Back pain is a significant health issue for people all around in the world. In the U.S., between 80 and 90% of people will suffer from back pain at some point in their lives. After the diagnosis, treatment can begin, but there are many complicating factors. The cause of the back pain and any underlying health conditions are important considerations when tailoring a pain management plan for each individual patient. Steroid injections for back pain are one treatment option that can be used in different ways for different patients.
Progressive treatment – steroid injections for back pain
In general, and depending on the severity of the pain, doctors will loosely follow a progressive treatment plan for back pain, starting with the least invasive treatments. The idea is to treat back pain with minimal intervention when possible.
Step 1: Rest
Although not recommended past the first few days, rest can be important following a back injury. Doctors may recommend using hot and cold therapy during this time to reduce swelling and pain.
Step 2: Non-steroidal anti-inflammatory drugs (NSAIDs)
This step is often concurrent with rest but may continue after the first few days. Non-steroidal anti-inflammatory drugs help control pain and inflammation. They are not recommended for use for long periods of time, as increasing doses over time can increase the chance of serious gastrointestinal side effects.
Step 3: Exercise
For patients whose back pain is adequately managed with a period of rest and NSAIDs, the doctor may recommend beginning a specific course of exercise for the back and abdominal muscles. They may also recommend physical therapy to teach patients how to safely and appropriately complete each exercise.
Step 4: Steroid injections for back pain
For patients who are experiencing refractory pain or pain that does not respond to the non-invasive treatments above, doctors may recommend steroid injections for back pain. There are a variety of injections, each used for different types of pain.
Lumbar facet block
A lumbar facet block is a steroid injection for back pain that actually performs two functions. Not only does the lumbar facet block help to reduce pain and inflammation but it can also help doctors to diagnose the cause or specific location of lower back pain.
A lumbar facet block is administered in the space between the facet joints on the spine. Facet joints are the bony protrusions located on the sides of the spine. In between each vertebrae is a disc containing lubricating fluid and cartilage. An anesthetic and anti-inflammatory steroid are injected into this site, guided by a fluoroscope. Pain may be immediately relieved due to the anesthetic, but that will wear off over a few days. The steroid is what provides longer-lasting pain relief by eliminating inflammation.
Lumbar facet blocks are used specifically for lumbar facet syndrome associated with chronic lower back pain, but they are also used as a diagnostic tool. If a lumbar facet block is administered and there is no pain relief, doctors know that they have not yet identified the source of the back pain.
Facet joint injections are steroid injections for back pain that offer immediate relief for many patients. This allows them to begin physical therapy and exercise that was impossible due to pain.
Epidural steroid injections
Another type of steroid injection for back pain is an epidural steroid injection. These injections are often recommended for chronic neck and lower back pain as well as radiculopathy (pain due to nerve damage).
While facet joint injections are placed into the joint itself, epidural steroid injections are administered into the epidural space of the spinal column (much like an epidural administered during labor and childbirth). The benefit of injecting into the epidural space is that this space has access to all areas of the spine. This means that one injection placed anywhere along the epidural space can travel to all spinal nerve roots. This may be less invasive than injecting directly into nerves or other sensitive spaces in the spinal area.
There are three typical placements of epidural steroid injections: transforaminal, interlaminar, and caudal. Transforaminal injections are generally placed above a nerve root in the epidural space so as to target just one side of the spine. Interlaminar injections are most common and involve an injection between two vertebrae (to affect both sides of the spine). Caudal injections are administered into the epidural space at the end of the spine (the sacral region). With caudal injections, larger amounts of steroid can be administered.
What to expect if receiving steroid injections for back pain
Both types of steroid injections for back pain are considered minimally-invasive procedures that are performed on an outpatient basis. The entire procedure takes approximately 15 minutes. The physician’s assistant or doctor will direct the patient to lie face down and will then prepare the injection site. A topical anesthesia will be applied. For more accurate injections, a fluoroscope will be used to guide the needle to the proper space, with contrast dye used to ensure placement.
When the needle is in place, the steroid will be administered. The amount will vary depending on how much area is being treated. In most cases, patients will feel immediate pain relief due to the anesthetic, but the long-term effects are due largely to the steroid itself.
Steroid injections for back pain may be administered again if no pain relief is achieved. Many researchers disagree on the safety and advisability of multiple injections spaced weeks apart, with some recommending months between injections.
Side effects of steroid injections
There are potential side effects of steroid injections for back pain, including:
- Sleep problems
- Hot flashes
- Increased risks of bleeding
- Changes in ability to regulate body temperature (periods of flushing and warmth)
- Temporary increases in blood sugar (important to note for diabetic patients)
- Transient increases in pain
- Water retention
- Tenderness at injection site
In general, these side effects are not long-lasting, but it is important to check with a doctor if they increase in severity or do not go away.
Steroid injections for back pain are often the last stop before surgery for patients experiencing back pain that does not respond to less invasive treatments. If you feel you might benefit from a steroid injection for back pain, talk to your doctor today.