Spinal injections are done on the spine and spinal nerves to
- diagnose or find the source of pain.
- predict the outcome of another procedure or surgery.
- provide pain relief by decreasing inflammation and swelling.
Why do I need a spinal injection to make a diagnosis?
Several structures in your spine can cause pain. One or more of these sites may be the source of your pain. As the pain lasts longer and doesn’t go away (becomes chronic), it is more complex and harder to find. It is helpful to think of the spinal injection as a test.
The sources of pain are called pain generators. To treat your pain, we must find the source(s) of pain from several likely sites and treat it. Sometimes, a routine exam in the clinic is not enough to make a diagnosis. We need X-rays, CAT scans or MRIs (imaging studies) to see if there are changes in your spine. These studies will pick up a herniated disc, nerve compression, and arthritic changes in the spine. But, whether or not there are changes in your spine does not always mean that this is where the pain is coming from. Some pain generators can look normal on imaging studies, while some that are not normal can be painless.
One way to find pain generators is by injecting and numbing a certain site with a numbing medicine (local anesthetic) and anti-inflammatory medicine (steroid) and then watching for any changes in your pain. Your doctor will examine you, study your X-rays, and make a list of sites that will need to be tested. You will most likely need more than one injection to pinpoint the source(s) of your pain. The sites will be injected one at a time. You will fill out a pain log for 2 weeks after each injection. This will help your doctor see how much pain you had after the injection. The results will help your doctor make a diagnosis and plan your treatments. In some cases, the source of pain may not be found. If this happens, the blocks help to narrow down the sites that might be the source of pain.
Is Spinal Injection Right For Me?
Spinal injections are used for moderate to severe pain in patients who have not gotten better from other simpler treatments. Spinal injections are rarely the first line of treatment. Your doctor will first try simpler treatments that may include modified rest, pain medicines, physical and psychological therapy. Your doctor may ask for a spinal injection if you do not get better and are still limited in what you can do after using simpler treatments. Your doctor may request a spinal injection if you started to get better at first but have made no more progress with simpler treatments. Sometimes when pain is severe and disabling, injections may be used early instead of waiting. Spinal injections will only help certain sites of pain. Whole body pain and pain that cannot be pinpointed often will not be helped.
What are prognostic blocks and why do I need these before my surgery or neurolysis?
Prognostic blocks direct future care. The manner in which your pain responds to local anesthetic blocks will guide the surgeon to the site that needs help. Disc injections are done before fusion to find the levels to fuse and to reveal the status of nearby discs. In the same way, local anesthetic blocks before nerve destruction can predict how the procedure will work. If there are any harmful effects from the procedure, the temporary blocks give you a chance to find out what they might be before you agree to the nerve destructive block (neurolysis).
How do I get ready for this procedure?
1. Do not eat for 6 hours or drink for 2 hours before your procedure. You may take a sip of water if you need to take medicine.
2. Take your normal medicines on the day of the procedure unless told otherwise by your doctor.
3. 1 week before the procedure
- If you take aspirin (including baby aspirin) for your heart or blood vessels as prescribed by your doctor, you will need to stop taking it. You will need a written note from your doctor saying it is ok to stop taking your aspirin.
- If you take Plavix® (clopidogrel), you will need to stop taking it. You will need a written note from your doctor saying it is ok to stop taking your Plavix®.
4. 3 days before the procedure
- You cannot take herbal medicines, fish oil, or Vitamin E.
5. 1 day before the procedure
- You must stop taking anti-inflammatory medicines. Examples of anti-inflammatory medicines are: Advil®, ibuprofen, edtodolac, indomethacin, naproxen, Aleve®, Feldene®, diclofenac, Mobic®, and piroxicam. You do not need to stop taking Celebrex®. If you are unsure if any of your medicines are in this group, ask your doctor.
6. Call your family doctor for instructions if you take blood thinners such as heparin or Coumadin® (warfarin). Your blood clotting times will need to be normal (INR less than 1.4) before your procedure.
7. Call your family doctor for instructions if you take medicine for diabetes. This procedure may increase your blood sugar for a short time.
8. If you have glaucoma, this procedure could make your glaucoma worse. Please discuss this with your eye doctor to see if this is safe for you.
9. Before the procedure, tell us if you have any drug allergies or if you have had a reaction to X-ray dyes (contrast dyes), iodine, Betadine, seafood, shellfish, latex, or numbing medicine (local anesthetics).
10. Make sure someone is able to drive you home. You can not drive yourself home after the procedure.
11. Bring your pain medicines with you to the hospital. Make sure you have enough with you to take after the procedure. You may still need it. The doctor who does your injection will not give you a prescription for pain medicine to take home.
12. Bring your latest MRI or CT scans (films) if these were not done at UW Hospital or Research Park Clinic. You are responsible for getting and bringing your films. If you do not bring these films with you, your procedure cannot be done. If you have had any spine surgery in the past, you need to bring an MRI or CT scan that was done after your surgery. If you are unsure where or when your MRI or CT scan was done, call your doctor. If your scan was done at UW Hospital or Research Park Clinic, you do not need to bring your films.
13. You must be healthy on the day of the procedure.
- You must be free of infection, not taking antibiotics.
- You must not have cold or flu symptoms.
- You must not have any rashes or skin lesions.
- You must not have a fever greater than 100.4°F.
14. If you are feeling sick or have a cold before the procedure, call the team to let us know. Please try to call 24 hours or more before the procedure.
15. Call (608) 265-1770 if you need to cancel or have any questions.
What can I expect?
You will be taken to a prep area. Before the injection, you will change into a hospital gown and an IV will be started in your arm. You will be asked many questions about your medical history, current health, and current medicines. You will fill out a pain diagram. One of the health care team will go over a consent form with you. The health care team will explain the purpose of the procedure; give a brief description of it, and list possible complications for you before you sign the form. If you have any questions, they will be answered at this time. Your family and friends can be with you before and after the procedure. No family or friends are allowed into the procedure room.
The test is done in a procedure room that has an X-ray machine. If needed, you will be given a medicine to relax you through your IV. You will remain awake throughout the test.
You will lie on the table. You will be on your stomach for low back injections and on your side for neck injections. We will check your blood pressure, heart rate, and oxygen level. We will use pillows to help position you and make you comfortable. The site to be injected will be cleaned. Then, your neck or back will be covered with a sterile drape. Using the X-ray machine, your doctor will carefully guide a thin needle into your back or neck near the spine. The exact place depends on the type of injection. Your doctor will inject X-ray (contrast) dye through the needle to make sure it is in the correct place. X-rays will be taken. The local anesthetic and steroids will be injected. During this time, you will be asked to lie very still and not talk. It most often takes 30 to 45 minutes.
When it is over, you will go to the recovery room where nurses and your doctor will watch you for 30 to 60 minutes. You will be asked how much pain you are having and where the pain is. The staff will make sure you have something to eat and drink. Before you go home, you will be checked briefly to make sure you are doing ok.
You will be given a pain log to complete for the next 14 days. This will let us know if and how much your pain was decreased. Complete this form. Make a copy for your records and mail it back to us in the prepaid envelope. We will need this information to decide if you will or will not benefit from similar injections in the future.
You will be given a Health Facts for You sheet before you leave. It will explain what to expect after your injection and what to do if you have questions or concerns.
Your driver will take you home. If a sedative medicine was used, you should not drive or make important personal or business decisons until the next day.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 01/17/2013
Copyright © 12/28/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5952
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