Originally published in the Williamson Herald —

It can be hard to find the right time to address recurring back pain. Between our busy schedules, the rumored risks of many procedures and the daunting task of locating the source of pain, many people simply learn to live with discomfort.

But a solution to a pain-free life may be closer than you think with nonsurgical treatments from the Bone and Joint Institute of Tennessee. Dr. Zachary Kalb, a physiatrist specializing in interventional spine medicine, clarifies common misconceptions surrounding spinal injections and their pain relief benefits.

“Spinal injections can be the perfect solution for people who are not surgical candidates or those who experience pain despite a prior surgery,” said Dr. Kalb. “These nonsurgical injections can mitigate pain and help patients live better lives.”

Although there are many types of spinal injections, epidurals are the most common. These injections are used to reduce uncomfortable burning, tingling and numbness associated with nerve pain, which often results from stenosis — a condition where nerves are compressed due to a narrowing of the surrounding space.

“Most patients with this condition experience associated pain in legs and arms, pain that radiates around the ribcage and even headaches,” said Dr. Kalb. “However, we exhaust all other treatment methods before opting for injections.”

Dr. Kalb first puts each patient on a physical therapy plan, suggests over-the-counter medications, modified activity levels and other treatments like dry needling or acupuncture to relieve pain. If these methods do not provide relief within four to six weeks, then it’s time to consider an injection. 

“The epidural injections apply an anti-inflammatory effect to a painful nerve root, reducing pain and allowing the area time to heal,” said Dr. Kalb. “And contrary to popular belief, these injections are very low risk.”

Additional myths surrounding spinal injections include: 

1. Pain level

Most people are hesitant to get a spinal injection, even when they need one, because they believe them to be painful. Combining years of experience administering these injections with the use of a local anesthetic, Dr. Kalb assures patients that they should not be fearful of the pain.

“These injections are generally no more painful than a bee sting lasting two to three seconds at most,” said Dr. Kalb. “Some may feel increased pressure at the injection site and/or the affected limb while the medicine is injected along the affected nerve.”

Some patients may also experience a temporary numbness in the leg which subsides within a day, but nearly all patients are able to walk immediately following the injection. 

2. Injection site

Another widely held belief is that the medicine is injected directly into the spine, which is false. Epidurals are administered with the needle tip placed along the periphery of the spinal canal.

“Similar to the epidural used during labor and delivery, the medicine is injected into the epidural space,” said Dr. Kalb. However, these injections target a specific nerve where pregnancy epidurals flood the spinal canal with medicine and anesthetize many nerves to eliminate pain during the delivery.”

Additionally, the injection site can change depending on the affected nerve’s location. The lumbar spine is the most common area to inject as it includes five different nerve roots. Providers can pinpoint the most effective injection sites using physical exam, patient history, X-ray and MRI results.

3. Multiple injections

Patients may also be reluctant to get an injection as they believe they will require multiple injections to remain pain-free.

“When a patient needs a spinal injection, I never plan to perform more than one,” said Dr. Kalb. “Every person’s body responds differently to the medicine, making pain relief times vary greatly. I have patients that only attain short term relief with the numbing agent and others that attain years of relief.”

Even though the injected medication starts working 24 hours after it is injected, it can take two to three weeks to reach full effect. Dr. Kalb waits at least three weeks to reevaluate patients. This allows time to see if just one injection provides significant, long-lasting pain relief. However, research shows that relief can compound if a patient receives a second injection within three months of the prior injection. 

“Most insurances will cover up to four spinal injections per year, but rarely do patients require four in order to attain long-term pain relief,” said Dr. Kalb. “With minimal risk, these injections can dramatically improve quality of life. If typical over-the-counter treatments and home remedies do not relieve the pain, don’t hesitate to come see us to start living a more comfortable life without back pain.”