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Injection Treatments

Overview

Definition

 

Epidural Steroid Injections

  • Delivers pain medicine into the body through a fat-filled area that covers the spinal cord

  • Used for difficult-to-treat pain caused by inflamed spinal nerves

  • Used for conditions like herniated discs, “slipped” vertebrae, joint cysts, bone spurs, spinal arthritis

  • Side effects: flushing of face and chest, sleeping problems, anxiety, menstrual changes, water retention, pain increases for several days after the procedure

  • Usually an outpatient procedure

  • Pain relief can occur 1-3 days after the injection, but sometimes it takes a week

  • Often gives pain relief for several months

  •  Injections can be repeated if the pain returns

Nerve Blocks

  • Different types of nerve blocks:

    • Sympathetic blockade- medication blocks pain from the sympathetic nervous system in one area

    • Neurectomy- a damaged peripheral nerve is surgically destroyed

    • Rhizotomy- surgeon destroys the root of the nerves that extend from the spine

    • Epidural analgesia- injecting medicine outside the spinal cord

    • Spinal analgesia- injecting medicine into the fluid that surrounds the spinal cord

    • Peripheral nerve blockade- injecting medicine around a target nerve that is causing pain

  • Nerve blocks provide immediate relief

  •  Pain relief may be short-term or long-term

  • Repeat injections may be needed

  • Uses: labor and delivery pain, pain after surgery, cancer-related pain, arthritis pain, trigeminal neuralgia, low back pain, migraines, occipital neuralgia, complex regional pain syndrome

Joint Injections

  • Corticosteroid Injections

    • A steroid and a numbing agent is injected directly into the joint

    • Reduce pain and inflammation

    • Pain relief lasts a month unless Zilretta is used. Zilretta can last for up to three months.

    • It is possible to have a pain flare-up in the joint after the injection, but this usually only lasts for 48 hours

    • Repeat steroid shots can cause the cartilage to deteriorate

    • These injections should only be done 2-3 times a year

    • More research is needed for long-term benefits

  • Hyaluronic acid

    • Hyaluronic acid is a natural lubricant that breaks down in joints affected by osteoarthritis. These injections replace the lubricant that was broken down.

    • One injection per week for 3-5 weeks

    • Can provide significant relief from pain and stiffness for up to six months

    • Can be used on knees shoulders and hips

  • Prolotherapy

    • A series of injections of an irritant into joints, ligaments, and tendons

    • Injections stimulate the healing of injured tissues; plays a role in cartilage growth

    • 15-20 shots given monthly for 3-4 months

    • More research is needed to confirm the safety of injections

    • Use on any joint affected by tendinitis or osteoarthritis

    • Study done on 20 participants showed a significant decrease in pain

  • Platelet-Rich Plasma

    • Made from your own blood and then injected into your joint

    • Contains platelets and proteins that have anti-inflammatory and immune-modulating effects

    • Can be given as a one-time shot or done once a week for three weeks

    • Relieves pain and stiffness, but more research is needed to determine the long-term efficacy

    • One study showed a decrease in pain for up to 12 months

    • Works best in patients who do not have severe cases of osteoarthritis

  • Stem Cell Injections/Autologous Fat Injections

    • The stem cells can come from either bone marrow or fat tissue. The cells are injected into a painful joint.

    • Some studies have shown symptom improvement

    • Has the potential to prevent disease progression

    • More research is needed

Trigger Point Injections

  • Trigger points are “knots” located in skeletal muscle that cause pain

  • Trigger points are caused by acute trauma or repetitive microtraumas

  • Used to treat myofascial trigger points; effective at deactivating trigger points

  • They can be done with a local anesthetic, corticosteroids, botulinum toxin, or without any injection substance (dry needling)

  • Cause temporary relaxation of the muscle

  • One study showed trigger points can cause a significant decrease in pain in people with post-mastectomy pain syndrome (2021)

Sources

Epidural corticosteroid injections. Epidural Corticosteroid Injections | Johns Hopkins Medicine. (2019, November 19). Retrieved March 17, 2023, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/epidural-corticosteroid-injections#:~:text=In%20the%20simplest%20of%20terms,the%20surrounding%20nerves%20from%20damage.

Nerve blocks. Nerve Blocks | Johns Hopkins Medicine. (2021, May 27). Retrieved March 17, 2023, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/nerve-blocks

Joint injections for arthritis pain: Arthritis foundation. Joint Injections for Arthritis Pain | Arthritis Foundation. (n.d.). Retrieved March 17, 2023, from https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/joint-injections-for-arthritis-pain

Raeissadat, S. A., Ghazi Hosseini, P., Bahrami, M. H., Salman Roghani, R., Fathi, M., Gharooee Ahangar, A., & Darvish, M. (2021, February 3). The comparison effects of intra-articular injection of platelet rich plasma (PRP), plasma rich in growth factor (PRGF), hyaluronic acid (HA), and ozone in knee osteoarthritis; a one year randomized clinical trial. BMC musculoskeletal disorders. Retrieved March 17, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7860007/

Zhao, A. T., Caballero, C. J., Nguyen, L. T., Vienne, H. C., Lee, C., & Kaye, A. D. (2022, May 31). A comprehensive update of prolotherapy in the management of osteoarthritis of the knee. Orthopedic reviews. Retrieved March 17, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235417/

Rahimzadeh, P., Imani, F., Faiz, S. H. R., Entezary, S. R., Zamanabadi, M. N., & Alebouyeh, M. R. (2018, January 4). The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clinical interventions in aging. Retrieved March 17, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5757490/

Topol, G. A., Pestalardo, I. G., Reeves, K. D., Elias, F., Steinmetz, N. J., Cheng, A.-L., & Rabago, D. (2022, November 14). Dextrose prolotherapy for symptomatic grade IV knee osteoarthritis: A pilot study of early and longer-term analgesia and pain-specific cytokine concentrations. Clinics and practice. Retrieved March 17, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9680458/

Bennell, K. L., Hunter, D. J., & Paterson, K. L. (2017, April 6). Platelet-rich plasma for the management of hip and knee osteoarthritis – current rheumatology reports. SpringerLink. Retrieved March 17, 2023, from https://link.springer.com/article/10.1007/s11926-017-0652-x

Hammi, C., Schroeder, J. D., & Yeung, B. (2022, November 25). Trigger point injection – statpearls – NCBI bookshelf. National Library of Medicine. Retrieved March 17, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK542196/

Khoury, A., Keane, H., Varghese, F., Hoseini, A., Mukhtar, R., Eder, S., Weinstein, P., & Esserman, L. (2021, September 17). Trigger Point Injection for post-mastectomy pain: A simple intervention with high rate of long-term relief. NPJ breast cancer. Retrieved March 17, 2023, from https://pubmed.ncbi.nlm.nih.gov/34535677/