Injections for Pain Relief

Injections to Help Relieve Symptoms of Pain

Fluoroscopic Guided Steroid Injection for Knee Pain

Overview

This is an outpatient procedure designed to help relieve the patients with arthritis of the knee. Utilizing fluoroscopic guidance allows the physician to inject an inflammation-reducing steroid with maximum accuracy.

Preparation

The physician swabs the knee, injects a numbing medication and positions a special X-ray device called a fluoroscope. To make sure the medicine injection gets to the space inside the joint, the physician first uses an injection of dye. The dye shows appears on the fluoroscope image. If the dye pools in the soft tissue at the front of the knee, the physician adjusts the needle placement to the targeted area. When the dye reaches the targeted area - the space inside the joint - the physician is ready to inject the medication.

Injecting the Medication

The rear of the syringe is removed from the needle and a syringe filled with a local anesthetic and steroid is attached. The physician injects the medication into the joint.

End of Procedure

The local anesthetic and steroid solution in the knee joint will reduce inflammation and pain for the patient The injection can be repeated as necessary.

Lumbar Steroid Injection

Overview

This injection procedure is performed to relieve low back and radiating leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions.

Patient Positioning

The patient lies face down. A cushion under the stomach area provides comfort and flexes the back. In this position, the spine opens and allows for easier access to the epidural space.

Tissue Anesthetized

A local anesthetic is used to numb the skin. All the tissue down to the surface of the lamina portion of the lumbar vertebra bone is anesthetized. The physician slides a thicker needle through the anesthetized track.

Fluoroscopic Guidance

Using a fluoroscope for guidance, the physician slides the needle toward the epidural space between the L-4 and L-5 vertebra. A contrast solution is injected. The physician uses the fluoroscope to confirm the correct location of the needle tip.

Steroids Injected

A steroid-anesthetics mix is injected into the epidural space, bathing the painful nerve root with soothing medication.

End of Procedure

The needle is removed, and a small bandage is applied to cover the tiny needle surface wound. In some cases it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication. Many patients get significant relief from only one or two injections.

Medial Branch Block

Overview

This diagnostic procedure is performed to identify a painful facet joint. The facet joints are the joints between the vertebrae in the spine. They allow the spine to bend, flex and twist.

Preparation

In preparation for the procedure, the patient is positioned on his stomach. The physician injects a local anesthetic. This numbs the skin and tissue around the facet joint that is suspected of causing the patient's pain.

Contrast Dye Injected

Once this tissue is numb, the physician inserts a needle into the skin. The needle is carefully guided down to the facet joint. The physician injects a contrast solution through this needle. The contrast solution helps the physician see the area on a camera called a fluoroscope. The fluoroscope provides live x-ray images. The physician uses the fluoroscope to confirm the location of the needle's tip.

Anesthetic Injected

Once the physician has confirmed that the needle is positioned correctly, the physician attaches a syringe containing an anesthetic medication. This medication is injected around small nerves called the medial branch nerves. These carry signals to and from the facet joints. The anesthetic will temporarily block sensation in these nerves.

End of Procedure

If the temporary injection relieves the patient's pain, the physician may inject a more long-lasting anesthetic. If the temporary injection does not relieve the pain, the physician may test nearby facet joints to identify the correct one.

Thoracic Epidural Steroid Injection

Overview

This outpatient procedure is an injection performed to relieve pain in the upper back.

Preparation

The patient sits or lies down to expose the back. The back is cleaned and sterilized, and a local anesthetic is administered to numb the tissue of the injection site down to the spinal column.

Inserting the Needle

The physician uses an x-ray device called a fluoroscope to guide a needle down to the vertebra that is causing the pain. The needle is carefully pushed into the epidural space, which is the area surrounding the spinal cord. A contrast solution is injected to confirm the needle's position.

Inserting the Medication

The physician injects a steroid-anesthetic mix into the epidural space, bathing the painful areas with soothing medication. The mixture will help reduce inflammation and reduce pain.

End of Procedure

The needle is removed, and the injection site may be covered with a small bandage. Extended pain relief usually begins within three to five days of the injection. In some cases it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication. However, many patients get significant relief from only one or two injections.

Shoulder Joint Injection

Overview

This outpatient injection procedure relieves pain in the shoulder and arm caused by arthritis, injury or disorder.

Preparation

In preparation for the procedure, the shoulder is cleansed and sanitized. Local anesthetic is administered to numb the tissue at the injection site. The physician may choose from multiple needle approaches, depending on which part of the shoulder requires treatment.

Needle Insertion

The physician carefully guides a needle into the shoulder joint. The physician may guide the needle with the help of an x-ray device called a fluoroscope. If so, the physician may inject contrast dye to confirm the needle's placement.

Pain Relief Injection

When the needle is in position, the physician injects a mixture of anesthetic and steroid medication. The medication will help reduce inflammation and relieve pain.

End of Procedure

When the injection is complete, the needle is slowly withdrawn. The injection site may be covered with a small bandage. For many patients, extended pain relief begins within two to three days of the injection. In some cases it may be necessary to repeat the procedure one or more times to receive the full benefit of the treatment.

Cervical Steroid Injection

Overview

This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves.

Patient Sedated

The procedure is performed with the patient lying down. Intravenous sedation may be administered, and a region of skin and tissue of the neck is numbed with a local anesthetic delivered through a small needle.

Needle Inserted

Using x-ray guidance (also called fluoroscopy), the physician guides a larger needle to the painful area of the neck. The needle is inserted into the epidural space, which is the region through which spinal nerves travel.

Contrast Dye Injected

Contrast dye is injected into the space to make sure the needle is properly positioned near the irritated nerve or nerves.

Steroid Injected

A combination of an anesthetic and cortisone steroid solution is injected into the epidural space. The steroid is an anti-inflammatory medication. It is absorbed by the inflamed nerves to decrease swelling and relieve pressure. The needle is removed and a small bandage is applied.

End of Procedure

The patient goes to a recovery room and is given food and drink and discharged with post treatment instructions. Some patients may need only one injection, but it may take two or three injections (administered weeks apart) to provide significant pain relief.