Epidural injections utilise corticosteroids and local anaesthetic, which are injected into the epidural space under X-ray guidance.
There is no evidence that epidural injections are helpful in chronic back pain. There is some evidence that epidural injections may be useful in treating acute symptoms of sciatica-type pain (or radiculopathy). However, the effectiveness is rather short-lasting, with some improvement in the three - to six - week period following the injection. There is hardly any benefit after three months from the epidural injection. Generally, epidural injections are not recommended for long-term pain relief in chronic back pain.
Facet joint injections use corticosteroids and local anaesthetic which is then injected under X-ray guidance into the facet joint considered to be the cause of lower back pain. It is essential to undertake relevant investigations, including MRI and SPECT scans, to establish if indeed the facet joints are the possible cause of lower back pain or not.
The effectiveness of facet joint injections in lower back pain is not assured, although they can provide some pain relief in a short-term period. Generally, facet joint injections are not recommended for long-term pain relief in chronic back pain.
Nerve root injections or nerve root blocks use a local anaesthetic, sometimes combined with a corticosteroid, and under X-ray guidance infiltrate one or more particular nerve roots. This treatment can provide some pain relief in radiculopathy syndromes; that is, when specific nerve roots are affected by a process causing their irritation and inflammation.
The pain relief is usually short-term, lasting typically four to eight weeks. This technique is not recommended for long-term pain relief in chronic back or neck pain.
There are many various painkillers and pain modification drugs used to treat back pain, neck pain and radicular pain symptoms, including sciatica.
Most commonly used are paracetamol, a non-steroidal type of medication, and acetaminophen. These medications can be obtained over the counter in most places. Non-steroidal medications include naproxen, ibuprofen, diclofenac, indomethacin, etodolac, piroxicam, mefenamic acid, ketoprofen and many others. They are helpful in particular with short-lasting episodes of pain. However, they can cause gastric erosion and stomach ulcers and can also have severe consequences in patients who are asthmatic. These types of medications have side effects and contraindications. Thus, their use and doses must be discussed with a physician.
In some cases, an opioid type of analgesia is used. These are required for severe lower back and radicular pain, including sciatica. However, due to their addictive nature, this type of medication should not be used beyond two to three weeks.
Mild to moderate pain may respond to codeine or tramadol.
Moderate to severe pain may respond to hydrocodone, oxycodone, hydromorphone and morphine. In some cases of severe spinal pain, transdermal patches of fentanyl are used.
The use of any opioid medication, doses, indications, contraindications and side effects must be discussed with a relevant physician or pain specialist. Their use must be prescribed and guided by a competent professional.
Examples of Medication Mistakes:
Avoid Getting the Wrong Prescription:
Spinal pain and radiculopathy, including sciatica, are more likely to respond to treatment if the individual suffering from one of these conditions has a positive attitude and appropriate education. Thus, psychological support in patients with spinal conditions is genuinely precious and relevant. It has been documented that individuals suffering from lower back pain and scoring highly on the Keele STarT Back Screening Tool are likely to fail the treatment unless adequate psychological support is provided.
In some cases, and especially in individuals suffering from chronic, long-standing back pain and sciatica, the pain can cause depression and anxiety. Equally, depression and anxiety can make back pain and sciatica significantly worse and overall exacerbate many symptoms besides the pain.
There are many types of psychological support which can be utilised for individuals suffering from spinal and radicular pain. Most commonly is cognitive behavioural therapy (CBT). If you suffer from a spinal condition, and if that condition is long-standing, then getting adequate psychological support and guidance is paramount. Indeed, it should be an essential part of pain management and treatment.
Spinal manipulation is a manual therapy in which pressures and loads are applied to the spine. It combines moving and jolting joints with a massage. It can be a part of physical therapy. It is designed to treat back, neck and shoulder pain and headaches.
It may be helpful in patients with spinal or back pain only. Spinal manipulation therapy is not recommended for radiculopathy ( pain radiating down one's arm or leg ) and sciatica-type pain. It is contraindicated and should not be used in individuals presenting with neurological deficit ( weakness and loss of sensation ). In those cases, serious spinal conditions must be ruled out first.
Spinal manipulation therapy is usually provided by chiropractors and physiotherapists. Before trying spinal manipulation therapy, you should discuss this method with your physician.
Spinal cord stimulator insertion is a surgical treatment for spinal (back) pain and can be useful especially for failed back syndrome. Please follow the link to Failed Back Syndrom