As the number of pain management patients in United States continues to increase, pain itself is turning into big business. It is often times helpful for patients to receive an injection to avoid or delay surgery, or to allow individuals the ability to participate in physical therapy. Focal injections can also decrease the need for opiate pain medications.
Let's look at a few different types of injections and how well they work. The first type is soft tissue injections in the extremities. An example of this would be an injection of steroid medication into the shoulder area that is called the subacromial bursa. Impingement syndrome is one of the most common diagnoses seen in medicine today, and a subacromial injection can permit patients increased function of their shoulder and significant pain relief.
Another type of soft tissue injection example would be one for tennis elbow. This is a condition around the elbow that involves inflammation and pain of the tendon insertion on the outer part of the elbow. Injections of steroid work very well for this region, and often times the doctor will place small holes in the bony region to enhance blood flow and healing of the area.
Another type of injection performed in the extremities is a nerve block. Let's use an example of a supra-scapular nerve block which is a nerve that can become compressed around the shoulder region. Injecting steroid medication around the area of compression may allow a patient to participate in physical therapy along with providing excellent pain relief and may help the patient avoid surgery.
Additional examples of extremity nerve blocks will include a lateral femoral cutaneous nerve block, an ankle block, or a carpal tunnel injection. Occipital nerve blocks are utilized for occipital neuralgia. Occipital neuralgia may be a significant cause of migraine headaches, and blocking the nerves in this area may provide months of pain relief. If that works well, the pain doctor may move on to a radiofrequency ablation which may provide pain relief for over a year.
When it comes to interventional spinal injections, there are a few different types. These can be grouped into 3 different categories. The 1st are injections in or around the facet joint. Pain doctors may inject medication right into the joint or potentially around the joint which is called a medial branch block. The evidence for medial branch blocks is strong and can give weeks to months of pain related along with acting as a diagnostic injection. A subsequent procedure when that injection wears off called a radiofrequency ablation may allow patients to receive pain relief for over a year.
The next category of injections are referred to as epidural steroid injections. Evidence for these injections is strong, and there are currently three different types used by pain doctors. The first is known as interlaminar injections, which is the oldest type and has been done since the 1960s. Transforaminal epidural steroid injections are the newest type performed and allow the pain doctor to get fairly close to the area of the pinched nerve with steroid medication. The last type of epidural started injection is called a caudal injection, and works very well in situations where steroid is needed to work on multiple areas of compression.
The last category of spinal injections involves procedures to remove scar tissue. This is called an adhesiolysis and may be performed under a fiber-optic camera guidance. This is the least used of the interventional procedures.
Other procedures performed by pain doctors should be placed into a category termed exotic. These would be such things as superior hypogastric plexus blocks, sympathetic blocks, and Botox injections for neuromuscular conditions.
Lastly, one of the more exciting procedures in pain management they are spinal cord stimulator's. These are permanent implants that can help provide electrical stimulation around the spinal cord and decreased pain in situations where there is no solution to caring the painful problem.
As the years go by in pain management, technology continues to improve and it is a very exciting field presently. More research is necessary to keep up with the amount of pain issues in this country and keep coming up with new solutions to help those in need.
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