Therapeutic injections pros and cons homework help
Therapeutic injections are normally joint injections administered for the relief of chronic pain and inflammation. They are a minimally invasive pain relief treatment commonly used to relieve the discomforts caused by gout, arthritis, and tendonitis.
These injections are used in patients who are experiencing either acute or chronic discomfort. They are usually reserved for patients who have not achieved desired relief from more conservative measures like physical therapy.
There are various types of therapeutic joint injections the most common of which are steroidal injections. Many of them are designed to provide immediate relief following the injections. Others are slow-release treatments over several weeks or months after the injection.
For how long does therapeutic injection last?
The length of time for relief varies from patient to patient although most of them have discomfort relieved for up to 6 to 8 weeks.
Types of pain treated using therapeutic injections
Many types of conditions can be treated which include:
- Psoriatic arthritis
- Rheumatoid arthritis
- Facet joint syndrome
- Degenerative disc disease
- Carpal tunnel syndrome
- Spinal stenosis
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Types of therapeutic injections
There are different types of therapeutic injections depending on your treatment plan. Some of the injections that your orthopedic specialist may recommend include:
- corticosteroid injections- they are one of the most common types of therapeutic injections. Corticosteroid injections use an anesthetic numbing agent that is combined with a
corticosteroid to relieve joint pain and inflammation. Examples of corticosteroids include dexamethasone, methylprednisolone, and triamcinolone.
- Epidural injections- they are normally performed to alleviate spinal pain in the legs or arms that results from an inflamed spinal nerve. Just like corticosteroid injections, epidural injections use an anesthetic combined with a corticosteroid injection that is normally injected into the epidural space just outside the spinal cord.
- Face joint injections- they are a type of spinal cord injections that are used to relieve pain in the middle back, neck, or lower back. Facet joints are tiny joints near the back of the spine that connect each vertebra. When these joints get injured or begin to degenerate, injections are used to alleviate spinal pain as well as the pain that radiates to the buttock, shoulders, and upper legs.
- Sacroiliac injection- it is similar to face joint injection but with the exception that they are injected into the sacroiliac joint which connects the sacral region of the spine to the pelvis. These injections are mostly used to relieve pain in the sacroiliac joint as well as pain in the lower back, legs, and buttocks, and in most cases, pain is usually reported on one side.
- Visco-supplementation injections- it is normally the injection of hyaluronic acid into the joint to improve the viscosity of joint fluids which improves joint mobilization. Most of the time, visco-supplementation has effectively helped some patients to manage their pain without joint replacement surgery.
- Trigger point injections- a trigger point is an injured part of the muscle such as a pressure point, a knot, or a tender area. This kind of pain can be found in a part that has sustained an injury or in any muscle in the body. It is commonly found in the shoulder, neck, or back. This kind of injection involves the injection of a local anesthetic into the site of the pain.
- Joint injections – this procedure uses a needle to inject a local anesthetic into a joint. Healthcare providers usually inject a needle into the skin to inject the medication.
- Regenerative medicine-it utilizes the body’s natural healing properties to heal itself from the inside. Pain management specialists normally diagnose musculoskeletal injuries that can benefit from regenerative medicine. This helps not only in improving only the patient’s physical pain but also the psychological effects of long-term pain medication use.
- Nerve blocks- this involves injections of local anesthetic into the nerves or groups of nerves to treat localized pain. The numbing anesthetic temporarily relieves pain for about 14 to 24 hours. In case long-term pain relief is required, the physician usually inserts a catheter to slowly deliver the anesthetic over some time.
- Joint aspiration injection- it is usually a procedure where a needle is used to remove fluid from a joint. Healthcare professionals inject a needle into the skin to remove the fluid or to inject pain-relieving medicine.
Benefits of therapeutic injections
The majority of people fear needles although once they get past their initial anxiety, many patients do not fear getting their next injection. Therapeutic injections can be used on their own or together with other treatment plans. The benefits of treatment plans include:
- Therapeutic injections reduce the symptoms of many conditions-just like prescription medicines, these injections normally treat pain that stems from many other conditions and symptoms which include: Rheumatoid arthritis, psoriasis arthritis, degenerative disc disease, osteoarthritis, gout, sciatica, spinal stenosis, bursitis, etc
- They help to reduce pain- sometimes the pain becomes unbearable which makes some patients need an extra boost for their physical therapy or chiropractic care. Such patients are usually hesitant to try prescription medication or undergo surgery but they realize they need something fast and effective. Patients choose treatments/injections depending on their conditions and their symptoms affect their lives, while others request more one type of injection.
- They help reduce swelling- in most patients’ pain usually stems from swelling and inflammation inside the body even when there is no visible physical injury. In cases where swelling occurs, the space in our bodies becomes tight while the nerves become compressed. This then results in pain, numbness, or tingling. Therapeutic injections help to reduce swelling by delivering anti-inflammatory agents directly into the affected muscle or joint. It also helps to decrease excess fluid and get rid of the pain-causing chemicals that stem from inflammation. Facet injections are common anti-inflammatory treatments that also help reduce swelling.
- Therapeutic injections provide lasting relief- a prescription injection/medication provides short-term relief. A few hours later, the pain returns accompanied by nausea, a dry mouth, or other unpleasant side effects that come from the medication. Therapeutic injections provide relief that lasts for weeks and sometimes even months after the final visit. Some of the patients even go pain-free for over a year after trying therapeutic injections. Patients also have an option of returning for many injections over a certain period like weeks or months. This greatly helps in ensuring that pain does not come back quickly.
