Injection Information

Injections performed in our office

There are two major classes of injections used for non-surgical interventional pain management, those that are performed in our office setting, and those injections that are referred outside of our office.  This handout describes the epidural injections performed at Connecticut Neck and Back Specialists’ office that are used to treat pain in and around the spine.

All non-operative injections are used to treat pain in combination with medication and physical therapy. They can also be used for diagnostic reasons to validate findings on history, physical exam, and imaging or to localize and define a pain generator. Injection techniques may help control pain from degenerative disc disease, injury, osteoarthritis, and nerve compression.

Trigger Point Injection:

These injections are given in an office setting. They are usually a mixture of low dose steroid and anesthetic. These injections are placed into the muscles surrounding the painful areas to help break up painful muscle spasms.

Sacroiliac Joint Injection:

The sacroiliac joint is the large joint that connects your ilium (pelvic bone) to the spine. It is located in the pelvis just above the tailbone. Inflammation and contracture of the sacroiliac joint can cause low back and buttock pain. An injection of an anesthetic and steroid into this joint may help relieve pain.

Lumbar Facet Joint Injection and Medial Branch Block:

Joint inflammation between the moving joints of the vertebrae can cause back pain. The facet joints are the small paired joints in the back of the spinal column that connect one vertebra to the next. Standing or extension of your back can put loading stress on these joints, leading to pain. A facet joint block is an injection of local anesthetic and steroid medication into the joint. A medial branch block uses similar medication injected outside the joint space near the nerve that feeds that particular facet joint. If relief is found with facet injections or medial branch blocks but it is not long lasting, a radiofrequency ablation may be considered.

 

Radiofrequency Nerve Denervation/Ablation (RFD):

Facet joints are small paired joints that connect one vertebra to the next, and degeneration of one or more of these joints may give rise to the neck or low back pain. Radiofrequency nerve ablation uses radio waves to produce heat directed at a specific facet joint nerve. The heat destroys the nerve and can relieve pain on a sustained basis.  This procedure is performed outside of the CTNB office.

What to Expect During the Procedure

  • The procedure is performed in a sterile setting similar to an operating room.
  • The injection site is sterilized and draped. Skin numbing medication is injected into and around the procedure site.
  • Fluoroscopic guidance is used during the procedure to guide the needle into the proper position.
  • After the needle is placed, an anesthetic and steroid are injected.

After the Procedure

  • The patient is taken to the recovery area where the medical staff will continue to monitor you.
  • You will be released to go home with verbal instructions.

The anesthetic will provide relief for the first 2-6 hours. This will wear off and the beneficial effects of the steroids usually require 2-3 days to take hold, but may take as long 7-14 days. Keep track of how long relief lasts, and report it to your physician on your follow up appointment.

Patient Preparation

It is important to follow all pre-test instructions. These instructions generally include:

  • Stop blood thinning medication 5 days prior to the test.*
  • Stop anti-inflammatory medication 2 days prior to the test.
  • Some injection facilities may require that you arrange for someone to provide transportation home.

*If you are taking blood thinning medications such as aspirin, Coumadin, Warfarin, Lovenox, Plavix, Brilinta, Xarelto, Pradaxa, and Eliquis, you may be asked to stop taking these medications 3-5 days prior to your procedure. Contact your doctor who prescribed this medication first to make certain that you may safely stop these medications. If you cannot stop these medications, please notify our office.


Injections performed outside our office

There are two major classes of injections used for non-surgical interventional pain management, those that are performed in our office setting, and those injections that are referred outside of Connecticut Neck and Back Specialists’ office to be performed by a pain management physician specialist.  This handout describes the injections performed outside of the Connecticut Neck and Back Specialists’ office that are used to treat pain in and around the spine.

All non-operative injections are used to treat pain in combination with medication and physical therapy. They can also be used for diagnostic reasons to validate findings on history, physical exam, and imaging. Injection techniques may help control pain from degenerative disc disease, injury, osteoarthritis, and nerve compression.

