Epidural steroid injections are a common treatment option for many forms of low back and leg pain.The injection may be sufficient to provide relief, however, it is commonly given in conjunction with a comprehensive rehabilitation program to provide additional benefit.

Back injections may help treat two major back pain diagnoses: radiculopathy and spinal stenosis as well as help determine what is actually causing the pain.

Radiculopathy refers to inflammation or damage to a nerve usually in the neck or the low back. The problem originates where the nerve exits the spine. With radiculopathy, sharp pain shoots from the lower back down into one or both legs or from the neck into the arm. A herniated disc can cause radiculopathy.

With spinal stenosis, the lower spine becomes narrowed. As a result, it compresses the nerves inside. This usually causes pain in the buttock or leg and may or may not be accompanied by back pain.

Epidural means “around the spinal cord.” Typically, given by anesthesiologists or interventional radiologists with special training.  The doctor inserts a needle through the skin toward the spine maneuvering the needle between the bones of the spine.  This is the “epidural space.” When the needle is in position, the doctor injects a solution containing a steroid medicine, also called a corticosteroid.

Radiofrequency ablation (RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.

RFA can be used to help patients with chronic low-back and neck pain and pain related to the degeneration of joints from arthritis.

After local anesthesia is administered, the doctor inserts a small needle into the general area where the patient is experiencing pain and a microelectrode is inserted through the needle to begin the stimulation process.  A small radiofrequency current is sent through the electrode into the surrounding tissue, causing the tissue to heat.

Neurostimulation works by applying an electrical current to the source of chronic pain. This creates a sensation that blocks the brain’s ability to sense the previously perceived pain.

Neurostimulation has become a standard treatment for patients with chronic pain in their back and or limbs who have not found pain relief from other treatments.

There are two related forms of electrical stimulation commonly used to treat chronic pain:

• Spinal cord stimulation: In spinal cord stimulation, soft, thin wires with electrical leads on their tips are placed through a needle in the back near the spinal column.  A small incision is then made and a tiny, programmable generator is placed under the skin in the upper buttock or abdomen. The generator emits electrical currents to the spinal column.
• Peripheral Nerve Field Stimulation: Very similar to spinal cord stimulation, peripheral nerve field stimulation involves placing the leads just under the skin in an area near the nerves involved in pain.

In both approaches, the generator can be programmed in a way similar to using a remote control to adjust the television. The intensity of electrical stimulation can be changed, and the system can be turned on and off to provide optimal pain relief. Although programming is initially done at the surgical center, patients can learn how to control the stimulation on their own and adjust it to their pain levels.

A sacroiliac (SI) joint injection, also called a sacroiliac joint block, is primarily used to diagnose or treat low back pain and/or sciatica symptoms associated with sacroiliac joint dysfunction.

The sacroiliac joints lie next to the spine, one on the right and one on the left, and connect the sacrum with the hip on both sides.  Joint inflammation or dysfunction in this area can cause tremendous pain.

A therapeutic SI joint injection provides relief of the pain associated with sacroiliac joint dysfunction.

The sacroiliac joint is numbed with a local anesthesia using fluoroscopy (X-ray guidance) for accuracy, contrast is injected into the joint to ensure proper needle placement and proper spread of the numbing medication.

If the therapeutic sacroiliac joint injection is successful in reducing or eliminating the patient’s pain for a longer duration, it may be repeated up to three times per year, in conjunction with physical therapy and rehabilitation program, to help the patient maintain normal function.