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Injections for chronic back pain

If you have chronic back pain, it means that you’ve had the pain for over three months. Injections are used to deliver a combination of local anaesthetic and steroid into or near your spine to help ease chronic back pain. Sometimes they’re used to help identify the source of back pain by blocking pain in certain areas.

You will meet the doctor carrying out your procedure to discuss your care. It may differ from what we’ve described here as it will be designed to meet your own needs.

Injections into or near your spine deliver pain-relieving medicines directly to the source of your pain. They can help ease chronic back pain or sciatica (shooting pain down one or both of your legs). How long an injection will help ease your pain for can vary. But it may last up to three months.

There are two medicines used in injections for chronic back pain. A local anaesthetic is used to block pain from the injected area. Steroids are used to reduce swelling and irritation (inflammation) in the injected area.

There are four main injection techniques available for chronic back pain.

  • Epidural injection. This targets the space that surrounds your spinal cord and can be used to help with disc-related pain.
  • Nerve root block injection (also known as transforaminal epidural injection). This targets individual nerves in your spine.
  • Intra-articular facet or sacroiliac joint injection. This targets the joints that link the bones of your spine.
  • Medial branch block injection. This procedure is used to diagnose your back pain. It targets the nerve supply to the facet joint in your spine.

Epidural injections and nerve root block injections help ease sciatic pain so you can progress with physiotherapy or other rehabilitation. The evidence for these treatments and intra-articular facet joint injections is varied and they may not always help. Speak to your doctor for more information.

Medial branch block or sacroiliac joint injections help to identify the source of the pain so that your doctor can plan appropriate treatment.

The type of injection you have will depend on your specific symptoms and the reason for having the injection.

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Details

  • Preparation Preparing for an injection for chronic back pain

    An injection is usually done as a day-case procedure by a doctor who specialises in pain management. You will usually have your injection under local anaesthesia. This completely blocks pain from the injected area and you will stay awake during the procedure. Your doctor may offer you a sedative to relieve any anxiety and help you relax.

    You should tell your doctor about any health conditions you have, such as diabetes or bleeding disorders. You also need to tell your doctor about any medicines you’re taking, such as aspirin, clopidogrel, dabigatran or warfarin. You may be asked to stop taking certain blood thinning medicines for several days before the procedure.

    You must tell your doctor if you could be pregnant. This is because X-rays are used during the procedure, which may harm your unborn baby. If you’re pregnant, your doctor will talk to you about alternative options because injections won’t be suitable.

    Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. If you’re unsure about anything, ask. No question is too small. Being fully informed will help you feel more at ease. You’ll need to give your consent for the procedure to go ahead by signing a consent form.

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  • Alternatives What are the alternatives to injection for chronic back pain?

    It’s important to remember that simpler pain-relieving therapies can help to ease back pain too. Examples include pain-relieving medicines, exercise, manual therapy (including spinal manipulation) and acupuncture. It’s a good idea to try some of these less-invasive therapies before opting for injections.

    Yoga and relaxation may also help ease back pain. There isn’t much proof to say whether TENS (transcutaneous electrical nerve stimulation) can help reduce chronic back pain. However, some people find it works for them. Chat to your doctor about TENS if you’re considering trying it.

    Understanding more about back pain and the ways you can manage it can be helpful. The more informed you are about your treatment and management options, the better position you’re in to make a decision that’s right for you.

  • The procedure What happens during an injection for chronic back pain?

    The procedure usually takes between 20 to 40 minutes, and you may be asked to wear a gown.

    Your doctor will tell you what position to sit or lie in. For example, you may be asked to lie on your side with your knees drawn up and chin tucked in. This position helps to open up the space between the bones in your back.

    If you’re having a sedative, your doctor will inject it into a vein in the back of your hand.

    A machine called a fluoroscope is usually positioned close to the area being injected. This shows real-time X-ray images during the procedure. Your doctor will use this to guide the needle into the correct place.

