Anesthetic or corticosteroid injections for low back pain

Examples

Trigger point injections. Sometimes, putting pressure on a certain spot in the back (called a trigger point) can cause pain at that spot or extending to another area of the body, such as the hip or leg. To try to relieve pain, a local anesthetic, either alone or combined with a corticosteroid, is injected into the area of the back that triggers pain (trigger point injection).

Facet joint injections. A local anesthetic or corticosteroid is injected into a facet joint, which is one of the points where one vertebra connects to another.

Epidural injections. A corticosteroid is injected into the spinal canal where it bathes the sheath that surrounds the spinal cord and nerve roots.

These injections can be done by an orthopedist, an anesthesiologist, a neurologist, a physiatrist, a pain management specialist, or a rheumatologist.

How It Works

Local anesthesia is believed to break the cycle of pain that can cause you to become less physically active. Muscles that are not being exercised are more easily injured, so the irritated and injured muscles can cause more pain and spasm and can disrupt sleep. This pain, spasm, and fatigue, in turn, can lead to less and less activity.

Steroids reduce inflammation. So a corticosteroid injected into the spinal canal can help relieve pressure on nerves and nerve roots.

Why It Is Used

Injections may be tried if you have symptoms of nerve root compression or facet inflammation and you do not respond to nonsurgical therapy after 6 weeks.

How Well It Works

Research has not shown that local injections are effective in controlling acute or chronic low back pain that does not spread down the leg.¹

Side Effects

Trigger point injections

Possible side effects include nerve or other tissue damage, infection, or excessive bleeding.

Facet joint injections

Possible side effects include pain at the injection site, infection, excessive bleeding, nerve damage, or spinal cord inflammation.

Epidural steroid injections

Rare possible side effects include headache, fever, spinal cord inflammation, or infection.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

These injections can be painful.

Most orthopedists and rheumatologists advise against repeated injections of corticosteroids directly into joints, including joints of the spine, because degeneration or damage to joint cartilage may occur.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: February 3, 2010
Medical Review:	William M. Green, MD - Emergency Medicine Robert B. Keller, MD - Orthopedics
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