The most common procedures performed in pain management today include epidural steroid injections and facet injections. However, they’re not interchangeable procedures and there are different reasons for doing each one.
Individuals have facet joints at every level of the spine from the neck all the way down to the sacrum. Facet joints permit an impressive range of motion for the spine and contain cartilage similar to the hip or the knee joints.
As individuals age, these joints are prone to developing arthritis and pain. This is called facet syndrome.
As with arthritis of the hip or the knee, facet joints do well with steroid injections for pain relief. Injections into symptomatic facet joints may provide months of pain relief and are commonly performed into multiple joints at the same time. If an individual has arthritis in one facet joint, most likely he or she has it in a few. Pain doctors in Florida will inject steroid medication and numbing medicine into the affected joint and possibly also right around the joint for optimal pain relief.
So for those with chronic neck or back pain due to facet arthritis, the facet injections often work exceptionally well. This may be in conjunction with medial branch blocks and possibly subsequent radiofrequency ablation.
For those with pinched nerves that are causing either leg pain or arm pain, this is when an epidural injection becomes pertinent. When a nerve root gets pinched, this occurs in the spinal canal as a nerve roots come off of the spinal cord. The nerve root may get pinched from a herniated disc, which is known in layman’s terms as a slipped disc.
Nerves may also be compressed from a condition called spinal stenosis. Stenosis involves arthritis over growing bone and soft tissue over time, and pinching on nerve roots as they try to get out from the spine.
Spinal stenosis may lead to multiple nerve roots in the neck or low back pain being pinched at the same time, leading to pain in one or both arms or legs. When a nerve root is pinched in the low back, it leads to sciatica in the legs. If the same occurs in the neck, it leads to arm pain which is known as radiculopathy.
An epidural steroid injection involves placement of cortisone around the area of the nerve being pinched. This can decrease inflammation and reduce pain dramatically from the herniated disc and pinched nerve. These injections involve the needle going into the spinal canal which is different than facet injections. The facet joints are behind the spinal canal.
So one similarity is that both injections involve a steroid injection. Another similarity is that both provide typically a few months of pain relief but do not fix the problem. Rather they are very good at masking pain for a time period.
Another similarity is the risks involved with these procedures. They’re very low and include a small risk of infection, bleeding, nerve injury and possibly allergic reaction to the medications used. There may be a slight transient reaction to the cortisone such as weight gain or elevated blood sugars.
The main difference between the procedures is where they are performed and why. Facet injections are primarily performed for chronic neck and back pain due to spondylarthritis, whereas, epidural injections are performed for nerve related pain in the arms or legs
Thankfully, regardless of which procedure tends to be indicated, it does work very well for their indications. It may be that both are necessary to obtain adequate pain relief especially if back pain and sciatica are present at the same time.
Pain clinics in Florida offer a multitude of interventional procedures including both facet blocks and epidural injections. The Florida Pain Network connects those in pain with pain relievers including pain management Orlando clinics, Port St Lucie, Fort Lauderdale, and many more.
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