What is the role of therapeutic injections in the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Local anesthetics, corticosteroids, or other substances may be directly injected into painful soft tissues, facet joints, nerve roots, or epidural spaces. They may also be given intrathecally. Therapeutic injections have been advocated to alleviate acute pain or an exacerbation of chronic pain, help patients remain ambulatory outpatients, allow them to participate in a rehabilitation program, decrease their need for analgesics, and avoid surgery. Local injections into paravertebral soft tissues, specifically into myofascial trigger points, are widely advocated. However, a double-blind study to compare local anesthetic with saline injections and a prospective randomized double-blind study to compare dry needling with acupressure spray applications of lidocaine, corticosteroids, and vapor coolants revealed no statistically significant difference in therapeutic effects.

Injections can also be used to irritate pain-sensitive spinal tissues to determine whether they are pain generators. Carefully placed contrast dye or normal saline can provoke a pain pattern similar to the patient's primary complaint. Performed under fluoroscopy, contrast dye will document the targeted structure and provocation site, and it is followed by the application of a local anesthetic to ablate the pain, which further verifies the target’s role as a pain generator. Some believe that a successful therapeutic intervention can be achieved by using local anesthetic combined with corticosteroids. Some structures can be denervated by radiofrequency ablation or chemical neurolysis to eliminate pain for a prolonged period of time. These techniques receive some support from evidence-based informed data reviewed in this section.


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