Posted in aches, Arthritis, Chronic lower back pain, chronic pain, Fibromyalgia, Inflammation, Knee pain, Muscle and joint stiffness, Rheumatoid Arthritis

PART 5 – INJECTIONS, SURGERY IMPLANTS, AND MORE…OH MY!

Part 5A – Injections

 Good afternoon and thank you for stopping in to review Part 5A – Injections of 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. As I write I’ll be inputting my experience in italics.

Let’s start with the injections recommended by doctors as being an option other than 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)               

Facet Rhizotomy                                              

Sacroiliac Joint Block

Trigger Point Injection                           

Nerve Block

There are other branches of injections that are extensions of these, but the above 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 in the lumbar section of the spine. However, Epidural Steroid Injections injected in the cervical (neck) and thoracic (mid spine) areas of the spine are very 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 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 pain and inflammation area. Earlier studies show that doctors did not use this method of determining the placement of the injection. A request for more studies has been issued even though most studies report 50% or more patients report pain relief with ESI. A word of warning – be sure to seek a professional with considerable experience directing injections with fluoroscopy for careful placement.

The attraction of ESIs is the medication is delivered directly into the pain source whereas oral pain medications have a less-focused contact with undesirable side effects. 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 provided. A compressed or inflamed nerve root will produce back or leg pain. Because a MRI doesn’t show which nerve causes the pain, a 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 professional 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 injections’ purpose is to confirm a diagnosis. SNRBs are limited to three times a year. And because of the difficulty of administering SNRBs, be sure to 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:

 

{illustration from Google search (innova-pain.com)}

 

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 experience physician.

Nerve Block:

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.
  • Preemptive nerve blocks avoid successive pain from procedures causing problems.
  • 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 to you and your pain.

Radiofrequency Neurotomy for Facet and Sacroiliac Joint Pain

An injection procedure that is used to treat facet or sacroiliac joint pain caused by arthritis, other deteriorating changes, or from an injury is called a Radiofrequency Neurotomy. The goal of interrupting pain signals to the brain uses a heat lesion on certain nerves to eliminate pain. Radiofrequency ablation and radiofrequency neurotomy, 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.[1]

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.

(I had the RFA as a last-ditch effort to find another form of pain relief prior to the implant of the Spinal Cord Stimulator. With hopes that the RFA would last at least one year (or minimal one month) I went through three different nerve blocks until the radiofrequency ablation was finally performed. Painful, stressful, and just downright annoying … I had the RFA which lasted three months to the day. Unfortunately, there’s no if, or, maybe that circles this procedure. Most insurance companies require all avenues be followed before going forward toward other pain treatment options.)

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. 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. If you proceed into any course of treatment with expectations that your pain will be gone for good, stop. Chronic pain does not go away. The best we as pain patients can hope for is the ability to function within our daily lives with as little pain as possible. Believe me, I’ve tried just about everything and have found that a pain level of 4 sure beats the heck out of a level 10!

Next week, we explore the surgeries of implants and other forms of relief! Until then, have a wonderful week!

[1] www.spine-health.com/treatment/injections/radiofrequency-neurotomy-facet-and-sacroiliac-joint-pain article

Author:

After training for copywriting, I am currently blogging for a living! So far working with a company that outsources for other companies and I've become the "preferred writer" for two companies!!! I'm very excited about having my own blog site and look forward to adding interesting info for you!

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