Injections and nerve blocks for low back pain
Description
Injections to treat back pain deliver medicine right to the origin of the pain. Your doctor will inject a mixture of steroid and numbing medicines into this area. These medicines decrease swelling and pressure around a nerve or inside a joint. This lessens your pain.
You may have this kind of injection when other treatments have not helped. If your pain lessens or goes away after the injection, your doctor may be able to tell what is causing your pain.
Another type of injection for back pain is called an epidural steroid injection.
Facet joint injection
Facet joints are where 2 vertebrae that are next to each other form a joint. They allow your spine to move, twist, and bend. Problems in these small joints cannot be diagnosed on x-rays or MRI scans. An experienced doctor may be able to diagnose a problem in a facet joint based on your symptoms and a physical exam.
A facet joint injection should be done only by a doctor who has experience doing this type of injection. It is not a cure by itself. But it can be part of a long-term plan to manage chronic back pain.
When you have the injection:
- You will lie on your stomach.
- The needle will be inserted through your skin.
- Your doctor will use a special x-ray machine that shows real-time pictures to help guide the needle to the correct spot in your back.
It is hard to know before you have it if the injection will help. Sometimes more than one injection is done. Your doctor will ask you right after the injection how it is working. This can allow them to isolate the problem area.
Selective nerve root block (SNRB) to diagnose and manage back pain
Nerve roots are bundles of fibers that come out of each section of your spine. Some of them deliver signals to your brain that make you feel pain. A selective nerve root block (SNRB) injection is mostly used to find the source of pain in a nerve root. The injection also may bring relief of low back pain or leg pain.
A nerve root that becomes compressed and sore can cause back or leg pain. If an imaging study such as an MRI shows more than one nerve is involved, an SNRB injection can help locate the source of pain.
An SNRB should be done only by a doctor who has experience doing this type of injection. It is not a cure by itself. But it can be part of a long-term plan to manage chronic back pain. SNRB is also called transforaminal epidural injection.
The injection is done using a similar technique to facet joint injections, described above.
Sacroiliac joint injection
The sacroiliac joint is located between the lowest part of your spine, called the sacrum, and a bone in your pelvis called the Ilium. There are 2 sacroiliac joints in your spine, one on the right and another on the left.
Swelling and inflammation in this joint can cause low back pain and buttock pain. Psoriatic arthritis, reactive arthritis, and ankylosing spondylitis are common causes of pain in the sacroiliac joint.
When you have the injection:
- Your doctor will clean the area of your back where the needle will be inserted. Your doctor may put medicine on your skin to numb this area. You may also be given medicine to help you relax.
- Most of the time, your doctor will use an x-ray machine that shows real-time pictures to help guide the needle to the correct spot in your lower back.
- The doctor will inject a mixture of steroid and numbing medicines into your sacroiliac area.
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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