Chronic pain is characterized as lasting beyond the normal healing period or longer than three months. It may be vague or intense and there may not be signs on x-rays or other tests to indicate the source of the pain since it can sometimes be generated by tissue injury. Most pain in the back and down the legs has both mechanical and inflammatory causes.
There are a number of treatment options available:
Epidural Steroid Injections
These are injections of steroids (cortisone medicines) into the space just outside the covering (the dura) of the spinal cord. Because the injection is outside (epi) the dura, it is called an epidural injection. This procedure has nothing to do with spinal anesthesia used for operations.
The spinal cord travels from the brain to the waist in a tunnel in the back part of the spine. About every inch along the way, the spinal cord gives off branches to the right and left. These branches carry sensations from the brain to various parts of the body to make things move. Also, these branches send back a variety of sensations (e.g., pain) through the cord and then to the brain.
These injections are performed when it is thought that inflammation is part of the process that causes the pain. A steroid medicine, which is a very potent antiinflamatory drug, works best when it is injected into the area where the inflammation is occurring. Because the nerves of the spinal cord pass through the epidural space, the medicine comes in contact with them. The injections can be made anywhere along the spine: neck (cervical), midback (thoracic), lower back (lumbar), and tailbone (caudal).
Joint injection is frequently used to treat injured joints resulting from acute or repetitive injury. The technique requires two steps. First, and for purposes of minimizing any pain associated with the procedure an injection of local anesthetic (Procaine or Lidocaine) into the skin may be done. This may be followed with the injection of a local anesthetic (Procaine or Lidocaine) and/or a steroid medication (Depomedrol, Celestone or Aristospan) into the joint. The injection may need to be repeated in some cases, based on your response. Depending on the joint, X-ray guidance may be used.
Neural Therapy is an injection technique frequently used by physicians to help patients with long standing pain. It requires the injection of a local anesthetic (Procaine or Lidocaine) into the scar tissue of the skin (old and new), but does not involve injections into any other areas of the body. The purpose is to decrease pain associated with the scar tissue. Since the scar tissue is often associated with an injury, it is not uncommon for patients during the procedure to have some recall as to an original trauma causing the injury. Since this may result in some temporary anxiety and/or apprehension regarding the procedure, your physician will discuss any additional interventions, if any, that may become necessary.
Prolotherapy is an injection technique that is recommended for tightening ligaments and areas of the body where the muscle attaches to the bone. This technique requires two steps. First, and for purposes of minimizing any pain associated with the procedure an injection of a local anesthetic (Procaine or Lidocaine) into the skin may be done. The second step is the infusion of the actual treating solution, which, depending on the patient, may be concentrated sugar water (Dextrose or glucose); refined cod liver oil (Sodium Morrhuate); or another medication such as Phenol, Glycerin or Pumice. This second injection is made based on a physical exam by your physician and a determination as to the source of the injury, normally where the ligament or muscle attaches to the bone. Because of the manner in which the treatment works, it may be necessary to do a series of injections in order to obtain the full benefit of treatment.
Trigger Point Injections
Trigger Point Injection is an injection technique frequently used to help patients with long standing pain resulting from an acute muscle injury often associated with repetitive motion. As a result of the injury the muscle tires out quickly, puts additional strain on the joints associated with the muscle and can cause significant radiating pain. By treating the muscle, the additional strain on the joint is alleviated. The technique requires two steps. First, and for purposes of minimizing any pain associated with the procedure an injection of local anesthetic (Procaine or Lidocaine) into the skin may be done. This may be followed with the injection of a local anesthetic (Procaine or Lidocaine) and/or a steroid medication (Depomedrol, Celestone or Aristospan) or medication to decrease nerve irritability (Sarapin) into the “trigger point” in the muscle or ligament.