What are anti-inflammatory injections?
Virtually all joint pain is caused by inflammation to some degree. An anti-inflammatory injection reduces inflammation in and around joints, and therefore reduces joint pain. Some anti-inflammatory injections also reduce pain by blocking enzymes that transmit pain signals (e.g., cyclooxygenases).
The two main types of anti-inflammatory injections are 1) injected into a muscle or a vein (systemic) or 2) injected into a joint, such as the knee or in spinal joints (intra-articular).
Systemic Anti-Inflammatory Injections – Systemic anti-inflammatory injections are administered to treat pain throughout the body. Since the drug is infused in the muscle or bloodstream, the effects of the medicine can be felt everywhere. One of the most commonly used systemic anti-inflammatory injections is ketorolac (brand name Toradol). Ketorolac is a powerful non-steroidal anti-inflammatory drug that can reduce inflammation. Ketorolac can also relieve pain as potently as opioid drugs.
Intra-Articular Anti-Inflammatory Injections – Intra-articular anti-inflammatory injections are highly targeted to specific types of pain. For example, a physician may infuse a combination of a local anesthetic (e.g., lidocaine) and a corticosteroid (e.g., dexamethasone) into a knee of a patient with severe knee osteoarthritis. The anesthetic immediately deadens the pain for hours to days, while the anti-inflammatory corticosteroid reduces inflammation and pain over weeks to months (and perhaps longer).
As with any substance that enters the body, anti-inflammatory injections may cause certain side effects. Ketorolac (Toradol), for example, can only be administered for a maximum of five consecutive days because of possible side effects. Drugs administered directly into joints usually cause fewer serious side effects because they mostly act locally. For anti-inflammatory drugs injected into joints, the issues are usually not caused by the drug, but by the injection. Patients who receive intra-articular injections are at risk for bleeding, joint infection, or damage to the joint. Risks are much less likely to occur if the injection is performed by a physician with solid training and experience.
Almost any joint in the body can be treated with intra-articular injections, from hips and knees to fingers, wrists, and ankles. When the area is difficult to reach with a needle, the physician can use a bedside ultrasound machine to guide the needle to its proper place. The areas most commonly treated with anti-inflammatory injections are the knee, hip, wrist, and spine. In the spine, surgeons usually target the facet joints between spinal bones or the epidural space around the spine or around the nerve roots. Facet joint injections can be administered in the cervical, thoracic, or lumbar spines, corresponding to the neck, upper back, and lower back, respectively. If the nerve root is the source of symptoms, a transforaminal epidermal injection (or less commonly, an interlaminar epidural injection) may be performed. In some cases, the space is so small that a special x-ray machine called a fluoroscope is used to reach the precise spot with the treatment needle. In some cases, the physician will administer a nerve block which deadens the nerve or nerve plexus temporarily. A nerve block is often done so that patients can participate in physical therapy or other rehabilitation exercises, or to help the spine surgeon diagnose the precise source of neck or low back pain.
When it comes to getting anti-inflammatory injections, the choice of physician matters. Systemic anti-inflammatory injections into a muscle or a vein can be provided by virtually any healthcare professional. Intra-articular injections — that is, injections into a joint — should be administered by a healthcare professional who has extensive training in giving these types of anti-inflammatory injections. The physicians with the most experience providing intra-articular anti-inflammatory injections are neurosurgeons, orthopedic surgeons, interventional radiologists, and rheumatologists.
If you are seeking an anti-inflammatory injection into one of the spinal joints (e.g., facet joint injection), then the most experienced providers are anesthesiologists that specialize in pain management and some spine surgeons. In fact, chronic neck and lower back pain should be managed by a spine surgeon in general, not because surgery is always needed, but because most spine surgeons are experts in treating neck or lower back pain in all forms. Spine surgeons can differentiate between different types of neck and lower back pain, prescribe conservative treatments and/or provide epidurals, nerve blocks, facet joint blocks, and perform spine surgery if and when the time is right.
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