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Injections for chronic back pain

This factsheet is for people who are having an injection for chronic back pain (back pain that lasts over three months), or who would like information about it.

Injections are used to deliver a combination of local anaesthetic and steroid into or near your spine to ease chronic back pain. Sometimes they are 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 is described here as it will be designed to meet your individual needs.

About injections for chronic back pain

Injections into or near your spine help deliver pain-reducing medicines directly to the source of pain and can ease chronic back pain or sciatica (shooting pain down one or both of your legs). The effects of a successful injection can vary but may last up to three months.

There are two medicines used in injections for chronic back pain. 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 injection techniques available for chronic back pain.

  • Epidural injection. This targets the space that surrounds your spinal cord.
  • Nerve root block injection (also known as transforaminal epidural injection). This targets individual nerves in your spine.
  • Intra-articular facet or sacroiliac joint injection. These target 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 your 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 is based on your specific symptoms and the reason for having the injection.

Illustration showing spine section

What are the alternatives?

Other pain-relieving therapies can help to ease back pain, such as pain-relieving medicines, exercise, manual therapy (including spinal manipulation) and acupuncture. Improving your understanding of back pain and the ways you can manage your pain through education programmes can be helpful. Yoga and relaxation may also help ease back pain. There isn’t enough evidence to say whether TENS (transcutaneous electrical nerve stimulation) is effective at reducing chronic back pain.

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 an 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. This relieves anxiety and helps you to relax.

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

If you’re a woman of child bearing age, you must tell your doctor if you could be pregnant. X-rays are usually used during the procedure. They are safe for adults, but may harm your developing baby. If you’re pregnant, your doctor will talk about alternatives to the procedure.

Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during an injection for chronic back pain?

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

Usually you will lie on your abdomen (tummy), but 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 and 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 and/or feeling for specific bones in your spine. He or she will clean the injection site with a sterile antiseptic wipe and inject the local anaesthetic so that you don'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, as 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 (he or she will inject a special dye containing iodine that shows up on X-rays) before injecting 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.

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. You will 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 have had a sedative during the procedure.

Your nurse will give you some advice about caring for your back. You will be given a date for a follow-up appointment.

Recovering from an injection for chronic back pain

Sedatives temporarily affect your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your doctor's advice.

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 injections aren’t a cure for back pain and it's the physical therapy that will help improve your medical condition in the long-term.

What are the risks?

As with every procedure, there are some risks associated with injections for chronic back pain. We have 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.

  • Loss of leg strength, muscle spasms and inability to pass urine.
  • 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.
  • Feeling weak, dizzy or faint. The steroids can cause a drop in blood pressure.
  • Swelling of your hands and feet. The steroids can cause fluid retention.

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.
  • Infection. 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.
  • Allergic reaction, such as a rash or itching.

 

Produced by Rebecca Canvin, Bupa Health Information Team, July 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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