Anesthetic and Corticosteroid Injections
Trigger Point and Facet Point Shots Given for Back Pain
May 10, 2009
Occasionally, placing pressure on a specific spot of the back (known as a trigger point) may bring about pain in that area or extending to another region of the body, like the hip or lower portion of the upper leg. To control pain, a local anesthetic, either solely or jointly with an adrenal cortical steroid, will be given at the region of the back that activates pain (trigger point shot).
In facet joint shots, a local or corticosteroid is needled into a facet joint, which is among the places where one vertebra joins with another. For epidural shots, a corticosteroid is advanced into the spinal canal where it affects the sheath (covering) that encircles the spinal cord (medulla spinalis) and nerve roots.
The shots can be given by an orthopedist, an anesthesiologist, a brain doctor, a psychiatrist, a pain management doctor, or a rheumatologist.
How Anesthetic and Corticosteroid Injections Work
Local anesthesia is used to disrupt the cycle of pain that may make someone turn less physically active. Muscles that are not being used are more easily hurt, so the irritated and wounded muscles may cause additional pain and spasm and may interrupt sleep. This discomfort, spasm, and tiredness, in turn can result in less and less physical activity.
Steroids decrease inflammation, so a corticosteroid needled into the spinal canal may help control pressure on nerves and nerve roots.
Using Anesthetic and Corticosteroid Injections
Shots may be useful if you have signs and symptoms of nerve root compaction or facet inflammation and you don't react well to nonsurgical treatment following six weeks of therapy. Studies have not proven that localized shots are effective in keeping down long-term lower back pain.
When utilized to address long-term low back pain, a facet joint shot of a corticoid is less potent than a placebo shot and can even be dangerous.
Evidence proving the efficacy of epidural steroid shots varies among research facilities. Studies do not show a clear benefit. However, a few individuals appear to get short-term alleviation, particularly from pain that goes down the upper leg.
Side Effects of Anesthetic or Corticosteroid Injections
Potential side effects of trigger point injections are: nerve or other tissue injury, infection, or exuberant bleeding. Possible side effects of facet joint injections are: pain at the injection location, infection, heavy bleeding, nerve impairment, or spinal cord inflammation.
Rare, uncommon and potential side effects of epidural steroid shots are: migraine, high fever, spinal cord infection, or inflammation.
These shots are painful. Most orthopedists and rheumatologists recommend against recurrent shots of corticosteroids directly in joints, including articulations (joints) of the spinal column, since degeneration or injury to joint cartilage can happen.
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References:
Van Tulder M, Koes B (2006). "Low back pain (chronic)." Clinical Evidence. (15).
Datta D, et al. (2005). "Low back pain." In: ED Harris Jr et al. "Kelley's Textbook of Rheumatology." (7): 1; 588–600. Philadelphia: Elsevier Saunders.
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