Injections for Pain Relief

Myofascial pain comes from your skeletal muscle and connective tissue. When muscle is overused, it can form knots in the trigger points of those muscles. This can happen to your back, shoulder, hip, leg or any body part with soft tissue.

If your muscle forms knots in trigger points, you may need a more targeted treatment approach. At BIDMC we use dry needling to relax the muscle.

What To Expect During Dry Needling

Here’s how dry needling works:

We also offer wet needling. This procedure follows the same process but includes a numbing medicine.

The goal of needling is to cause a twitch response. Without it, your chance for pain relief is much lower.

Afterward, you may be sore at the injection site. You should be able to return to normal activity within one to two days.

In general, needling is appropriate for nearly all adult patients.

At the Spine Center and the Arnold-Warfield Pain Center, we use the most advanced techniques to treat your pain. Image-guided injections provide relief at the source of your pain.

We use imaging devices such as an MRI or X-ray fluoroscopy to guide the needle to the precise pain point. This lets your doctor deliver numbing medicine or steroids directly to the joint, muscle or nerve causing your pain — without damaging any nearby tissues.

We offer several types of image-guided injections:

We provide ESI as an outpatient procedure to deliver anti-inflammatory medicine to a precise area of the epidural space in the spine. We use continuous X-ray guidance called fluoroscopy to guide the needle to the right location.

Benefits of ESI

• Helps with diagnosis. ESI can diagnose and treat spinal pain. We place medicine in a precise area and monitor your response. This provides details on which nerves may or may not be involved in causing your pain. Your doctor uses this information to pinpoint a treatment location.
• Reduces inflammation. ESI calms inflamed tissue in the nerve root. 
• Relieves pain. ESI relieves pain in the arm and legs caused by an irritated nerve root.

What to Expect During an ESI Procedure

An epidural steroid injection takes about 15 minutes. After you enter the procedure room:

• You will lie face down on a table.
• Your doctor injects numbing medicine into your back.
• Your doctor injects contrast dye into the treatment area. The dye makes the structures of the spine visible on an X-ray.
• Your doctor injects steroid medicine into the precise treatment area of your spine, using X-ray images to guide the needle.

After the injection, we observe you for 20–30 minutes before you can go home.

• Your arms and legs may be weak from the numbing medicine.
• Arrange for someone else to drive you home.
• Be careful when moving around for the rest of the day.

How Long Does ESI Work?

It can take a few days for an ESI injection to take effect.

• Many patients enjoy a decrease in arm and leg pain.
• Pain reduction usually lasts between six and 12 weeks. 
• ESI can be repeated.
• Patients who feel better may not experience complete pain relief.

At BIDMC, it’s our goal to help you reduce your level of pain.

Common Misconceptions About ESI

• Frequency. There is no maximum number of ESI treatments. You may get relief after one or two treatments, or you may need more injections. Your doctor will talk with you about the right number of treatments for you.
• ESI versus epidural anesthesia. An ESI is not the same as epidural anesthesia used during childbirth and certain surgeries. An ESI involves one needle and uses X-ray guidance. Side effects such as headaches that sometimes occur after epidural anesthesia are rare after an ESI. 

This advanced technique delivers steroid medicine to a specific area of the spine using the foramen. The foramen are openings between the vertebrae where spinal nerves exit the spine and travel to other parts of the body.

Benefits of Transforaminal ESI

• Reducing pain. This procedure may reduce pain in the arms or legs caused by nerve problems in the spine. This is because medicine is delivered into the foramen, where the nerve begins. 
• Identifying the correct nerves. When your doctor injects the temporary numbing medicine lidocaine into your back before the procedure, he will ask you about your pain. If your pain is relieved right away, then your doctor knows they have targeted the correct location. This information ensures that future steroid injections or surgery target the right nerves.

Considerations 

Spine injections should be performed only by doctors with special training in neurology. Before your ESI procedure, your doctor will review detailed pictures of your spine using an MRI or CT scan. This helps determine the best approach during your transforaminal ESI.

What to Expect During a Transforaminal ESI 

A transforaminal ESI takes about 15 minutes. After you enter the procedure room:

• You will lie face down on a table.
• Your doctor injects numbing medicine into your back.
• Your doctor injects contrast dye into the treatment area. This makes the structures of the spine visible on an X-ray.
• Your doctor injects steroid medicine into the precise treatment area of your spine, using X-ray images to guide the needle.

After the injection, we observe you for 20–30 minutes before you can go home.

• Your arms and legs may be weak from the numbing medicine.
• Arrange for someone else to drive you home.
• You should be careful when moving around for the rest of the day. 
• You may feel some discomfort for a few days after your injection before you have less pain.

How Long Does a Transforaminal ESI Work? 

It can take a few days for a transforaminal ESI injection to take effect.

• Many patients enjoy a decrease in arm and leg pain.
• Pain reduction usually lasts between six and 12 weeks.
• Transforaminal ESI can be repeated.
• Patients who feel better may not experience complete pain relief.