Dubai, UAE- UPANDRUNNING’s Sports Medicine and Interventional Pain Specialist, Dr Tom Saw answers questions regarding the usage of injections in treating pain.
Why would a Doctor recommend an injection as treatment?
The injection helps in several ways. Commonest is to help settle pain and speed recovery by settling inflammation and allowing return to rehab or training. The injection can give a definite diagnosis as to where the pain is coming from. We commonly see this with pain around the hip that could come from the back or hip or both. Injecting the hip joint allows us to identify the cause of the problem. We can inject around trapped nerves to help reduce the inflammation and reduce the pain of sciatica and speed the patients recovery. We can inject gels into joints to improve lubrication and reduce the pain and symptoms of wear and tear and arthritic joints.
Injections are used for different reasons. The commonest is a corticosteroid, this is different to the anabolic steroids used illegally for body building. The corticosteroid is an artificial version of the bodies own steroids. These do not block pain but act as an effective anti-inflammatory help to reduce pain and improve function.
We do sometimes inject only local anaesthetic as a pain block. We use this to help diagnose complex condition sand to get a definite diagnosis by injecting the source of pain, this may be into a joint, around a nerve or ligament. The pain relief can last from an hour to 12 but will give us a good idea as to whether that is the problem area.
Is there a limitation in the number of injection I could have?
No, the number of injections is based on clinical grounds, the safe dose of steroid and anaesthetic and your response. We base what we inject and the amount on the minimum dose necessary to treat the condition. We may sometimes inject a course of treatment over 2-3 sessions as this is most effective. The steroid doses we use are always very small and we calculate the safe dose for all patients.
Does it need to be done under x-ray guidance?
All our spinal injections are done either under US guidance in the clinic or for the more complex ones under live digital x-ray guidance in the Theatre in hospital. This allows us to position the needle most accurately. Some injections into large or easily identifiable joints or structures e.g. the knee can be done using anatomical landmarks. Otherwise we can use US to guide us to joints, ligaments or nerves.
What can I do after my injection?
For most injections we ask you to take things gently for 2-3 days, keep the area dry for 24 hours and no bathing or soaking for 48 hours. It takes a few days for the steroid to work and you will gradually feel more comfortable. Liaise with your doctor and therapist how early you can return to gentle activity and resume your rehabilitation and training.
How quickly will it work?
Different injections take a varied amount of time to take effect. When we use local anaesthetic for an injection to get a diagnosis we will expect a result within 2-3 minutes but it will wear off in a few hours. But it will have given us our answer by then. Steroid injections take 3-4 days to start working and can take 2-3 weeks to have effect and can take a full 6 weeks to see the maximum benefit. The doctor will tell you what to expect after the injection.