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    Anesthetic or Corticosteroid Injections for Low Back Pain

    Anesthetic or Corticosteroid Injections for Low Back Pain

    Examples

    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 try to relieve pain, a local anesthetic , either alone or combined with a corticosteroid , is 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

    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. Then 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

    Injections may be tried 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

    Research has not shown that local injections are effective in controlling acute or chronic low back pain that does not spread down the leg. 1

    Side Effects

    All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

    Here are some important things to think about:

    • Usually the benefits of the medicine are more important than any minor side effects.
    • Side effects may go away after you take the medicine for a while.
    • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

    Call 911 or other emergency services right away if you have:

    • Trouble breathing.
    • Swelling of your face, lips, tongue, or throat.

    Call your doctor if you have:

    • Hives.
    • Pain and swelling around the injection site that lasts more than 2 days.

    One common side effect of this medicine is pain and swelling the first day or two after the injection. It may help to apply ice at home for 15 to 20 minutes.

    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 but 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

    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.

    Nobody likes needles. But experienced doctors can usually do the injection in under 30 seconds. It does hurt, but it's quick.

    Taking medicine

    Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

    There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

    Advice for women

    If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

    Checkups

    Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

    Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

    References

    Citations

    1. Wildstein MS, Carragee EJ (2009). Low back pain. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 1, pp. 617?625. Philadelphia: Saunders Elsevier.

    Credits

    By Healthwise Staff
    Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
    Specialist Medical Reviewer Robert B. Keller, MD - Orthopedics
    Last Revised May 14, 2012

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