Good Monday! And thank you for stopping by to read the latest post in the Relief Options for Chronic Pain series! This week’s information is familiar to me because I have had most of the injections discussed here, along with a Spinal Cord Stimulator implant. So, as I write I’ll be inputting my experience with each option of pain relief in italics.
Let’s start with the injections recommended by doctors as being an option to opioid use. These are the injections most prescribed for chronic lower back pain as well as other chronic pain:
Epidural Steroid Injections
(Selective) Nerve Root Blocks (SNRB)
Facet Joint Block
RFA (Radiofrequency Ablation)
Sacroiliac Joint Block
Sacroiliac Joint Fusion (SI Fusion)
Trigger Point Injection
Extensions of these injections are listed, but these injections appear to be the ‘primary’ injections selected.
Epidural Steroid Injections (ESI):
These injections are prescribed as relief for chronic lower back pain and are injected into the lumbar section of the spine. However, Epidural Steroid Injections injected into the cervical (neck) and thoracic (mid-spine) areas of the spine are common. The consensus from most pain physicians is ESIs offer temporary relief spanning from one week to one year. And those patients reporting long-term relief are less credible.
(I was given this injection while living in Mt. Pleasant, SC thirteen years ago. Due to the extreme lower back chronic pain I agreed to the injection with the hope it would alleviate the pain, and it did – for one year. Coupled with the injection I saw a physical therapist for six months but eventually, the pain returned.)
The use of fluoroscopy or X-ray assists the physician with placing the medication in the pain and inflamed area. This helps the physician to inject the medicine in the area the patient feels the most pain. (A word of warning – be sure to seek a professional with considerable experience directing injections with fluoroscopy for careful placement.) This act makes an ESI a more desirable injection compared to oral pain medications which have a less-focused contact. An ESI helps control inflammation (it has been determined chemical inflammation produces pain) and flushes out chemicals and inflammatory proteins from the area. ESIs are performed up to three times per year and usually given in sets of three. More detailed information regarding ESIs can be found here.
Selective Nerve Root Block (SNRB):
Used to diagnose the source of Nerve Root Pain and provide relief of low back or leg pain, a Selective Nerve Root Block (SNRB) is a good choice for the patient. A compressed or inflamed nerve root will produce back or leg pain. Because an MRI doesn’t show which nerve causes the pain, an SNRB assists in isolating the pain source. This may be used a treatment for pain management of a far lateral disc herniation (when a disc ruptures outside the spinal canal)
The nerve is approached where it exits the foramen (the hole between the vertebral bodies) with an injection of steroid (relieves inflammation) and lidocaine (numbing agent.) Fluoroscopy, which is a live x-ray, assists the physician in finding the specific area of pain. If the patient reports no pain, then it is surmised the injected nerve root was the source of pain.
Success depends upon whether the injection was administered to alleviate pain from a primary diagnosis or if the injection’s purpose is to confirm a diagnosis. SNRBs are limited to three times a year. (Again, because of the difficulty of administering SNRBs, seek an experienced professional.)
Facet Joint Block (FJB):
Paired joints, or facet joints, have side by side surfaces of cartilage (the tissue that cushions between the bones) and a surrounding capsule: an illustration from Google search
Degeneration of cartilage with aging and injuries of twisting (dancing?) may cause damage to either one or both facet joints. A Facet Joint Block can alleviate the pain and/or confirm the specific source of back pain for patients. FJBs are like SNRBs and should be administered by an experienced physician.
Used for pain treatment and management, nerve blocks are injections of medication into specific areas of the body. Various problems need diverse types of nerve blocks including:
- Therapeutic nerve blocks used to treat painful conditions.
- Diagnostic nerve blocks used to determine pain sources.
- Prognostic nerve blocks predict the outcomes of given treatments.
- Pain from other procedures may be avoided by preemptive nerve blocks.
- Nerve blocks can be used to avoid surgery.
Note, however, if your pain isn’t related to pain in a single or group of nerves, nerve blocks may not work for you. Your physician will advise which nerve block is beneficial for relieving your pain.
Radiofrequency Neurotomy for Facet and Sacroiliac Joint Pain
Radiofrequency Neurotomy (RFN) treats facet or sacroiliac joint pain which may result from an injury or deteriorating problems like arthritis. The goal of interrupting pain signals to the brain is using a heat lesion on specific nerves to alleviate pain. RFA and RFN, used reciprocally, refer to a procedure that ruins the performance of the nerve using radiofrequency energy.
There are two primary types of radiofrequency ablation (RFA) 1- A medial branch neurotomy (ablation) affects the nerves carrying pain from the facet joints and 2- A lateral branch neurotomy (ablation) affects nerves that carry pain from the sacroiliac joints.
Prior to the RFA a lateral branch or medial branch nerve block is usually performed to prove the patient’s pain is transmitted by those nerves. Additional injections including sacroiliac joint injection or facet joint injection along with other treatments may be requested prior to the RFA.
Facet Rhizotomy and Sacroiliac Joint Block Injections:
A Facet Rhizotomy injection is recommended if the patient has experienced satisfactory results from three Facet Block Injections. By disabling the sensory nerve that goes to the facet joint, long lasting pain relief is provided by the Facet Rhizotomy injection.
Sacroiliac Joint Block Injections (SI Joint) are used for diagnosing and treating pain associated with sacroiliac joint dysfunction. The SI Joint lies next to the spine connecting the sacrum (bottom of the spine) with the pelvis (hip)
Trigger Point Injections
Trigger Point Injections (TPIs) treat muscles that contain trigger points or knots of muscle formed because the muscles do not relax and are painful. In some cases, the knots can be felt under the skin. The nerves around the trigger points may become irritated and referred pain may develop. The pain felt in another part of the body is commonly known as ‘referred pain.’
Trigger point becomes inactive and the pain alleviates when the trigger point injection is provided. In most cases, a brief course of treatment results in sustained relief.
There are instances when physicians will prescribe only one injection for your pain. If your physician explains this is the course he follows, simply ask why? Why not three? In cases studied throughout the country, it is stated that the ‘single-shot blocks’ do not give the patient’s pain the full recovery that a set of three shots gives. Many studies conclude that ‘single-shot blocks’ are of short duration and only add the patient’s increased need for narcotics.
In any case, injections, like many other forms of pain relief, are temporary. As you begin a course of treatment to relieve CHRONIC PAIN your pain will not be gone for good. Chronic pain does not go away. The best we can hope for is the ability to function in our daily lives with as little pain as possible. The ongoing battle against the DEA and CDC have triggered more problems to the action of lowering dosages or stopping opioids altogether – the name of the nonexistent Opioid Epidemic. This morning I read another article about a Montana woman, Jennifer Adams, young, beautiful, with her whole life in front of her. She was unable to live by the ‘rules’ of physicians telling her to reduce her opioids to help her deal with her pain. Seriously? When will the public along with the DEA, CDC, and our government begin listening to chronic pain patients?
I don’t know, but I do know this. We have to fight…now, or we are going to lose and there will definitely be an epidemic of suicides among the chronically ill patients who know of no other way to relieve their pain.
Next week, we explore the surgeries of implants and other forms of relief! Until then, have a wonderful week!