Anesthetic or corticosteroid injections for low back pain

Examples

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Trigger point injections Sometimes, putting pressure on a certain spot in the back (called a trigger point) can cause pain at that spot or extending to another area of the body, such as the hip or leg. To relieve pain, a local anesthetic, either alone or combined with a corticosteroid, may be injected into the area of the back that triggers pain (trigger point injection).

Facet joint injections A local anesthetic or corticosteroid is injected into a facet joint, which is one of the points where one vertebra connects to another.

Epidural injections A corticosteroid is injected into the spinal canal where it bathes the sheath that surrounds the spinal cord and nerve roots.

These injections can be done by an orthopedist, an anesthesiologist, a neurologist, a physiatrist, a pain management specialist, or a rheumatologist.

How It Works

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Local anesthesia is believed to break the cycle of pain that can cause you to become less physically active. Muscles that are not being exercised are more easily injured, so the irritated and injured muscles can cause more pain and spasm and can disrupt sleep. This pain, spasm, and fatigue, in turn, can lead to less and less activity.

Steroids reduce inflammation, so a corticosteroid injected into the spinal canal can help relieve pressure on nerves and nerve roots.

Why It Is Used

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Injections may be appropriate if you have symptoms of nerve root compression or facet inflammation and you do not respond to nonsurgical therapy after 6 weeks.

How Well It Works

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Trigger point injections

Research has not demonstrated that local injections are effective in controlling chronic low back pain.¹

Facet joint injections

When used to treat chronic low back pain, facet joint injection of a corticosteroid is no more effective than a placebo injection and may even be harmful.¹

Epidural steroid injections

Evidence supporting epidural steroid injection is mixed. Research does not demonstrate a clear benefit.^{2 1} But some people seem to get short-term relief, especially from pain that spreads down the leg.³

Side Effects

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Trigger point injections

Possible side effects include nerve or other tissue damage, infection, or excessive bleeding.

Facet joint injections

Possible side effects include pain at the injection site, infection, excessive bleeding, nerve damage, or spinal cord inflammation.

Epidural steroid injections

Rare possible side effects include headache, fever, spinal cord inflammation, or infection.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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These injections can be painful.

Most orthopedists and rheumatologists advise against repeated injections of corticosteroids directly into joints, including joints of the spine, because degeneration or damage to joint cartilage may occur.

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References

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Citations

1. Van Tulder M, Koes B (2006). Low back pain (chronic), search date November 2004. Online version of Clinical Evidence (15).

2. Koes B, Van Tulder M (2006). Low back pain (acute), search date November 2004. Online version of Clinical Evidence (15).

3. Datta D, et al. (2005). Low back pain. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 1, pp. 588–600. Philadelphia: Elsevier Saunders.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer	Robert B. Keller, MD - Orthopedics
Last Updated	February 6, 2008