MBBS, DA, FRCA, FFPMRCA

Consultant in Pain Medicine


Conditions Treated


  1. Back pain
  2. Spinal Pain
  3. Knee Pain
  4. Hip Pain
  5. Shoulder Pain
  6. Neck Pain
  7. Leg pain
  8. Persistant Pain after Surgery
  9. Persistant Pain after Trauma
  10. Reflex Sympathetic Dystrophy
  11. Complex Regional Pain Syndrome
  12. Chronic pelvic pain
  13. Urogenital pain
  14. Cervicogenic headache
  15. Abdominal Pain
  16. Elbow Pain
  17. Fibromyalgia
  18. Headaches
  19. Myofascial Pain
  20. Nerve Entrapment Pain
  21. Neuropathic Pain (Nerve Pain)
  22. Sciatica
  23. Arm Pain


Some common Injection Treatments


Diagnostic facet joint blocks, medial branch blocks and Sacroiliac Joint blocks

Facet joint blocks and SI Joint blocks are used to test whether there is pain coming from the joints of the spine.  They are done with local anaesthetics and steroid.  Usually there is increased pain after the local anaesthetic has worn off and before steroids start acting for 2 or 3 days followed by possible relief.  Occasionally the aggravation in pain can go on for longer.   These facet joint blocks tend not to cause long-term relief of symptoms but can be helpful to decide whether to go on to facet joint denervation, a procedure that may lead to a better long-term relief.


Please see sections on common side effects, complications,  warnings and medical disclaimer in the bottom of the page
   
 Spinal facet joint and Sacroiliac  joint denervation


These procedures work in  patients who continue to experience more than 50% relief after diagnostic injections.  This may lead to longer periods of pain relief . However, there is a possibility of the regrowth of the nerves and sometimes repeating the procedure may be necessary.  Sometimes for upto 3 months after the procedure, the patient may experience increased pain.   During this time extra pain killers may be needed and physiotherapy needs to be continued.  The chances of permanent long term flare up are less than 1%.  Patients may experience long-term numbness, altered sensation and occasionally soreness of the back.  Local anaesthetic and steroids are used to help cover post-operative soreness.


Please see sections on common side effects, complications,  warnings and medical disclaimer in the bottom of the page


Ultrasound guided nerve blocks


Ultrasound guided injections to suprascapular nerves for shoulder pain, occipital nerves for headaches, inguinal nerves for abdominal pain and genicular nerves for knee pain may reduce the sensitivity of the nerves and may lead to short or long-term pain relief.  If these diagnostic injection does work but wears off, a pulsed radiofrequency treatment may be offered in suitable patients . These treatments often needs to be combined with Physiotherapy and antineuropathic medicines.


Please see sections on common side effects, complications,  warnings and medical disclaimer in the bottom

of the page


Trigger point injections


Injections of trigger points with local anaesthetic and steroid may help reduce pain coming from irritated  muscles.  Injections can calm inflamed muscles.  They are not permanent and may in fact cause an increase in pain for a few days before relief, if any.  Occasionally injections of local anaesthetic and steroid into the skin can cause changes to the skin itself, leading rarely to fat atrophy. 


Please see sections on common side effects, complications,  warnings and medical disclaimer in the bottom of the page


 Caudal epidurals


 These procedures are performed to help reduce leg pain, particularly where there is a strong neuropathic element.  Usually a mixture of local anaesthetic and steroid is injected. There is risk of long lasting minor neurological event and minor  risk of infection.  The risk of  events such as significant headaches due to a spinal tap is 1% or less.  Normally after such procedures there may be leg heaviness, itching, shivering, fall in blood pressure followed by increase in pain for a day or two.  Although these procedures do no tend to give long-term relief some patients derive significant pain relief.


Please see sections on common side effects, complications,  warnings and medical disclaimer in the bottom of the page


Intravenous Guanethidine Blocks 


 Guanethidine intravenous Blocks are done in an attempt to reduce the sympathetic element of pains.  The procedure is performed with a cuff around the affected part and the medicines are injected intravenously. A tourniquet is required to obstruct blood flow during the procedure and the cuff stays up for 20 minutes .The procedure itself can cause pain because of the cuff pressure. 
There is often a worsening of pain on injection and for usually only a few days afterwards, although longer periods of pain have been reported. The procedure is often repeated up to 3 times.  Some patients notice a marked decrease in pain with a course of blocks.   
Patients who suffer from clots and thromboembolic disease should not undergo this procedure.  For a few days after the procedure the patient may feel light headed or generally unwell due to the administered medicines.  Neurological problems are very rare as the pressures and times  of the tourniquet involved are relatively short.


Please see sections on common side effects, complications,  warnings and medical disclaimer in the bottom of the page
 
  The use of Steroids in injections


They have been used by Pain Management Consultants, Rheumatologists, Orthopaedic Surgeons and Neurosurgeons.  Steroids work by reducing inflammation either in or around joints, or around nerves and can produce a marked relief of symptoms.  Although the effects of steroids tend not to last in the long-term, some studies have shown that the use of such drugs may reduce reduce the requirements for certain surgeries. Long-term use of steroids are associated with side effects such as weight gain, hair loss, loss of bone density, headaches, menstrual irregularity, changes in mood and rarely avascular necrosis of the hip, in the Pain Clinic setting such side effects are less frequently seen.  This is because the steroids have been given as a single dose and occasionally as a few doses.  


Please see sections on common side effects, complications,  warnings and medical disclaimer in the bottom of the page
 
Pulsed Radiofrequency 


 Pulsed radiofrequency is a technique whereby an electric current is applied to sensitive nerves or nerve endings. Electrical stimulation seems to desensitise the nerves.  There may be a few weeks to a month or 2 of increased pain before the relief is experienced.  No high temperatures are used and, therefore, the technique itself does not cause any clinical nerve injury as far as per recent research.  It can be repeated if necessary.  Often local anaesthetic and steroids are injected at the time to help cover the initial post operative soreness. 


Please see sections on common side effects, complications,  warnings and medical disclaimer in the bottom of the page
 
Common side effects, complications and warnings

​No procedure is without risks. Side effects of any procedure may include infection, bleeding, bruise, failure of the injection to work, pain at the site of injection, increase in pain generally and  injury of body structures with the injection procedure.

The use of steroids may lead to temporary headaches and weight gains.

Serious complications such as allergy, anaphylaxis, long term nerve damage or paralysis, abscess are very  rare with a probable risk of paralysis or abscess being 1 in 40,000- 50,000.
There is also the possibility of permanant long term flare up of usual pain after procedure, although this is usually less than 1%.
There may be other side effects involved which are beyond the limited capacity of this website.

Medical Disclaimer


The information provided is a simple, general and concise information intended for general public only. This is no substitution for advanced knowledge for medical practitioners. The author takes no responsibilities for inappropriate use of information provided on this website. Please refer to the page on disclaimers for further details.