When pain is at its worst, we’re tempted to try just about anything to get some relief, including procedures like nerve blocks or injections. But before you jump into a new procedure, you need to understand both the risks and the potential benefits.
The world of nerve blocks and spinal injection procedures for treating pain is sometimes referred to as interventional pain management, and it has played a fundamental role in how doctors treat pain for decades. These types of treatments are typically done with special imaging techniques, like live fluoroscopy, and focus on applying local anesthetics and/or cortisone around symptomatic parts of the body, like irritated nerves.
The idea of doing something on the spot to significantly alter a pain experience is, understandably, a very appealing concept to both patients and doctors; however, if the notion that a special procedure will magically solve all of your pain management woes sounds too good to be true, well, that is because it probably is. But, interventional pain procedures can play a helpful role in some cases. Here are some tips to help you decide if this right for you.
- Keep it simple – The more widespread your pain, the less likely one specific treatment will alleviate all of it. For example, epidural steroid injections done to reduce inflammation and irritation caused by herniated or bulging discs usually give the best results when the pain radiates in a pattern down a leg or an arm, as opposed to all over the body.
- Know what to expect – In general, pain procedures when done appropriately, have a reasonable chance of providing short-term relief of pain. For example, an epidural steroid injection for a bout of sciatica can reliably relieve the pain for a period of months, but the chances of achieving long-term results are less clear. Many studies find a lack of long-term relief for most nerve blocks and injections, while others suggest there may be some moderate lasting benefit.
- Be aware – There are potentially harmful bleeding risks with these procedures if you take blood thinners. I always have my patients work with their doctor to determine the best time to stop their blood thinners in order to minimize risks. If you have diabetes, cortisone injections can temporarily raise your blood sugar, so be sure to monitor your glucose carefully after the procedure and have a plan if it goes too high.
Don’t be the first in line – Avoid being a guinea pig for the latest and greatest procedure that has just hit the market. In my experience, many of these never really pan out as being particularly effective and are often riskier and more costly. The doctor delivering a brand-new treatment may have just learned about it during a weekend course on a cadaver. Do you really want to be one of their first live cases?
- Remember the “law of the hammer” – As the psychologist Abraham Maslow said, “If all you have is a hammer, everything looks like a nail.” Some clinicians rely so much on injection treatment that they begin to see it as the answer to every problem, avoiding all other alternative treatment options.
- People are complicated – The goal of interventional pain procedures is to attack the source of the pain with medications to tamp it down, but the model of why we hurt may be much more complicated than just treating the source of the original injury. Ongoing pain can lead to a whole host of neuromuscular changes from head to toe, where the best results come from a more comprehensive approach that treats the whole person.
- Ask the magic question – “Would you recommend this procedure to someone you love if they were in my position?” A pain specialist should never recommend any treatment, including nerve blocks and injections, that they wouldn’t fully embrace for their own family or even themselves if they had the same problem. It doesn’t hurt to ask.
Interventional pain procedures are optional, so you should pursue that route only if you feel comfortable with the risks, potential benefits, and the doctor and staff providing the service.