Back pain hindering you from your “New Year, New Me” goals? Well, you are not alone! Back pain is one of the most common issues people face. Whether it be bad posture, high impact sports, accidents, injuries, or wear and tear, our backs are susceptible to developing pain. Fortunately, surgery is not always the answer.
With or without surgery, injections and physical therapy are common, non-invasive options for managing, alleviating and treating back pain. There are several types of injections available, but it is important to remember that although one injection may have worked for a friend or family member, it does not necessarily guarantee the same results for you. Everybody is different and every injury is different.
What are the most common injections for back pain?
Platelet Rich Plasma (PRP) - Made popular by professional athletes, PRP injections help to promote tissue repair & accelerate the healing process. In order to obtain the platelets needed for the injection, a patient undergoes a blood draw. Once the blood draw is complete, it is placed into what is called a centrifuge. The centrifuge spins the blood at a high speed causing the platelets and red blood cells to separate. The red blood cells are discarded and the platelet is injected into the injured site. Patients who undergo a PRP injection typically see results in about 4-6 weeks.
It is important to note that PRP is typically not the first thing recommended when you are experiencing back pain. Doctors will want you to try other things like physical therapy or other injection types first. There are certain individuals who may not be appropriate for PRP injections including those that are pregnant, anemic, have blood/bleeding disorders, or who have a specific medical condition that could worsen with injections.
If you are considering PRP, check with your insurance to see if the procedure is covered. As of December 2018, not all insurances cover the procedure and require patients to pay out of pocket.
Epidural Steroid Injection - Many of us have heard the term epidural from childbirth, however epidurals can also be used to alleviate pain in the back. In an epidural shot used to treat back pain, typically a corticosteroid and an anesthetic are used together to help reduce swelling of the spinal nerves. Some common corticosteroids used include: methylprednisolone, dexamethasone,and triamcinolone. The injection is placed between the vertebrae (bone) and the dura sac surrounding the nerves of the spine. This space is referred to as the epidural space of the spine.
Some conditions that make you a candidate for an epidural steroid injection include: spinal stenosis, degenerative disc, sciatica, herniated disc, and spondylolisthesis. However, the injection is only meant to help with the swelling and pain associated with each of these conditions. It cannot decrease the size of a disc herniation. If you have an infection or bleeding problems, you are not a candidate for an epidural injection.
Those who undergo an epidural steroid injection can have relief for a few days to a full year. There are some limitations on how many epidurals you can have within a certain time frame, so it is important to consult with your physician. After an injection, your doctor will most likely recommend you continue physical therapy to help aide in the healing process. It is important to note that an epidural is a short-term solution, not a permanent solution to back pain.
Facet Joint Block - Within the spine are facet joints. Located on the side of each vertebra of the neck and back are facet joints that allow for motion, but also stability in the spine. A facet joint block, sometimes referred to as a facet joint injection, are guided by fluoroscopy or CT. A combination of cortisone and an anesthetic are injected into the facet joint. If multiple joints are affected, your doctor may perform multiple injections during the same procedure.
Facet joint blocks can be used for two different reasons: 1) to see if the pain you are experiencing is coming from a specific area or 2) to give you relief from pain. When used as a diagnostic tool, your physician can try a particular location and if the pain goes away, the doctor can determine that the particular facet joint is contributing to your problem. If the pain does not go away, the doctor may try a different location.
A facet joint block is most commonly suggested for someone suffering from arthritic changes in the spine. You may not be a candidate for facet joint block under the following circumstances: pregnancy, neurological disorder, bleeding problems/conditions. Infection, allergies to contrasting agents used in imaging, and/or inability to access the area.
Who performs these injections?
If you are going to be having any of the above injections done, the person with the expertise to safely perform the procedure include radiologists, physiatrists, anesthesiologists, neurologists, surgeons, and pain management physicians.
What happens if the injections don’t work?
If you undergo any of the above injections and do not see any benefit, it is possible your physician will suggest surgery. Most injections are used a precursor to surgery, helping people manage the pain until they are ready to have the surgical procedure done.
How often can you have an injection?
Every injection differs on how frequently you should have them. Be sure to consult with your physician as there is a limit on how many you should have in a given timeframe. Additionally, many doctors say that having injections over numerous years can also be detrimental. Having repeated injections can eventually damage the tissue.
If you are having pain and want to know your options, it may be time to consult with a specialist. Whether it’s an orthopedic doctor or pain management specialist, schedule an appointment with them to see what your options are.
If you want to try something before an injection, give us a call. Physical therapy is an alternative to injections that some people get relief from. Our physical therapists are here to help & can even give you some suggestions on which doctors to see.