Injections Can Ease Some Types of Pain for Months
Fifth in a series
Maybe you have back or leg pain that just doesn’t go away after a few weeks or even months. Or maybe an injury or arthritis has inflamed one of your joints – a shoulder or knee, perhaps.
Your doctor says that exercise can help, but right now you just hurt too much to get started. Or, in some cases, maybe you’re trying to avoid or postpone surgery for your problem.
For a variety of conditions, pain relief may come with a visit to the Einstein Pain Institute, where specialists can inject corticosteroid medications (also called steroids), local anesthetics or both into a joint or muscle, near a nerve, or into the epidural space around the spine.
In recent years, as Einstein Healthcare Network has reduced prescriptions for opioid medications, effective use of alternate approaches such as injections and other procedures for treatment of pain have become even more important.
How Injections Can Help
“Depending on the location of the pain, a lot of these conditions are amenable to injection treatments,” says Jasmeet Oberoi, MD, Medical Director of the Pain Institute.
“For example, sciatica, arthritis in the back, arthritis of the knees and the hips, the shoulders, all of those do respond quite well.”
Steroid medications, which are different from the anabolic steroids used by some athletes, can reduce inflammation and pain for months, sometimes longer, Dr. Oberoi says.
Nerve blocks, using local anesthetic, also can reduce pain by “resetting” nerves that have become overly sensitive.
Pain relief can help people to take other steps that improve body function and reduce pain and disability in the long run.
“It’s a partnership,” Dr. Oberoi says. “I mean, whenever we talk about opiate reduction and risk mitigation, all these things, the patient has to be a participant in it.
“So, if the patient is making lifestyle changes, they’re losing weight, they’re going for their physical therapy and doing home exercises, then things tend to work better.” (See “Physical Therapy Often ‘the Best Medicine’ for Pain.)”
Types of Injections
The following treatments are among the most common offered at the Pain Institute:
- Steroid injections are directed into joints, including those of the spine, and muscles. They may also include local anesthetics that numb the area while the steroids work to reduce inflammation.
- Nerve blocks use local anesthetics to numb nerves or groups of nerves in the spine, or elsewhere in the body, that are causing pain. They may also include steroids to improve longer-term results.
- Epidural injections target nerves in the epidural space within the spinal cord to provide relief to a larger area using local anesthetics and sometimes steroids.
A steroid injection can be helpful for a variety of conditions, including pain in the hips, knees, shoulders and other joints, Dr. Oberoi says.
“If somebody has tendinitis – like golfer’s elbow, tennis elbow and things like that – sometimes they just cannot rehab effectively,” he says.
“So a cortisone injection can be helpful to get them over the edge. Then, once they feel that mobility is coming back, they can go and learn the right exercises and stretches with the physical therapists, so they don’t have recurrent injuries.”
“If I do 100 injections, out of those 50% will probably do very well. They’ll get substantial relief for many months,” Dr. Oberoi says. “Out of the remaining 50%, about 20% will get good but not excellent benefit, and 30% may not get much benefit.”
Nerve Blocks and Epidural Injections
Nerve blocks address neuropathic (nerve) pain in the spine or elsewhere, conditions such as sciatica (nerve-related pain in the buttocks and legs), the skin condition shingles, certain kinds of hard-to-treat headaches, and lingering pain after chest surgery, Dr. Oberoi says.
“Take somebody I treated two years ago and now they have sciatica again, and they have not been that active,” he says. “So you can do a nerve block, get them back to some level of functioning so they can go to rehab and physical therapy.”
Epidural injections are helpful for certain kinds of nerve-related pain caused by a herniated disc or leg pain, says Christopher Plastaras, MD, a physical medicine specialist (physiatrist) at MossRehab.
“About 60% to 75% of people will get 50% pain relief or more at one to six months if you do one or two injections in combination with physical therapy,” he says.
Plastaras and Alyssa Marulli, MD, another MossRehab physiologist, do both epidural and joint injections.
The Long-Term Remedy: Exercise
Ultimately, exercise is the best medicine for many pain conditions, Dr. Oberoi and Dr. Plastaras emphasize.
“I tell people to put their stationary bicycle in the living room, not in the basement, so you’ll use it, biking and watching TV at the same time,” Dr. Oberoi says.
“Or I’ll just tell them, if they have steps, to just go up and down the steps five times, especially for the slightly older folks. It improves their balance and maintains their strength.”
The Pain Institute offers treatments at facilities on West Germantown Pike in East Norriton and on Tabor Road, Wayne Avenue and Bustleton Avenue in Philadelphia.
Dr. Plastaras sees patients at MossRehab offices on Township Line Road in Elkins Park and on South 23rd Street in Center City Philadelphia. Dr. Marulli sees patients at MossRehab locations in Elkins Park, on Tabor Road in Philadelphia and on West Germantown Pike in East Norriton.