Back Pain Injections: Different Types and What They Do

If you have back pain, you are not alone. In fact, about twenty percent of all Americans will have back pain each year. So, for those with severe back pain or pain that won’t go away, your doctor may recommend a shot (injection). These shots usually consist of a steroid and numbing medication. Additionally, they are often used as a conservative treatment for back pain, inflammation, and nerve damage.

That said, injections are not one-size-fits-all. Different types of injections offer relief for or help to diagnose different areas involved with back pain. Therefore, the type of injection you may be eligible for will depend on your pain level and location.

So, what are the different types of back pain injections? We will discuss the various injections performed at Advanced Ortho & Spine in the following post, as well as how they differ and what each is used to treat.  

Epidural Steroid Injections (ESI)

An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves.

During this procedure, medicines are delivered to the spinal nerve through the epidural space, which is the area between the protective covering of the spinal cord and vertebrae. Furthermore, the injected medicine includes both a long-lasting corticosteroid and an anesthetic numbing agent (lidocaine).

After the injection, pain relief can last from days to years, allowing you to improve your spinal condition with physical therapy and exercise.

Radiofrequency Neurotomy (Radiofrequency Ablation)

Another potential option for back pain relief is radiofrequency neurotomy for facet joint pain, also known as radiofrequency ablation. Patients who have had pain originating from the facet joints are candidates for this procedure. Areas of pain typically associated with specific facet joints include your buttocks if lumbar; upper back to lower back if thoracic, and lower neck to the back of the head if cervical.

During this procedure, a radiofrequency generator produces a localized heat lesion to either destroy or deactivate smaller nerves. This temporarily turns off their ability to send pain signals, leaving the surrounding region and larger nerves unaffected.

Usually, this treatment requires two office visits. Studies show, and Dr. Eby has seen, there is a 90% chance of significant pain relief following the procedure for up to six to twelve months.

Sacroiliac Joint Injections

Next on our list of injections for back pain is a sacroiliac joint injection. Candidates for this procedure include patients who have had pain originating from the sacroiliac (SI) joints, which are located in the back where the lumbosacral spine joins the pelvis (low back/upper butt). Typically, patients feel SI joint pain in an area from their lower back down to the buttocks. But if a joint is very inflamed, pain may even extend down the back of the leg.

During this procedure, an anesthetic (lidocaine) with a long-lasting steroid (cortisone) is injected into the affected the SI joint. Additionally, a small volume of contrast dye is used to confirm proper needle placement while using the x-ray machine. Fortunately, this injection only takes a few minutes. This steroid injection into can reduce inflammation in the joint space, reducing pain and other symptoms caused by inflammation.

After the injection, there may be immediate pain relief due to the anesthetic. Once the anesthetic wears off, the pain will return due to the mechanical process of needle insertion, as well as initial irritation from the steroid itself. However, you should start feeling relief between the third and fifth day.

Medial Branch Blocks

Another option for back pain relief is a medial branch block. Medial branch nerves are small nerves that branch out from the facet joints in the spine and carry pain signals from the facet joints to the brain. Depending on which facet joint is affected, the pain may occur in an area from your head, neck, lower and upper back. Facet joint injections, which we explain in the next section, are often used to identify a pain source, while medial branch blocks may be considered for pain relief for that pain source.

With that in mind, a medial branch block temporarily interrupts the pain signal being carried by the medial branch nerves that supply a specific facet joint. If the patient has the appropriate duration of pain relief after the nerve block, that patient may be a candidate for a neurotomy or a type of injection in which a heat lesion is used on specific nerves to interrupt the pain signals that go to the brain. Then, the neurotomy should provide pain relief lasting nine to fourteen months, sometimes even longer.

Facet Steroid Injections

Last on our list of back pain injections, is a facet steroid injection. As mentioned above, facet joints are joints in the spine that help support weight and control movement of the spine. These joints can become inflamed causing pain in your neck, upper or lower back, or buttock area.

During the procedure, a small quantity of dye that can be seen with an x-ray is first used to confirm that the injection is in fact being placed into the correct joint. Then, a local anesthetic and the steroid are injected. The goal of this injection is typically to confirm the source of a patient’s pain. The local anesthetic numbs the joint and if the patient experiences significant pain relief within fifteen minutes, the joint injected is the source of the pain.

After the shot, the pain relief may last a few hours or up to six months depending on the patient and the facet joint in question. More often, that pain returns before six months is up and the injection may be administered again or another treatment, called radiofrequency neurotomy, may be used.

In Closing

As always, it is best to speak with your doctor about injections for back pain relief, including which one may be right for you. Additionally, each of these injections requires insurance authorization. If you are referred to Advanced Ortho & Spine, our office takes care of ensuring your insurance authorization after your doctor sends an injection order to our team. We offer these injections Monday afternoons, Tuesday and Wednesday mornings, and all day on Thursdays.

James Eby, MD, is a board-certified physiatrist, who specializes in nonoperative spinal procedures at Advanced Ortho & Spine. He provides a full spectrum of Physical Medicine treatments. Contact us today for more information or to request an appointment. 






With two locations near Nashville in Mt. Juliet and Hermitage, Advanced Ortho and Spine provides patients with high-quality, personalized care while advancing orthopaedic excellence. Contact us today to learn more or to schedule your appointment.

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