Patients often have severe pain that has not responded well to conservative care. Rest, ice, physical therapy, and over the counter medications may not solve the pain problem. When the regular treatments are not working, sometimes it is appropriate to have a specific injection to treat pain. Most injections are used to decrease inflammation that is causing pain from a specific location, such as a joint, tendon, nerve or the spine. The most common medication injected is a corticosteroid, a type of steroid used to decrease inflammation.
The most common steroids used are:
How Pain Works
Pain is expressed as sensory signals from a structure that is generating unpleasant signals. The signals travel from a remote location in the periphery of the body, travel by the nerves to the spine, then travel up the cord to the brain to be deciphered. Unfortunately, the brain sometimes cannot identify the exact location that is generating the signals. Injections are recommended by many different physicians to control pain, but since pain is often very complex, determining what should be injected and where to inject it can prove problematic. A good patient history, physical exam, and sometimes, special studies including MRI scans are helpful to identify the possible sources of the pain signals. If the source is possibly acute inflammation and irritation of a structure, placing a steroid injection in the area may allow the structure to return to normal and alleviate pain.
The structures that receive injection include the space around the spine and spinal nerves – the epidural space – joints, areas around nerves, tendons, ligaments, bursa, and muscles. Any of these areas can become inflamed. If they are not healing with conservative care, then placing corticosteroid in the area can allow the inflammation to resolve. Once the inflammation is improved the structures need to be strengthened so that the problem does not return. Sometimes the procedure needs to be repeated to further decrease damage. At other times, multiple structures are inflamed and multiple structures need to be treated.
The key to successful injections includes having someone to determine what is wrong and the structures that need to be treated. Having a skilled clinician perform the injections is important. A physician who has been trained in interventions is also beneficial. The treating physician may be an expert in one of many specialties, but most commonly they are trained in Anesthesia, Physical Medicine or Radiology. An experienced specialist will be able to performed the injection comfortably and effectively. Consult a Physical Medicine pain specialist to develop a comprehensive treatment plan if your symptoms are not resolving.
Thomas Cohn, MD
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