Injections: A shot of relief
You may not like the idea of getting a shot, but injections often help relieve pain and inflammation and help improve joint movement. To control your pain, your doctor can inject medication directly into the problem area instead of prescribing pills to be taken by mouth. Injections are not a cure, but they can help you through a period of intense pain. Often, injections offer an alternative to patients whose only other choice to relieve pain is surgery. Injections also offer relief to patients for whom surgery is not a viable option because of other health conditions. Injections are used to relieve knee pain, low back pain, hip pain, and many other conditions resulting from acute injuries, overuse injuries, and medical conditions such as arthritis.
What are injections used for?
Corticosteroid medications imitate the effects of the hormones cortisone and hydrocortisone, which are produced by your adrenal glands. Corticosteroids can be injected into affected joints, such as the shoulder, elbow, hip, or knee, and can relieve pain for 4 to 6 months.
Injections are often given in the hip joint to relieve pain resulting from arthritis (Fig. 1). The most common disease that affects the hip, arthritis is a degenerative disease that can cause pain, stiffness, inflammation, and damage to the joint cartilage (the smooth tissue at the ends of bones that allows them to glide against one another). Such damage can lead to joint weakness, instability, and visible deformities that can interfere with basic daily tasks such as walking, climbing stairs, sitting, rising from a chair, or getting out of bed.
Usually, 3 injections of a corticosteroid are given over a 3-week period. The procedure is performed under fluoroscopy (visual diagnostic examination on a screen or monitor) while the patient lies on his or her back on the fluoroscopic table. After the hip is cleaned with iodine and alcohol, the needle is advanced into the hip joint. Often, a small amount of water-soluble contrast (dye) is injected to confirm proper needle location. Then, the needle is slowly withdrawn. The entire procedure only takes minutes, but the benefits can last for months.
Soft tissue injections
Trigger point injections
Nerve block injections
There are 3 major types of nerve blocks, peripheral, spinal, and sympathetic. Peripheral injections are used for localized pain and are injected away from the spine. For pain that affects a broad area, an anesthetic is injected in or near the spine. An injection directly into the spinal fluid is called an intrathecal injection. An intrathecal injection is often used during surgery on the abdomen or legs.
The sympathetic nervous system controls circulation and perspiration and are part of your autonomic nervous system. An injection of an anesthetic to block the sympathetic nerves can relieve chronic pain caused by diseases such as complex regional pain syndrome, which affects your sympathetic nervous system.
Some people simply don't like shots, while others have serious phobias about injections. Despite any fear you may have, if your doctor recommends an injection, you should consider the benefits. You may experience some pain initially during the procedure, but that only lasts minutes. On the other hand, if you have the injection, you could get a shot of relief that lasts for months.
Garland K. Gudger, MD