Most of the patients we see have chronic spinal pain caused by injury or irritation of one of the primary components of the spine – the bones, joints between the bones, discs and nerves. Once this pain occurs, the supporting muscles go into spasm to prevent further injury to the spine – and cause additional pain. Sometimes the spinal and muscle pain lead to stress and depression – and even more pain.While chronic spinal pain may be disabling and prevent you from living life to the fullest, it is not a life-threatening condition and can often be treated successfully.
Diagnosing Spinal Pain
When patients experience pain or weakness along the course of a nerve, patient history, physical examination and X-rays, including MRI scans, are often effective in diagnosing the source of pain. It’s more difficult to pinpoint the exact source for patients experiencing mostly back or neck pain, even with MRI scans. Because there are so many nerves connected to the spine, many of which overlap, there could be more than one cause of a particular pain. Since knowing the source of pain is key to the most effective treatment, especially when surgery is a possibility, we may suggest diagnostic injections.
During this procedure we inject specific parts of your spine with contrast dye and/or local anesthetic, and then monitor your pain. Whether or not you experience any pain relief – and how much – tells us a lot. So we may ask you to do whatever usually causes pain and see if anything has changed. Diagnostic injections often include a small amount of cortisone which, based on any pain relief it provides in the next week or two, also assists with an accurate diagnosis.
The appropriate combination of clinical information, imaging studies and diagnostic injection usually results in about a 75% success rate in diagnosing the source of your spinal pain.
Treating Spinal Pain
Depending on the cause of your chronic spinal pain, we will recommend some combination of physical therapy, surgery, pain management or therapeutic injections. The first treatment option is physical therapy, with an emphasis on activity and return to function, and it is often all that is needed. If your pain persists, we may then recommend surgery. However, the most successful surgery depends on having the most accurate diagnosis regarding the source of pain. When surgery does not seem likely to succeed, we will recommend ways to make living with your pain more bearable. This could involve anything from traditional pain medication to alternative medicine techniques such as acupuncture.
Finally, if we know the exact source of your spinal pain, we may recommend therapeutic injections. These typically consist of local anesthetic and cortisone medications, and may be accompanied by heat applications. Therapeutic injections not only have the potential to provide long-term pain relief, but even in the short-term will increase the effectiveness of other treatments.
Risks and Side Effects
We use X-ray guidance to ensure the maximum safety and success of all our spinal injection procedures. As with any medical treatment, however, there are possible risks which include bleeding, infection, allergic reaction, minor side effects and more serious complications.
Minor bleeding from the needle placement is not uncommon, however, to minimize the risk of serious complications, we instruct you to stop taking anti-inflammatories for three days prior to your procedure, stop taking aspirin for seven days prior, and notify us if you take blood-thinning medications.
Needle procedures seldom result in a significant infection, however, minor infections can lead to serious complications with certain disc injection procedures. As a preventive measure in those cases, we’ll administer antibiotics both intravenously and directly into the disc at the time of the procedure.
You may also have a minor allergic reaction to the medications used during the procedure, including the contrast material or “dye” used for more accurate diagnosis and treatment. To avoid more serious complications, be sure to let us know in advance of any medication allergies. Since all procedures use local anesthesia and intravenous sedation, we’ll take the further safety precautions of administering oxygen while constantly monitoring your blood pressure, heart rate, and oxygen levels.
Common minor side effects after injection procedures include temporarily impaired coordination, numbness or weakness, soreness or increased pain.
There may be lingering effects from the sedative medications, so we recommend you not drive, and limit any activities requiring coordination, for a day after the injection. You may also experience localized numbness or weakness for up to six hours until the local anesthetic injected into the spine wears off.
Some soreness at the site of the injection for a day or two is also not uncommon, and may be eased by applying ice packs.
Especially if you’ve had a discogram, don’t be surprised if you experience a higher level of pain for up to 10 days after the injection. Simply rest and take your usual pain medication, but let us know if the pain continues.
If your injection contained cortisone, note that it may take up to 14 days for the full effect, although you may find some pain improvement in just two to three days. Side effects are rare, but have been known to include: sweating, flushing, palpitations, increased heart rate, insomnia, anxiety, hiccoughs, headache, menstrual changes, upset stomach, frequent urination and slight fever with flu-like symptoms. Be sure to let us know if any of these side effects bother you intensely or for more than three days.
More serious complications are rare, but may include: increased pain, headache, temporary or permanent nerve damage, hip (bone) damage caused by steroids, seizures, difficulty breathing, collapsed lung, death and paralysis. Serious complications related to bleeding and infection in particular can occur after you’re back home recovering. With that in mind, please be sure to let us know immediately if you develop fever, progressive weakness or numbness, loss of bowel or bladder control or any other symptoms that concern you.