Back and Neck Pain? Spine Injections Offer Relief Without Surgery

Duke Spine Expert Explains How Spine Injections Work

By Morgan deBlecourt and Erin Hull
March 22, 2022
A man holds his back in pain while sitting in front of a computer

If back pain is making it difficult to accomplish daily tasks, spine injections are a low-risk treatment option that provide quick relief without surgery. Here, Duke’s Michael Guo, MD, a physiatrist  who specializes in treating spine-related problems with injections, explains common types of injections and the kinds of back and neck pain they treat.

Spine Injections Treat Two Main Types of Back and Neck Pain

According to Dr. Guo, spine injections are most effective at treating pain that radiates from the back or neck to the legs or arms (radicular pain) and localized pain that stays in one place (axial pain).

Radiating Back or Neck Pain

Radiating back or neck pain is usually caused by pinched nerves in the spine due to a slipped disc, spine joint arthritis, changes in your spinal ligaments, or other causes of spinal nerve irritation. Sciatica pain, also a type of radiating 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 your injection based on your symptoms, how many injections you need, and how much time should pass between injections. For accuracy, spine doctors use a special type of X-ray called fluoroscopy for guidance. The doctor places a needle into the epidural space -- the area between your spinal column and the outer membrane of the spinal sac -- then injects a steroid to help reduce inflammation and nerve irritation that may be causing your pain. On average, epidural steroid injections relieve pain for up to six months or more.

Back and Neck Pain that Stays in One Place

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. Treatments include steroid injections into the SI or facet joints. On average, joint steroid injections relieve pain for up to six months.

Another option specifically for facet joint pain is a nerve block with 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 to pinpoint and confirm your pain source. If you experience significant pain relief from both injections, you will return for radiofrequency ablation. During this procedure, your doctor will use a specially designed needle with a heated electrode tip to damage specific nerves so they can no longer send pain signals to your brain. On average, pain relief from a nerve ablation lasts about 10 months. 

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

Are Spine Injections Right for You?

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 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. Those patients may need to undergo surgery,” Dr. Guo said. “Even in those cases, our surgeons often recommend spine injections before considering surgery.”

What to Look for in a Spine Injection Expert

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 a special type of X-ray called fluoroscopy that guides your doctor during the procedure. When performed by a properly trained doctor with fluoroscopic guidance, spine injection risks are low and the potential benefits are significant.

Spine Injection Risks and Side Effects

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.

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