Conservative Back Pain Treatments in the Larger San Francisco Bay Area

Treatment options for spine pain exist beyond surgery, including physical therapy and spinal injections. It is important for patients to talk with a doctor about all the options for back and spine pain and pick the best treatment that fits their injury and lifestyle.

Physical therapy is a great starting place to try to decrease pain, promote healing and increase function to prevent further injuries. Physical therapy can include passive or active therapy, depending on what the medical team recommends. Passive treatment can include heat and ice, electric stimulation and acupuncture. Active physical therapy includes stretching, strengthening and pain relief exercises.

Golden State Orthopedics & Spine (GSOS) offers several injections to reduce or eliminate spine pain, falling into the categories of steroid injections and medial branch blocks/radiofrequency ablation. Because back and neck pain can often be due to spinal issues, though not exclusively, these nonsurgical spinal injection options provide targeted treatments for multiple kinds of pain in the spine, back, and neck.

Nonsurgical treatments and injections for spine pain at a glance:

• Golden State Orthopedics & Spine offers a range of conservative treatment options that do not include surgery, which may be effective in relieving spine pain.
• We explore these treatment options with each patient before considering surgery.
• Injections for spine pain are a common nonsurgical treatment option, and we offer epidural steroid injections, sacroiliac joint injections, medial branch blocks and medial branch radiofrequency ablation.

Spinal Injections

Spinal injections are a great temporary relief that will allow a patient to participate in physical therapy and suggested rehabilitative stretching without added spine pain. But we generally only recommend them after other nonsurgical measures have failed to bring relief, and the patient’s lifestyle is still negatively affected.

If a patient has one of the following conditions he or she should avoid having a spinal injection:

• Pregnancy (if X-ray in fluoroscopy is used)
• Infection
• Bleeding disorder or takes blood thinners
• Spinal tumor

If a patient has renal disease, diabetes or congestive heart failure, the patient may not be a good candidate for injections or may have to discuss with their other specialists whether they can even have an injection to the spine.

Steroid Injections

These are temporary measures that address the symptoms only and do not cure the cause of the pain. Steroids can calm inflammation in the joints and tissue, providing considerable relief. Thus, patients can return to physical therapy in order to obtain functional improvement.

Medial Branch Blocks

The medial branch block is a procedure in which a physician injects anesthetic near the small medial branch nerves connected to a specific facet joint. A medial branch block is primarily used as a diagnostic approach but can also be used as a short-term treatment option. Once the physician has identified the source of the pain in the facet joint, a radiofrequency ablation can treat that pain.

Facet joints are pairs of joints between the back of the spine and the vertebrae that provide stability and allow the spine to twist, bend and flex. The medial branch nerves are small nerves that feed out from the facet joint and carry pain signals to the brain.

A range of conditions can lead to inflammation of the facet joints including:

• Spinal stenosis
• Osteoarthritis
• Trauma to the back

The patient will lie face down on the procedure table, and the physician will use local anesthetic to numb the injection site.

As with many spinal injections, medial branch nerve block procedures are best performed under X-ray guidance, called fluoroscopy, for direction in targeting the correct nerve. Once the medical team has confirmed the correct location, a small amount of anesthetic is slowly injected onto each targeted nerve.

When the injection is completed, the doctor will then ask the patient to move in a way that would usually provoke the pain and see if the medial branch nerve block has reduced the pain. If the patient feels immediate pain relief after the injection, then that targeted facet joint is determined to be the source of the pain.

Once the doctor has identified the cause of the pain, he or she may recommend a radiofrequency ablation for longer-term pain relief.

Medial Branch Radiofrequency Ablation

A radiofrequency ablation, also known as a radiofrequency neurotomy, is a type of injection procedure used to treat facet joint pain. Before a radiofrequency ablation procedure takes place, a medial branch nerve block procedure will need to have been performed to accurately diagnose that the patient’s pain is being transmitted by those nerves.

During medial branch radiofrequency ablation, the patient will lie on his or her stomach and the injection site will be numbed with local anesthetic. Then the medical team will use fluoroscopy to confirm the correct placement of the needle. A second confirmation of placement is conducted using an electrical current passed through the needle to assure it is next to the targeted nerve. This will cause a muscle twitch and briefly recreate the pain.

The targeted nerves are then numbed and heat is applied. Radiofrequency waves heat the tip of the needle and it is placed on the nerve for 60 to 90 seconds. This creates a heat lesion on the nerve to disrupt the nerve’s ability to send pain signals to the brain. This allows the patient to keep functions like sensation and muscle strength.

Full pain relief can take 3-4 weeks after the procedure. This treatment can be a longer lasting treatment, with 30-50 percent of patients experiencing pain relief for as much as two years. Of the remaining patients, many will still get some pain relief but for a shorter period of time. The pain returns because nerves heal over time, and the procedure may need to be performed again.

Risks of Injections for Spine Pain

As with all minimally invasive medical procedures, there are potential risks associated with any of the spinal injection treatments. These include:

• Infection
• Bleeding
• Allergic reaction to the solution used
• Nerve damage/nerve paralysis

Specific treatment options for spine pain may have additional risks, and patients should talk to a physician about all possible risks as well as benefits prior to beginning any treatment.