Back and Neck Pain? Spine Injections Offer Relief Without Surgery

According to Dr. Guo, spine injections are most effective at treating pain that radiates from your back to your legs, or from your neck to your arms (radicular pain) as well as localized pain that stays along the middle of your back or the side of your neck (axial pain).

Radiating back or neck pain is usually caused by pinched nerves in the spine due to deterioration of the discs (slipped discs), spine facet joint arthritis, overgrowth of the spinal ligaments, or other causes of spinal nerve irritation (for instance, inflammation, infection, or trauma). Sciatica pain, pain in the legs with or without back pain, is caused by a narrowed spinal canal or pressure on the sciatic nerve.

People with radiating back pain often benefit from epidural steroid injections. Your doctor will determine exactly where to place the injection based on your symptoms, how many injections you need, and how much time should pass between injections. For accuracy, your doctors use a special type of X-ray called fluoroscopy to guide placement. The doctor places a needle into the epidural space -- the area between your spinal column and the outer membrane of the spinal sac -- and then injects a steroid to help reduce inflammation and nerve irritation that may be causing your pain. The duration of relief varies from person to person and even from one injection to the next, depending on the deterioration of your spine and the type of activities you perform. On average, epidural steroid injections relieve pain for up to three months or more.

Axial back and neck pain stays close to its source; it doesn’t radiate to your arms or legs. However, it can cause referred pain -- a dull, achy pain felt in your buttocks, groin, or upper back or arm that is unrelated to the pain source. Common causes of this type of back pain are arthritis in or injuries to the sacroiliac (SI) joint -- which connects your tailbone and pelvic bone -- or spinal (facet) joints along the back of your spine bone. Treatments include steroid injections into the SI or facet joints. On average, joint steroid injections relieve pain for up to three months or longer.

Another option specifically for facet joint pain are nerve blocks followed by ablation. This treatment may be slightly more effective than steroid injections but requires additional doctor visits. During the first two visits, your doctor will inject numbing medications around the small nerves (medial branch nerves) to pinpoint and confirm your pain source. If you experience significant pain relief from both nerve blocks, you will return for radiofrequency ablation. During this procedure, your doctor will use a specially designed needle with a heated electrode tip to damage the medial branch nerves so they can no longer send pain signals from the facet joints to your brain. On average, pain relief from a nerve ablation lasts about 10 months. Nerve blocks and ablation can also treat axial neck pain with similar results.

Learn more about spine injections and how they are used to treat back pain.

According to Dr. Guo, if you haven’t experienced relief from medications, physical therapy, or chiropractic care, spine injections may reduce your pain enough to avoid surgery. If symptoms improved at first but then return, you may benefit from additional injections.

“There are patients whose spinal changes are so severe that they may have limited or no pain relief from other treatments. Those patients may need to undergo surgery,” Dr. Guo said. “Even in those cases, our surgeons often recommend spine injections before considering surgery.”

It’s important to find a doctor with appropriate training, expertise, and experience. At Duke, non-surgical spine specialists like Dr. Guo and spine surgeons have completed special training to administer spine injections. For accuracy, Duke’s sterile procedure rooms are equipped with fluoroscopy, which doctors use to guide needle placement during injections. When performed by a properly trained doctor with fluoroscopic guidance, spine injection risks are low and the potential benefits are significant.

Like any procedure using needles, the risks of spine injections include bleeding, infection, and nerve damage. Common side effects include mild injection site pain, temporary worsening of symptoms, feeling flush, insomnia, headache, and increased blood sugar. These usually resolve within a few days.