant and last for up to three months. They also offer a potential alternative to spinal surgery.
It is certainly fair to say that they are frequently tried before any form of back surgery.
However, as we covered above, spinal injections for back pain also carry significant risks. As well as the potential side effects of taking any form of steroid, there are a whole host of risks associated with having injections in your spine.
One of these can be avoided if you have a fluoroscopy guided injection, where x-ray is used to locate the exact site for the needle to be inserted.
Even with this however, there are still plenty of risks and with a timeframe of only up to three months’ relief, and a limit to the number of injections you can safely have in any one year.
As a result, many other treatments for back pain such as treatment with a TENS machine, physiotherapy or massage are recommended substantially ahead of spinal injections.
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