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A trapped, inflamed nerve can cause pain in your
arm or leg without any backache (brachialgia or
sciatica) and an injection of local anaesthetic
and steroid around the nerve root will anaesthetise
the nerve and reduce any inflammation. One or
two small nerves convey pain messages to and from
the facet joints and the dural sheath, and these
can also be blocked and anaesthetised by this
technique.
These injections are performed by a relatively
small number of orthopaedic physicians who have
a special interest in relieving pain from spinal
disorders. They are extremely useful for chronic
sufferers and if your own doctor cannot help,
he might still be able to refer you to someone
with the expertise to give these injections.
The injection can be given in the doctor's surgery
or in an outpatients' department, and there is
no need for a general anaesthetic. To numb the
area You will be asked to lie on your front on
a couch while the physician injects a small amount
of local anaesthetic. The treatment is not painful
and takes about 10 minutes. The injection itself
may only take 30 seconds.
The only tiny risk from this injection is that
very occasionally the doctor may pierce the dural
membrane. Although it will not be very painful,
you will have to lie flat for 24 hours if this
happens in order to avoid a headache or dizziness
caused by any excessive leak of the cerebrospinal
fluid. This is by no means as serious as it may
sound. After two days the doctor will attempt
the correct placement of the needle once again.
Because of this albeit small risk, it is advisable
to take someone with you to drive you home should
you need to spend a day in bed, though if all
goes as it should you will be able to walk or
drive yourself.
If the relevant nerve root has been located successfully,
the anaesthetic mixed with steroid will provide
several days' pain relief. Prolonged or even permanent
relief may be obtained. Once again, the results
are variable and it is difficult for doctors to
predict how well a particular individual will
respond. There are few side effects if any from
this injection. If the needle has pierced the
dura, there will be no further symptoms or problems
after the initial day or two's headache and dizziness.
Trigger points are often treated successfully
with a course of local injections containing a
small dose of corticosteroid combined with local
anaesthetic, unless the spinal joints nearby are
the source of the problem. If this is the case,
the joints themselves have to be treated first,
and the muscles should then relax of their own
accord. Local injections are often most helpful
if they are combined with stretching exercises
to help muscles relax. The treatment can be given
in your doctor's surgery.
If your pain comes from sprained ligaments, you
might find that the injury is slow to heal. A
few people need a local injection of steroid with
some local anaesthetic added.
The doctor will identify your strained ligament
with his fingers and inject a drop at one end,
shift the needle slightly and inject another drop,
working this way until the ligament has been injected
along its entire length and breadth.
You may feel some soreness or aching for 24 to
28 hours after a steroid injection. Your doctor
will tell you to rest the joint by refraining
from excessive lifting, carrying and bending.
You will also be advised not to sit in one position
for long periods. After about ten days your doctor
will see you again so that he can assess your
progress.
The reason why you need to rest is because the
collagen (protein fibre) that provides tension
in the ligaments is affected for the first 10
to 14 days after a steroid injection, which makes
the tissues a bit weaker. After this the ligament
collagen returns to normal. A small amount of
steroid will probably be absorbed into your blood,
but not enough to cause any side-effects.
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