Steroid Injections for Back Pain
Steroid injections for back pain at a glance
- Steroid injections deliver corticosteroids that resemble the body’s anti-inflammatory hormone to specific areas in the back via a needle to decrease inflammation and provide pain relief.
- The three main types of steroid injections for the back are categorized by where the injection is made and include trigger point, facet joint and epidural.
- Steroid injections for back pain reduce the pain and increase mobility.
- Muir Orthopaedic Specialists uses epidural steroid injections and sacroiliac joint injections.
What are steroid injections for back pain?
Steroid injections are a common, nonsurgical treatment for spine, back and neck pain. Steroids, short for corticosteroids, are synthetic drugs that resemble cortisol, an anti-inflammatory hormone that the adrenal gland produces naturally. Steroids work by decreasing inflammation and reducing activity in the immune system, and are used to treat a variety of diseases and conditions, including spinal stenosis and sciatica.
Steroid injections are performed to help reduce the inflammation and pain associated with a compressed nerve. Nerves can be compressed by a herniated disc, spinal stenosis or bone spurs.
Steroids are administered two ways. They can be administered to the entire body system or injected into the entry point of the affected area. There are three main types of steroid injections for back pain associated by their location.
- Epidural injections: A steroid that is injected into the spinal canal around the area that surrounds the spinal cord and nerve roots for relief of sciatica.
- Trigger point injections: The steroid is injected into the muscles in the back that trigger or cause pain at that spot or extends to another area of the body such as the hip or leg.
- Facet joint injections: The steroid is injected into a facet joint, which is one of the points where a vertebra connects to another.
Benefits of steroid injections
Steroids work to reduce inflammation (heat, swelling, redness and pain). As a result, patients suffering from neck, spine or back pain typically feel less pain, swelling and stiffness and are able to function better after receiving steroid injections.
Steroid injections are a first-time option for patients who suffer from sciatic and do not want to have surgery. Steroid injections can be added to a treatment plan that may already include pain medications, anti-inflammatory drugs, physical therapy, occupational therapy or supportive devices such as canes or braces. Whether one or more of those treatment methods are used depends on the nature of the problem. They are used for long-term treatment of sciatic pain and are often repeated three to four times a year.
Steroid injection procedure
The patient will be given specific instructions prior to coming in for the injection and can usually continue on their normal medications with the exception of any blood thinners or anti-inflammatory medications.
- An intravenous (IV) line will be placed in one of the veins. Patients may be given medication to help them relax during the procedure.
- The patient will be placed on an X-ray machine over a bolster to help open up the spaces between the bones in the back. The X-ray is obtained to verify the proper level for the injection.
- The patient’s skin is cleaned and they are injected with a medication to numb the area.
- After the area is prepared and numb, the doctor will insert a needle through the skin and toward the spine. Once the needle is in the proper space, a small amount of dye may be injected to verify the position of the needle on the X-ray.
- A mixture of numbing medication and steroids is injected into the epidural space. The needle is removed and a bandage is placed over the site.
The injection is generally very quick and is administered in under five minutes. It is usually not painful because of the numbing medication used at the start. Many people have a mild tenderness in the days following the injection and it may help to apply ice to the affected area for 15 to 20 minutes at home.
Types of steroid injections offered at MOS
We treat patients in the Bay Area with lower back (lumbar), neck (cervical) or sciatica pain (hips, buttocks and legs) using epidural steroid injections and sacroiliac joint injections.
Epidural steroid injections
Epidural steroid injections are injected above the dura, the outer most layer covering the spinal cord and the nerves exiting the spinal cord.
Conditions that can cause acute or chronic back pain that can be treated by steroid injections include:
- Lumbar disc herniation
- Degenerative disc disease
- Lumbar spinal stenosis
- Cysts in the facet joint, the nerve root that can expand to spine structures
- Annular tear, tear in the outer disc.
This treatment option can give relief from one week up to one year. If proven successful, a patient may have up to three to four epidural steroid injections in one year.
We perform this procedure in our offices or at surgery centers. The patient will lie down on his or her stomach, and the orthopedist will use a local anesthetic to numb the area around the injection site. We use the transforaminal approach, which means the doctor will inject the steroid into the foramen, the side of the spine which the nerve exits.
Using fluoroscopy, which involves real-time, moving X-rays, the surgeon guides the needle to the correct location, then injects the steroid mixture. This mixture may include local anesthetic, saline and the steroid medication. This combination will give immediate pain relief and flush out inflammatory proteins and chemicals from the area causing pain.
Once the needle is removed, the patient will be monitored for a short time before being discharged. Patients are asked to rest for the remainder of the day and can use an ice pack at the needle insertion site if it is feeling tender.
A temporary increase in pain can occur for several days after the injections due to the pressure of the fluid injected or a chemical irritation. Only a very few patients report a spinal headache after the procedure; this is due to a dural puncture that occurs in 0.5 percent of injections. It usually goes away in a few days, but infrequently a blood patch is needed to alleviate the headache.
Sacroiliac joint injection
Sacroiliac joint injections, also known as sacroiliac joint blocks, are primarily used to diagnose or treat lower back pain and sciatica symptoms associated with sacroiliac joint dysfunction. Pain in the lower back and legs can be caused due to too much or too little movement in the sacroiliac joints. The two sacroiliac joints are located next to the spine and connect the spine with the hips.
The typical injection procedure will begin with the patient lying face down and the injection site is numbed. Under X-ray or ultrasound guidance, the doctor will place the needle into the sacroiliac joint, confirm the placement and then inject a small amount of anesthetic with a corticosteroid.
The anesthetic is used for the diagnostic portion of this injection. If the pain is eliminated, then we learn that this area was the pain generator and we have been able to diagnose sacroiliac joint pain. Then the corticosteroid reduces the inflammation, which is usually the cause of the pain, and that is the therapeutic portion of this treatment.
After the procedure, the patient will stay at the doctor’s office for a 30-minute observation period and is then released to go home and rest.
Risks & side effects of steroid injections
Steroid injections are one of the most effective ways to decrease pain and improve function. In addition, it’s important to keep in mind that not everyone gets the same level of relief from the injections.
Since the amount of steroid injected is usually small, injections may be repeated up to three times per year if necessary with no significant side effects. Common side effects include:
- Muscle tensions.