Local Injections

What are local injections?

Pain can be caused not only by nerves in the joints or nerve roots near the vertebral column, but also by inflammation in other joints or in soft tissues such as tendons or a bursa (plural: bursae). Bursae provide a kind of cushion between tendons and bones. If bursae become inflamed they can cause a lot of pain. The most well known example is shoulder pain. This can involve inflammation not only in the shoulder joint, but also in the bursa, the points of insertion of the tendons and the joint between the collar bone and the shoulder blade. We can relieve the pain by injecting anaesthetic with corticosteroids around or inside the joint or inside the bursa. Figure 1 shows an example of an injection into the bursa of the shoulder (number 1 in Figure 1).

 

bursaschouder

 

Figure 1. Left shoulder seen from above with a needle in the bursa of the shoulder.

What should I be aware of before undergoing local injections?

Any of the following situations should be reported to your pain specialist if he proposes a local injection:

  • If you are pregnant: since X-ray equipment is used, pregnant women may not undergo a local injection.
  • If you are ill or have fever on the day of treatment you cannot undergo a local injection and a new appointment has to be made.
  • If you are allergic to iodine, bandages, anaesthetics or contrast fluids, you should notify your pain specialist before the appointment for treatment is made.
  • If you are taking blood thinners, you should notify your pain specialist before the appointment for treatment is made. He will then consider whether the use of certain medications should be ceased temporarily.
  • No special preparations, such as an overnight bag, are necessary because the treatment is carried out on an outpatient basis.
  • You may eat before treatment and take your normal medication.
  • N.B.: this does not include blood thinners, as mentioned above.
  • Make sure you have someone to take you home, because you may not drive for 24 hours.

How should I prepare for local injections?

  • No special preparations, such as an overnight bag, are necessary because the treatment is carried out on an outpatient basis.
  • You may eat before treatment and take your normal medication.
  • N.B.: this does not include blood thinners, as mentioned above.
  • Make sure you have someone to take you home, because you may not drive for 24 hours.

How do local injections work?

  • The treatment will be performed in the surgical day-care centre, where you will be asked to change into a surgical gown. This gown closes at the back.
  • A nurse will escort you to the treatment room, where there is a treatment table, an X-ray machine and television monitors.
  • Depending on where the local injections are to be performed, you will be positioned on the treatment table on your back or stomach.
  • Your own pain specialist will estimate the right location of the injection.
  • The area around this site is then disinfected with a cold, red liquid. The pain specialist covers the area with sterile drapes.
  • After a local anesthetic has been applied to the skin, the pain specialist will bring under fluoroscopy (via television monitor) or by ultrasound the needle in the right place.
  • If the needle is in the right place a small amount of local anesthesia will be injected together with corticosteroids.
  • This numbness may last several hours.
  • You will then be asked to get dressed and to make an appointment with your own pain specialist to evaluate the effect of the treatment and discuss further treatment possibilities.
  • On the day of the treatment you should slow down and is advised not to participate for 24 hours in traffic.

What are dangers and side effects of local injections?

  • Sometimes an allergic reaction for the injected substances can occur.
  • In case you have diabetes your blood sugar level can become deregulated.
  • It is of importance to inform your pain specialist before the treatment is planned.
  • After a local injection your blood sugar level has to be controlled by your GP or treating internist.
  • In women, due to the corticosteroids, hot flashes can occur and the menstrual cycle may be become disrupted briefly.
  • Sometimes a small haemorrhage of the skin can occur with a prolonged pain for a week and than disappear.

When can I expect pain relief after the treatment?

  • After pains can occur following a local injection. These may last for several weeks but will eventually disappear.
  • The optimum results of treatment are seen after two weeks.
  • Around this time, a new appointment with your pain specialist will be made.