    Your doctor will carefully select a point to inject by using X-rays. He or she will clean the injection site with a sterile antiseptic wipe and inject a local anaesthetic. This means you won't feel the injection needle going into your back.

    Your doctor will carefully insert a thin, hollow needle into your back. You won't feel the needle going in, but once it has reached your spine, you may feel some discomfort. While the needle is being inserted, it's important that you don't move because any movement makes positioning the needle more difficult. You must tell your doctor if you feel any pain or discomfort as this may indicate that the needle is going into the wrong area.

    Your doctor will check the needle is correctly positioned by injecting a special dye containing iodine that shows up on X-rays. They will then inject the local anaesthetic and steroids into your spine.

    Afterwards, he or she will take the needle out and cover the injection site with a plaster.

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  • Aftercare What to expect afterwards?

    Your legs may feel numb or tingly, but this will pass quickly. Your blood pressure will be monitored for about 30 minutes after you’ve had the injection and you’ll be able to go home when you feel ready.

    You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours, especially if you’ve had a sedative during the procedure.

    Your nurse will give you some advice about looking after yourself when you get home and you’ll be given a date for a follow-up appointment.

  • Recovery Recovering from an injection for chronic back pain

    Sedatives temporarily affect your co-ordination and reasoning skills, so don’t drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards.

    The local anaesthetic will keep you pain-free for a while, but it's best to take things easy for the first 24 hours. After this, your back may start to feel sore again because the steroids take a few days to work. Your back pain or sciatica should start to improve within a few days of your injection.

    You should be able to start physiotherapy within a week of your injection. It's important to remember that injections aren’t a cure for back pain. It's the physical therapy that will help improve your medical condition in the long-term.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with injections for chronic back pain. We’ve not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. There are a number of possible side-effects of an injection for chronic back pain, including those listed below.

    • Pain and tenderness in your back or leg. This usually gets worse before it improves.
    • High blood sugar levels. If you have diabetes, you will be carefully monitored after the injection, but you must also keep checking your sugar levels when you get home.
    • Loss of leg strength, muscle spasms and having difficulty passing urine.

    More unusual side-effects include feeling weak, dizzy or faint, and swelling of your hands and feet.

    Complications

    Complications are when problems occur during or after the procedure.

    Complications of an injection for chronic back pain are rare but can be very serious. Possible complications are listed below.

    • Severe headaches. The needle punctures a hole in the membrane covering your spinal cord, which can cause spinal fluid to leak causing headaches that last for up to a week.
    • Bleeding. The needle can cut a blood vessel.
    • An infection. A bacterial infection in your spine can be very serious and will need intense antibiotic treatment.
    • Loss of feeling. Inflammation or nerve damage can cause loss of feeling for up to three months.
    • An allergic reaction, such as a rash or itching.
  • Pros and cons Pros and cons

    This information is intended to help you understand the advantages and disadvantages of having injections for chronic back pain. Think about how important each particular issue is to you. You and your doctor can work together to make a decision that's right for you. Your decision will be based on your doctor’s expert opinion and your personal values and preferences.

    Pros

    • The treatment is relatively quick. It takes 20 to 40 minutes, and is usually carried out as a day-case procedure, so you won’t need an overnight stay in hospital.
    • The steroids that are injected into your back can help reduce the swelling and inflammation, and therefore any pain or discomfort you have.
    • Although an injection for chronic back pain isn't a lasting cure, it can ease your pain. Being more comfortable will help make it easier for you to have physiotherapy or do other forms of exercise and physical therapy.

    Cons

    • Having an injection won't completely cure you of chronic back pain. You may need to have a further injections or other treatments.
    • It may feel uncomfortable having a needle injected into your back.
    • After you've had the treatment, the steroids may take a few days to work and your back may still feel sore.
    • Although rare, there are risks and complications of having injections for chronic back pain.
  • FAQs FAQs

    Can I have another injection if my back pain returns?

    Answer

    Depending on the specific cause of your of back pain and the type of injection you have, it may be possible to have a repeat injection.

