In our practice, we believe in finding the cause of the pain and addressing it to the best of our ability. Our multidisciplinary approach includes injections as a way to help diagnose, prevent, or treat acute or chronic pain. In most cases, your primary care physician will send a referral to a pain management specialist if they think injections is an appropriate course of treatment. We would confirm that course of treatment and decide, with the patient, which injection would be the most appropriate. Other times a patient may come in for a consultation and our team will discuss injections as part of their course of treatment.
Local anesthesics (numbing medications) are typically used to decrease the discomfort of a procedure, but are also used to help diagnose the cause of pain. These can be placed into/around joints and tendons (ie. Shoulder, knee, plantar fascia, etc), next to peripheral nerves (ie. the femoral nerve and it’s branches), or near the spine. Responses to such injections can help guide future therapeutic injections (ie. medial branch nerve blocks near the spine to diagnose spinal arthritis pain that can later be treated with radiofrequency ablation or “RFA”). A surgeon may recommend a spinal nerve block to diagnose the origin of nerve pain (selective nerve root block) in order to help guide surgical intervention. Likewise a surgeon may ask for an injection of contract dye into spinal discs in order to find out if and which discs may be causing pain (Provocative Discogram/Discography).
Like diagnostic injections, local anesthetics are often used to prevent the development of pain. An example is a nerve block before surgery in order to prevent and control pain after a surgery or procedure. Minimizing acute pain after surgery, procedure or injury can prevent the development of chronic pain.
Common therapeutic injections:
Steroids (often referred to as “Cortisone”) can be placed into and around tissues in order to decrease inflammation, and decrease the pain that results from that inflammation. These are commonly used in muscle trigger point injections (TPI), into joints (ie. knee injection), near tendons or nerves, or into the epidural space (epidural steroid injections).
Platelet-rich Plasma is a portion of a person’s own blood that is separated out using a centrifuge and injected in to tissues in order to create an inflammatory response which may promote healing.
Stem cells are either derived from the person getting the injection (by centrifuging bone marrow aspirates) or from other donors. These cells are then injected into areas of pain or degeneration (ie. knee with painful arthritis), where it is thought that growth factors and other molecules enhance regeneration of damaged tissues.
Kyphoplasty/Vertebroplasty is a treatment for painful fractures of the vertebrae which includes inflation of small balloons, often followed by injection of cement-like material to stabilize the fracture.
Botox is often injected in order to relax painful spasm of muscles (ie. torticollis) and is FDA approved for some forms of migraine headache in order to reduce severity and frequency of headaches.
Sympathectomy is an injection of local anesthetics or more permanent nerve-deadening agents (ie. phenol or alcohol) in order to treat or diagnose conditions such as Complex Regional Pain Syndrome (CRPS) or severe abdominal or pelvic pain.
If you are interested in finding out if and which kind of injections may help with your pain control, please give us a call