Interventional Pain Management
What are these injections?
Patients presenting with tendon inflammation, degeneration and tears, often present to the doctor with significant, pain and loss of movement of the injured limb. This leads to lack of sleep, and the inability to function normally, which in turn leads to anxiety, which further exacerbates the pain.
Injection of Corticosteroids (a chronic anti-inflammatory agent), has been found to decrease symptoms dramatically, and if used in conjunction with rest and physiotherapy, could lead to significant improvement in long term outcomes in this group of patients.
Another group of injections involves injecting the patient’s blood into the injured tendon (autologous blood injection), or injecting the patients platelets, which have been concentrated by spinning these down to concentrations above 1000 (normal platelet levels in autologous blood is 250). The growth factors in the platelets then result in restoration and healing of the existing tendon tissues.
Corticosteroids and blood products may also be injected directly into a joint to provide relief (i.e. the knee, shoulder and spine).
How are these injections performed?
You will be ushered into an ultrasound or CT room. Following which, the Radiologist will ask you a few questions and may examine your painful limb or area of pain. The area to be injected will then be cleaned with an antiseptic skin solution, following which, a small needle containing local anaesthetic and the substance to be injected, will slowly and carefully be guided into the area that is being injected. Ultrasound or CT may be used to guide the needle, and to ensure precise positioning of the needle tip. The injection itself normally takes less than a minute, and the only part of the procedure felt by the patient is the needle going through the skin.
Injections like hydrodilataion of the shoulder, normally takes longer, and maybe associated with mild discomfort as we stretch the shoulder capsule.
What are the side effects of these injections?
Pain may be worse in the 24-48 hours following the injection. This is normal, and oral pain tablets are indicated to help relieve symptoms in this period. Ice packs may also be useful in the acute stage, especially following autologous blood injections or platelet rich plasma injections. Corticosteroids usually take 3-5 days to take effect.
Any injection can potentially cause infection. The incidence of infection in joint injections is about 1 in 2000, and the incidence of infection in tendon injections is even less likely. If pain worsens over the few days following the injection than you are advised to contact us at 9337 8288 and consult your referring doctor as soon as possible.
Very rarely, bleeding may occur, following the injection, this may present with a lump or bruise in the area injected. Please contact us if you notice this.
How do I prepare for an injection?
If you are on Warfarin or any blood thinners, please notify our staff on booking your injection. We may need to speak with your doctor about suspending these for a few days. It is best practice to suspend all Non-steroidal anti-inflammatories (Aspirin, Neurofen, Voltarin and Mobic) for 4 days before the injection (for 7days before a Platelet Rich Plasma PRP injection).
If you have any overlying skin infections in the area to be injected, please notify us.
If you are allergic to local anaesthetic or corticosteroid (extremely rare), please notify us.
Besides this, no specific preparation is required.
How long should I expect the injection to last?
This varies considerably, depending on the area being injected, the severity of the injury, and the compliance of the patient and their willingness to use physiotherapy and other aids such as orthotics for plantar fasciitis, to prolong the effects of the injections. Some patients require only one injection, and some patients require ongoing injections for relief. Relief obtained from autologous blood injections and PRP injections is more long lasting than that from corticosteroid injections.
At DiagnostiCare we have considerable experience in interventional back and neck pain injections. Dr Stephen Fasulakis has been performing these procedures in New South Wales as well as at the Epworth Hospital in Richmond. He a member of the International Spinal Intervention Society, ISIS, as well as an accredited endovascular interventional radiologist with the Royal Australian and New Zealand College of Radiologists.
What we offer
Selective foraminal nerve root injection
Performed in the lumbar and cervical spine to confirm the site of origin of a patients discomfort
Epidural injections of analgaesia
Injection of the epidural space in order to relieve symptoms of nerve root irritation or symptoms of spinal canal stenosis
Facet Joint Injection
The joints between vertebral bodies are injected in patients presenting with mechanical back or neck pain
Sacroiliac joint inection, transfacetal drainage of synovial cyst are also offered.
Spinal injections are performed on the CT scanner using small, low dose volume scans to track the position of the needle.
Under sterile conditions, some local anaesthetic is administered at the site of injection, following which a needle is gently advanced into the epidural space/neural exit foramen/facet joint.
A mixture of corticosteroid and local anaesthetic are then injected into the required area
The injection takes about 15 to 20 minutes from start to finish, and the patient is observed for 30 minutes following the procedure.
Checklist before the injection
Please bring any recent scans that you may have had for review. We may need to cancel the injection and order updated scans, if no recent baseline study is available.
Please notify us if you are taking any blood thinners or anticoagulants such as Warfarin, Plavix and Nonsteroidal anti inflammatories such as Ibuprofen, Aspirin or Voltarin. These will have to be stopped a few days before the study.
Generally safe with very few serious complications reported.
As with any injection, there is a small risk of infection and bleeding.
Headache, if the the CSF spaces are inadvertently punctured. This is exceedingly rare.
Transient numbness in the legs or arms.
Severe side effect such as paralysis have been reported in the literature, but are extremely rare and largely avoidable by using good and meticulous techniques.
Frequently asked questions
How much am I out of pocket for a spinal injection?
Ans: Health care card holders and pensioners are bulk billed. All others are charged an out of pocket fee. Worksafe is billed directly for Worksafe patients.
How effective are spinal and nerve root injections?
Ans: About three quarters of patients have a significant improvement in symptoms. The improvement may last from a week to several months. More than one injection may be required.