This information will help you prepare for spinal injections for pain management.
Spinal nerves can become irritated and inflamed due to a variety of conditions, including:
- A problem with one of the rubbery cushions (disks) between the individual bones (vertebrae) that stack up to make your spine (herniated discs)
- Inflammation of the joints (arthritis)
- A narrowing of one or more areas in your spine (spinal stenosis)
- Spinal injury
Neck, back, and leg pain and possibly tingling can occur. Also, numbness or weakness that originates in the lower back and travels through the buttocks and down the large nerve in the back of the leg can result.
A spinal injection using steroids and/or numbing medications is often effective in decreasing pain. Steroids help to decrease nerve inflammation and discomfort. Numbing medication (lidocaine) can also be used to block the feeling of pain for a short period of time.
The injections may be done at different areas of the spine. Your doctor will decide which type of injection will be best for decreasing your discomfort. Types of spinal injections include:
- Epidural injection: The epidural space goes from the base of your head to the part of your spine that is below your hips. Nerves in the back are located in this space. A steroid and numbing medication can be injected into any area of the epidural space.
- Facet injection: The facet joint is where each bone of the spine connects to the next. Sometimes, the facet joints can develop arthritis and cause pain. Anti-inflammatory steroid and numbing medication can be injected directly into the facet joints to decrease pain.
- Medial branch block: Medial branch nerves are very small nerves that control sensation or feeling in the facet joint. These nerves send pain signals from the facet joint to your brain. Numbing medication can be injected around the medial branch nerve(s) to decrease pain from joint problems.
Before the Injection
- Tell your doctor about any of the following:
- All of your medical conditions
- All of the medications you are taking (including over-the-counter medications, vitamins, and herbal products)
- If you are taking any blood thinners, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs; i.e., ibuprofen (Advil®) and naproxen (Aleve®), warfarin (Coumadin®), enoxaparin (Lovenox®), dalteparin sodium (Fragmin®), clopidogrel (Plavix®), etc. If you are taking a blood thinner, your healthcare team at Memorial Sloan Kettering Cancer Center (MSKCC) will need to speak with the doctor who prescribed it for you. We must know if it will be safe for you to stop taking the blood thinner for your injection.
- Any history of allergies, especially to latex, iodine, contrast dye, lidocaine, or any antibiotics
- If you have or recently had an infection
- If you are presently receiving chemotherapy or radiation therapy
- If you think that you may be pregnant
- If you have any implants in your body (pacemakers, mediport, joint replacement, stents, shunts, breast implants, orthopedic hardware, etc.)
- If you have been told to take antibiotics prior to a dental procedure or surgery
- If you have had recent chest pain or trouble breathing
The Day of the Injection
- You can have a light breakfast on the morning of your injection.
- If you take daily medication, we will tell you which ones to take on the morning of your injection.
- For your safety, you must bring someone who will take you home after your injection.
- If you have been taking blood thinners, have had chemotherapy within the last month, or think that you may be pregnant, your physician may order blood tests to be done prior to the injection.
- The injection usually takes approximately 45 minutes.
- Prior to the injection, you will sign a consent form, change into a hospital gown, and have your blood pressure, temperature, breathing, and heart rate measured.
- Depending upon the injection site, you will lay on your abdomen or side. Using a special x-ray machine (fluoroscopy), your physician will locate where he will place the needle to inject the medication. A medicine will be used to numb your skin. Your physician will then insert a thin needle in the area where he will inject the medication. Before injecting the medication, a dye will be injected to check the position of the needle. Once your physician is sure that the needle is correctly placed, the steroid and/or numbing medicine (lidocaine) will be injected. The needle will be removed and a bandage will be placed over the injection site.
- Your physician will examine you and your blood pressure, heart rate, your breaths, and temperature at the end of the injection.
Caring for Yourself at Home
- You can remove the bandage from the injection site and shower on the morning after your procedure. Do not take a tub bath, soak in water, or swim for 24 hours after the injection.
- You can apply cold packs for soreness at the injection site (15 minutes on and 15 minutes off). Do not use heat on or near the injection site for 24 hours.
- Avoid strenuous physical activity and exercise (lifting weights, running, etc.) for one week following the injection.
- If you have stopped taking any medication for the procedure, ask your physician when you can start taking these medications again.
- For steroid injections, it may take up to 1 week before you feel the full benefit of the medication. In the meantime, you may take ________________ if you have discomfort.
- If you are a diabetic, you will have to monitor your blood sugar after the injection. Steroids can temporarily cause blood sugar to rise.
Call Your Doctor if:
- You develop changes in your vision, dizziness, bowel or bladder problems, increased drowsiness, a severe or persistent headache, a temperature greater than 100.4° F,
- You have any new or increasing pain, numbness, tingling feelings or limb weakness.
- You see any redness, swelling, drainage, or bleeding at the injection site.
- You have any problems or questions.