    Explanation

    The benefits of an injection can last up to three months. Repeat injections into your facet joint or nerve root aren't usually recommended because of the risk of causing further irritation or damage. Sometimes, it may be possible to provide more long-term pain relief using radiofrequency treatment, where nerves signalling pain are exposed to heat.

    You may be able to have another injection if the effects of the injection wear off. For example, you may find it impossible to do gentle exercises, which are an important part of managing back pain.

    You doctor will be able to talk to you about your options before you decide you go ahead with further injections. It may be that you want to try an alternative therapy first, which has fewer risks associated with it.

    What kind of exercise can I do to help my back after an injection for chronic back pain?

    Answer

    It's best to take it easy and start with gentle exercise, such as walking or swimming, to help reduce stiffness and discomfort in your back.

    Explanation

    An injection isn't a cure for back pain. The aim of the injection is usually to give you a pain-free 'window' to have physical therapies. Take it easy for the first few days after having an injection but aim to start a gentle exercise programme within a week of having your injection.

    Start by doing gentle walking or swimming, and make sure you follow your programme of stretches and exercises given to you by your physiotherapist. These will improve the strength of your back and stomach muscles.

    Why might injections for chronic back pain affect my blood sugar levels?

    Answer

    The injection itself has no effect on your blood sugar levels. It's the steroids in the injection that cause your blood sugar levels to rise.

    Explanation

    Steroid medicines (corticosteroids) reduce inflammation and are used to ease back pain. But they also affect the balance of water and salts in your body. So the side-effects of having steroids include swelling in your hands, feet or joints (caused by fluid retention), and high blood sugar levels.

    The rise in blood sugar levels becomes a problem if you have Type 1 diabetes. This is a condition where your body can't control the amount of sugar (glucose) in your blood because it can't produce the hormone, insulin. If you have diabetes, it’s important to tell your doctor before having an injection for chronic back pain.

    Also, keep a close check on your blood sugar levels after having an injection for chronic back pain and make sure that you drink plenty of water and eat properly. You must contact your doctor if your blood sugar levels remain high.

    For more information about the effects of steroids on blood sugar levels, ask your doctor.

  • Resources Resources

    Further information

    Sources

    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd edition. Oxford: Oxford University Press; 2010: 484–48
    • MacAuley D. Oxford handbook of sport and exercise medicine. 2nd edition. Oxford: Oxford University Press; 2012: 434
    • Early management of persistent non-specific low back pain. National Institute for Health and Care Excellence (NICE), May 2009. www.nice.org.uk
    • European guidelines for the management of chronic nonspecific low back pain. European Commission, Research Directorate General. www.backpaineurope.org, published 2004
    • Discogenic low back pain. BMJ Best Practice. www.bestpractice.bmj.com, published 14 January 2014
    • Benyamin RM, Manchikanti L, Parr AT, et al. The effectiveness of lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain. Pain Physician 2012; 15:E363–404
    • Cortiocosteroid injections of joints and soft tissues. Medscape. www.emedicine.medscape.com, published 24 June 2013
    • Epidural steroid injections. Know Your Back. www.knowyourback.org, published 17 July 2009
    • Personal communication. Dudley Bush, Consultant Anaesthetist, Spire Leeds Hospital, 25 July 2014
    • Epidural steroids cause blood glucose spike in patients with DM. Medscape. www.medscape.com, published April 2011
    • Steroids & diabetes. National Diabetes Service Scheme. www.ndss.com.au, published August 2009
    • Therapeutic injections for pain management. Medscape. www.emedicine.medscape.com, published 7 June 2013
    • TENS pain relief for back pain. Backcare. www.backcare.org.uk, published 2010
    • Physical activity and exercise. Backcare. www.backcare.org.uk, published 2010
    • Epidural steroid injections. Medscape. www.emedicine.medscape.com, published 29 July 2013
    • You and your anaesthetic. Royal College of Anaesthetists. www.rcoa.ac.uk, published May 2008
  • Related information Related information

  • Author information Author information

    Reviewed by Alice Rossiter, Bupa Health Information Team, August 2014.

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