Epidural Steroid Injection (ESI):

The word epidural refers to the space surrounding the membrane (dura) that covers the spinal cord and nerve roots. Disorders such as spinal stenosis and a herniated disc can cause nerve irritation, inflammation, and pain. An epidural injection places anti-inflammatory and anesthetic medication into the epidural space. Epidural injections are performed in the cervical, thoracic and lumbar spine. By administering the epidural injection in a specific location, the patients’ response may be diagnostic as well as therapeutic. The benefit of an epidural injection usually occurs within 7-10 days of the injection. A local anesthetic is also given and there may be diagnostic pain relief for 2-6 hours. Up to 3 injections over a span of weeks to months may provide more profound relief. Dural puncture with associated headache is the most common complication of epidural steroid injections and occurs only 5% of the time. This can easily be treated with the administration of a blood patch.

Epidural Injections can be given via 2 different techniques:

Selective Nerve Root Block (SNRB) or Transforaminal Nerve Block:

This kind of injection targets a specific nerve. Pain and discomfort from a pinched nerve in the neck or lower back may be relieved by an SNRB or a transformational injection. The injection is also diagnostic to help your surgeon localize where your pain comes from within the spinal column.

Interlaminar:

These injections are given in the midline of the spine. It is placed in the epidural space between 2 vertebral segments. Interlaminar injections have many roles. They are typically used for central or multilevel spinal stenosis as they can target many nerves over one. Also, in some instances, the approach to a transforaminal injection may be deemed unsafe and an interlaminar injection might be a safer option.

 

Cervical and Thoracic Facet Joint Injection and Medial Branch Blocks:

Joint inflammation between the moving joints of the vertebrae can cause neck and back pain. The facet joints are the small paired joints in the back of the spinal column that connect one vertebra to the next. Standing or extension of your neck or back can put loading stress on these joints, leading to pain. A facet joint block is an injection of local anesthetic and steroid medication into the joint. A medial branch block uses similar medication injected outside the joint space near the nerve that feeds that particular facet joint. If relief is found with facet injections or medial branch blocks but it is not long lasting, a radiofrequency ablation may be considered.

Radiofrequency Nerve Denervation/Ablation (RFD):

Facet joints are small paired joints that connect one vertebra to the next, and degeneration of one or more of these joints may give rise to the neck or low back pain. Radiofrequency nerve ablation uses radio waves to produce heat directed at a specific facet joint nerve. The heat destroys the nerve and can relieve pain on a sustained basis.

What to Expect During the Procedure

  • The procedure is performed in a sterile setting similar to an operating room.
  • The injection site is sterilized and draped. Skin numbing medication is injected into and around the procedure site.
  • Fluoroscopic guidance is used during the procedure to guide the needle into the proper position.
  • After the needle is placed, an anesthetic and steroid are injected.

After the Procedure

  • The patient is taken to the recovery area where the medical staff will continue to monitor you.
  • You will be released to go home with verbal instructions.

The beneficial effects of the steroids usually require 2-3 days to take hold, but may take as long 7-14 days. Keep track of how long relief lasts, and report it to your physician on your follow up appointment.

Patient Preparation

It is important to follow all pre-test instructions. Please ensure you have proper instructions from your provider. These instructions generally include:

  • Stop blood thinning medication 5 days prior to the test.*
  • Stop anti-inflammatory medication 2 days prior to the test.
  • Some injection facilities may require that you arrange for someone to provide transportation home.

*If you are taking blood thinning medications such as aspirin, Coumadin, Warfarin, Lovenox, Plavix, Brilinta, Xarelto and Pradaxa, Eliquis, you may be asked to stop taking these medications 3-5 days prior to your procedure. Contact your doctor who prescribed this medication first to make certain that you may safely stop these medications. If you cannot stop these medications, please notify your treating physician.