Back pain injections Which injection fits which kind of back pain

“Should I get an injection for my back?” depends on one thing above all: where the pain is coming from. A muscle, a nerve and a joint each need a different injection, and the wrong one simply will not help. This guide compares the main options our pain management physicians use, so you know what to ask at your visit. For every back condition we treat, see lower back pain treatment.

Types of back pain injections

Trigger point injections: for muscle knots

When a tight band of muscle is tender and refers pain nearby, a trigger point injection (sometimes called a muscle knot injection) can help. A small amount of local anesthetic, sometimes with a corticosteroid, is injected directly into the knot to release it. It is quick, and most people go back to normal activity the same day. Ultrasound can help guide injections into muscle and soft tissue; the second video shows an ultrasound-guided injection in the lower back. More on trigger point injections.

Epidural steroid injections: for an irritated nerve

When a disc bulge or narrowing of the spine irritates a nerve root, pain shoots into the buttock and leg (sciatica). An epidural places anti-inflammatory steroid next to that nerve. The animation in the first video highlights an irritated nerve beside the lower spine. Epidurals are done under live X-ray, and the third video shows contrast dye being drawn up to confirm where the medicine will spread. See epidural steroid injections, our post on how an epidural treats back pain, and epidural steroid injection recovery.

Medial branch blocks: to test the facet joints

Facet arthritis causes a deep ache beside the spine that is worse with standing and leaning back. A medial branch block briefly numbs the small nerves to those joints. If your usual pain drops for a few hours, the facet joints are likely the source. Our post on facet joint pain explains the test.

Radiofrequency ablation: longer relief for facet pain

After a positive test block, radiofrequency ablation uses a heated probe tip to stop those nerves from carrying pain signals. Relief often lasts many months and can be repeated if the nerves regrow.

How back pain injections are guided

Image guidance lets the physician see the target instead of working by feel. Fluoroscopy (live X-ray) shows bone and, with a little contrast dye, where the medicine will flow, which is why it is used for epidurals and facet procedures. Ultrasound shows muscles and soft tissue without radiation and suits many muscle and joint injections. Your physician explains which guidance your procedure uses before it is scheduled.

How long relief lasts

• Trigger point injection: from days to several weeks; often repeated a few times alongside stretching and strengthening
• Epidural steroid injection: the steroid usually starts working within two to seven days, and relief lasts weeks to several months
• Medial branch block: a few hours, by design, because it is a test
• Radiofrequency ablation: often many months

Results vary from person to person. An injection that brings no relief is still useful information, because it helps rule a source in or out.

Who is a good candidate, and who is not

Injections make most sense when pain has lasted several weeks despite exercise and physical therapy, when the exam points to a specific source, or when pain is blocking you from doing rehab at all. Tell your physician if you take blood thinners, have diabetes, an infection or a fever, a contrast dye allergy, or could be pregnant, because these can change the plan or the timing.

Injections work best as part of a plan

An injection lowers pain; it does not strengthen the back or change how you move. The weeks of lower pain are the time to build strength and endurance with physical therapy, offered at our Brooklyn and Staten Island offices. Our guide to chronic back pain treatment covers the full range of non-surgical options.

When to get help right away

Go to an emergency room or call 911 for back pain with loss of bladder or bowel control, numbness in the groin, sudden leg weakness, or fever.

Related care at Precision Care Medical & Sports Performance

A back pain doctor near you

Every injection starts with an evaluation by one of our pain management physicians. Pain procedures are performed at all three offices, and your physician explains where and when yours will be scheduled. For back pain treatment in Brooklyn, Ashley Marcus, MD sees patients at our Brooklyn pain management office, convenient to Sheepshead Bay, Midwood and Coney Island, and physical therapy is offered there too. If you need a back pain doctor on Staten Island, Jake Stephen, DO sees patients for pain management on Staten Island, close to New Dorp, Great Kills and Oakwood, also with physical therapy on site.

For a back pain doctor in Midtown East, Yuri Gordin, MD sees patients at the Precision Care Spine & Pain Center in Midtown Manhattan, 150 E 55th St, an easy trip from Spanish Harlem, Washington Heights, Turtle Bay and the Upper West Side. Physical therapy is not offered at the Midtown Manhattan office. Searching for a back pain doctor near me? Request an appointment or call the office closest to you.

Questions patients ask

Educational only, not medical advice. These videos and this article explain common problems and treatments in general terms. They are not a diagnosis or a treatment plan for you. Results vary from person to person. See a qualified clinician about your own symptoms, and call 911 or go to an emergency room for an emergency.

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