Epidural Steroid Injections
The fluoroscope is a powerful tool that is being used increasingly in the modern pain clinic for the diagnosis and treatment of persistent pain. During fluoroscopy, the patient is positioned between an x-ray source and a fluorescent screen. The live images generated by the fluoroscope allow the physician to visualize and target the suspected physical generators of pain within the body. The radiation exposure from fluoroscopy is minimal and the real-time imaging allows for precision, comfort and safety during interventional pain procedures.
Inflammation as a Source of Pain
New research has identified inflammation within and around neural structures as a common occurrence in painful conditions. Neural inflammation has been shown to facilitate pain processing and increase firing of pain neurons within ganglia, nerve roots, and the spinal cord, and it is thought to be instrumental in the development and perpetuation of many types of persistent pain. Epidural injection is a safe and effective method to “put out the fire” of inflammation.
Epidural Injections Deliver Medication
The epidural space allows unique access to the spinal cord and nerve roots at every level of the spine. Epidural injections provide a safe, low-risk, nearly painless means of delivering a variety of medications directly to the nervous system. Medications used alone or in combination include steroids, local anesthetics, and opioids. Once delivered into the epidural space, these medications may block pain impulses, stabilize irritated nerve structures, reduce inflammation and swelling, and reverse the biochemical changes that are known to occur within the nervous system when pain persists.
Disc Herniation and Inflammation
The process of intervertebral disc herniation is a prime example of an acute process often associated with spinal inflammation and severe persistent pain. Outward movement of the caustic disc nucleus causes inflammation and swelling to occur within the confined spaces of the spinal column, and may cause sensitization and compression of the spinal cord and nerve roots, resulting in severe radicular pain. Irritated nerve roots in turn send signals to muscles which then may spasm. When pressure is increasingly intense, sensorimotor changes may occur. Disc herniation and secondary spinal inflammation do not usually cause nerve damage, thus early surgical intervention is often not indicated. Since herniated disc material may be resorbed over time by the body without surgery and since surgery cannot “cure” the underlying problem of disc degeneration, it is usually wise to consider surgical intervention only after conservative care fails.
An Extension of Conservative Care
Epidural steroid and local anesthetic injection may effectively decompress the spinal area, reverse inflammation, and relieve symptoms without surgery while the body resorbs herniated disc material over time. Since persistent inflammation may cause pressure damage to nerves and result in fibrosis and the formation of scar tissue within the spinal column, reversal of inflammation should be a prime goal of therapy. Spinal injection is considered an extension of conservative care by many spine specialists and is typically performed in a series of three injections at two-week intervals if symptoms are persisting.
Fluoroscopy and Pain Relief
With the use of fluoroscopy, small doses of local anesthetic can be deposited directly onto specific anatomical structures to aid in pain diagnosis. If pain relief occurs, the injected structure may be identified as a pain generator and future injection therapy, physical therapy, or surgical intervention can be targeted accordingly. The use of fluoroscopy in pain treatment allows medications to be deposited more precisely onto the site of pathology.
Benefits of Fluoroscopic Injections
Fluoroscopic injection often allows invasive pain management to be performed with more comfort, fewer complications, and better results. Fluoroscopy in the pain clinic is useful for:
- Precise localization of pain-generating structures
- Guiding and documenting placement of medication even in patients with difficult anatomy
- Predicting the results of proposed surgical intervention
- Guiding surgical therapy
Requiring Fluoroscopic Guidance
Certain injections require fluoroscopy or some other form of x-ray guidance
and cannot otherwise be performed. These injections include:
- Selective nerve root block
- Transforaminal epidural steroid injection
- Sacroiliac joint injection
- Lumbar sympathetic block
- Celiac ganglion block
- Spinal facet joint block
- Intervertebral disc injection
- Trigeminal block
- Neurolytic block
- Radiofrequency neuroablation
At MAPS Medical Pain Clinics, routine use of the most advanced fluoroscopes available improves our ability to accurately diagnose and effectively treat persistent pain.