Many Chronic Pain conditions may respond to selective injection treatment directed to the cause or focus of pain. Such therapy may provide reduction of pain for weeks or months, allowing additional rehabilitation and physiotherapy treatment or reduction in medication..
All injection therapy may cause side effects. These are usually minor and temporary.
The following injection techniques may be considered:
Simple nerve blocks, trigger point and joint injections
Intra-muscular Botulinum toxin injections
Intravenous lignocaine infusion
Spinal injection, including epidural, nerve root block and facet joint injection
Sympathetic nerve block, including stellate ganglion, lumbar sympathetic, coeliac and hypogastric block
a) Simple nerve blocks and joint injections with local anaesthetic and steroid: may be undertaken under X-ray control. Examples include trigger point injection, ilioinguinal, pudendal, occipital and suprascapular nerve block, rectus sheath infiltration and intra-articular knee and hip injection.
b) Botulinum toxin injection: may be considered for persistent muscle spasm pain that responds to trigger injection with local anaesthesia injections.
c) Intravenous lignocaine infusion: may be considered for fibromyalgia or complex neuropathic pain conditions.
d) Spinal injections: therapeutic spinal injections with local anaesthesia and steroid deliver treatment to the focus of pain in the spine. They may provide pain relief for weeks or months, allowing healing or providing long term benefit.
Injections can be directed at any level in the spine from the neck (cervical) to the lower back (lumbar and caudal). Examples of such injection treatment include:
Epidural Injection. This may be undertaken to reduce nerve and inflammatory pain associated with a disc herniation, sciatica and spinal stenosis.
There is evidence to suggest that the injection into the epidural space, reduces inflammation and the abnormal excitability in the nerve tissue.
Nerve root block. The nerve root is a branch of the spinal cord and supplies various parts of the body. If irritated through pinching or pressure from discs or degenerate joints, nerve pain may be experienced, typically in the arm or leg.
The injection is undertaken under X ray guidance with local anaesthesia and steroid and may provide pain relief for weeks to months.
Occasionally it may be necessary to repeat such treatment.
Facet joint injection. The facet joints are small joints that help to stabilise and allow flexibility of the spine. These joints may degenerate as part of the normal aging process, or may be sprained through trauma to the spine, such as in a road traffic accident.
A facet joint or nerve block may reduce the pain signals originating from the affected joint for weeks or months, allowing additional therapies to strengthen the back and prevent recurrence.
The treatment may need to be repeated or a longer lasting treatment considered, such as radiofrequency denervation.
e) Sympathetic nerve blocks. Injections with local anaesthesia delivered to the specialized plexus of nerves may provide pain relief for weeks to months, allowing healing or providing long term benefit.
Sympathetic nerve pain may be associated with chronic abdominal and pelvic pain, complex regional pain syndrome and following trauma or surgery to a limb.
Examples of such injection treatment include Stellate Ganglion, Lumbar Sympathetic, Hypogastric Plexus Block and Coeliac Plexus Block.
All injections are undertaken under x ray control and may be repeated or a longer lasting treatment considered, such as radiofrequency denervation.