Injections

In a small number of chronic pain patients there may be some select sites that can be injected to reduce some of the pain being experienced.

Facet joint injections and Medial-Branch blocks

Within the spinal column the vertebral bones are connected one upon the next by intervertebral discs in the front part of this structure, and small joints at the back. These joints are called by a variety of names including "facet joints" or "zygapophyseal joints" or "Z-joints".

These facet joints are subject to developing arthritis, and can therefore potentially be a cause of neck or back pain. Various treatments for this form of pain exist including some medications, steroid injections into the facet joints, or nerve blocks of the nerves which supply these joints.

Accurately identifying the correct level at which facet joint arthritic pain is occurring is sometimes difficult, with the pain description, clinical examination, and review of medical imaging all being helpful in this regard. Sometimes diagnostic blocks are required to confirm the diagnosis.

If the diagnosis is confirmed and short-term benefit has been obtained from local anaesthetic or steroid injections some patients will be offered treatments to the nerves which supply these joints, the medial branch of the dorsal ramis, which can result in more prolonged pain relief.

Paravertebral or Nerve-Sleeve Injections

Nerves leave the spinal column at each level in close proximity to an intervertebral disc through an opening termed the intervertebral foramen. In some patients pain can be caused if the nerve is irritated at this point, for example by a protruding intervertebral disc or from a nearby arthritic facet joint.

Pain is experienced both close to the vertebral level at which the nerve is irritated and along the pathway of the nerve, even down into the foot or hand.

A paravertebral injection is undertaken under x-ray guidance and an injection of local anaesthetic and steroid is placed in close proximity to the affected nerve as it exits from the spinal column through the intervertebral foramen and adjacent to the damaged intervertebral disc or arthritic joint.

Patients typically experience a short period of numbness due to the local anaesthetic included in the injection. This can also result in some short-term weakness. Any long-term benefit is of quite varied duration from days to months.

Patients having this procedure come in to hospital as day stay patients and will require a separate person to assist them home.