Injection Therapies - Conservative Measures: Back Pain

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Injection therapies

Injection therapy is not suitable for everyone with back pain, but may benefit people who are suffering the sharp, shooting pain from nerve compression, such as sciatica. Depending on the problem, the injections might target the epidural space, lumbar disks or facet joints (see Figure 11).

Figure 11: A look at two injection therapies A. Epidural steroid injections involve the injection of steroid medications into the epidural space. This area lies outside the dura mater, a membrane that covers the spinal cord. B. When back pain is caused by an irritated facet joint, a doctor may suggest treating the problem with an injection of a steroid combined with a local anesthetic. Known as a facet joint injection, this therapy delivers medication directly into the affected joint.

When appropriate, injection therapies can be effective. Studies have reported, for example, that 70%–80% of people with acute sciatica experience an improvement in their symptoms following epidural injections. But even in these cases, the epidural injection is not a cure per se, but rather a way to relieve pain while the back heals naturally.

Injection therapies are done on an outpatient basis by a skilled specialist, such as an orthopedist, anesthesiologist, radiologist, or neurologist. The specialist injects the back with anesthetic agents, glucocorticoids (more commonly known as steroids, although they are different from the drugs some athletes take to bulk up), or both.

Keep two things in mind, however, before undergoing any type of injection therapy. First, such injections are not proven remedies for back pain. In fact, a 2001 review in Spine, which analyzed 21 previous clinical trials of various types of injection therapies, found that most studies were so poorly designed their results cannot be trusted. Even the few rigorous studies were unable to provide convincing evidence that injection therapies alleviate back pain.

A second issue to consider is that not only do injections provide little demonstrable relief for back pain, they actually hurt in some cases. The injections themselves can be quite painful. And repeated exposure to glucocorticoids may destroy cartilage in the treated joints.

Last updated:	January 23, 2007