- Therapeutic injections help in pinpointing the source of pain- health professionals use therapeutic injections to help relieve pain but sometimes injections have diagnostic benefits. For example, facet point injections are a trusted diagnostic tool that is used by most medical professionals. When this numbing medicine gets to the treated joint, a patient may experience immediate relief. This, therefore, helps the doctor to determine whether pain originates from this joint or the other one, hence making it easier to develop an effective treatment plan. Facet joints are the small joints that are situated between the vertebra in the spine, and they help the spine to twist and bend instead of remaining rigid. Without the facet joint, it would be very difficult to perform many functions like stretching. Lifting or even walking.
When facet joints get inflamed, they can cause pain in the back or neck hence limiting movement. Physicians treat this kind of pain with local anesthesia and anti-inflammatory medications so that the body can resume its normal functions.
- Therapeutic injections usually complement other treatments- some of the patients usually treat therapeutic injections after all other treatments fail while others enhance the effectiveness of other treatments by combining them with therapeutic injections. These are the other potential treatments for patients who receive therapeutic injections: physical therapy, acupuncture, massage therapy, chiropractic care, cryotherapy, heat therapy, spinal decompression, etc.
There are times when patients use injections as the last resort before requiring surgical procedures. Many of them end up realizing that therapeutic injections are strong enough to shield pain and result in long-lasting relief from unpleasant symptoms.
- Sometimes insurance may cover therapeutic injections- some pain management providers accept insurance plans. Coverage is not guaranteed although your insurance provider may cover some bit or all of the cost associated with therapeutic injections.
- It helps to improve the quality of life of the patient- with the help of therapeutic injection, patients can improve their well-being and quality of life. They can also use fewer painkillers which helps to avoid or delay or avoid or delay serious surgery. After treatment patients can resume their regular lives, do their job peacefully, and also enjoy time with family and friends.
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How therapeutic injections are given
Therapeutic injections are usually given by a specialist doctor in a health facility. They can be given in several different ways which include:
- Into the joints (an intra-articular injection)
- Into the spine (an epidural injection)
- Into the muscles (an intramuscular injection)
- Directly into the blood (an intravenous injection)
Therapeutic injections usually take a few days to start working although some start working as early as within hours, and their effect wears off after a few months. Some of the pain-relieving injections contain local anesthetic which provides immediate pain relief that lasts for a few hours.
Side effects of therapeutic injections
The possible side effects of therapeutic injections depend on the body part where the injection has been given. Side effects of injections into the joints and the spinal cord include the following:
- Temporary bruising or usually a collection of blood under the skin on the area the injection has been given
- Pain and discomfort for a few days at the area that has been injected- use paracetamol to relieve pain
- Flushing of the face for a few hours after injection
- An infection that causes redness, swelling, and pain – can be a sign of an emergency. Seek medical care immediately
- There is a loss of fat where the injection was given and this could cause dimples in the skin that may become permanent
- In case the patient has high blood pressure; the pressure would go higher for a few days after the injection
- In cases where the patient is diabetic, the blood sugar levels may go up for a few days after injection.
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Who can have steroid injections?
Most people can get steroid injections, however, there is a need to tell your doctor before having treatment if:
- Have had a steroid injection in the last few weeks. This is because you need to wait at least 6 weeks between injections.
- You have had an allergic reaction to steroids in the past
- If you have had 3 steroid injections in the previous year. This is because doctors recommend not more than 3 injections in the same area within 12 months.
Complications from therapeutic injections
On rare occasions, serious complications and adverse events after therapeutic injections can occur. They include the following-:
- Infections-generally infections may occur within the body affecting the brain, the spinal cord, occur locally, or in an area that was injected.
- Bleeding – any damage to the arteries may cause localized bleeding and pooling of blood within the soft tissues, membranes of the spinal cord, and the epidural space. A hematoma or a blood clot may form within the artery which might end up blocking the blood supply to vital tissues such as the spinal cord or the brain.
- Dural puncture- inadvertently inserting the needle into the spinal cord’s outer membrane may end up causing a Dural puncture a condition which is called a wet tap and normally causes the cerebrospinal fluid to leak out, decreasing CSF pressure in the brain which results in a headache.
- Nerve damage- any damage to the neighboring nerves may cause abnormal sensations, loss of sensation, or seizures. When the cauda equina nerves are damaged at the base of the spinal cord, it results in a medical emergency which is known as cauda equina syndrome. This kind of syndrome causes loss of bladder and bowel control. Therefore, it needs immediate treatment to prevent paralysis of the lower body.
- Heart / cardiovascular complications- sometimes after being injected with epidural steroid the patients may experience a decreased heart rate and low blood pressure.
Cons of therapeutic injections
They include the following:
- Epidural steroid injections in most cases produce small or insignificant positive changes in terms of leg disability in the short term. These improvements were not satisfactory over a longer period compared to the placebo effect.
- It has been noted that there is a higher risk of fracture and deterioration of the skeleton as a result of steroid injections that might have been contaminated with fungi. Most patients’ deaths are correlated with fungal meningitis which is usually a result of contaminated injections.
- Steroids are known to have a few side effects which include bleeding and damage to the nerves. One of the medications associated with steroids is also known to trigger some side effects such as high blood sugar levels, cataracts, and ulcers. Prolonged treatment with steroids can also lead to an increased risk of osteoporosis. This is due to the higher risk of fractures because of the increased fragility of the skeleton.
- Those patients who suffer from back pain without sciatica show no improvements from their injections although their physicians continue to have the steroid treatment prescribed to them.
- The charges associated with these steroid injections continue to rise dramatically. Given their limited effects, many of the patients see no real use in them. Patients, therefore, need to be aware of all their treatment alternatives so that they can make comparisons in terms of the rates of efficiency, cost, and also long-term effects hence making an informed decision.
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Steroid injection plays an important role in radicular pain as proven by some controlled many uncontrolled studies including meta-analysis. However, there are no well-designed validation studies available to substantiate their use in the case of spinal pain syndrome. Conservative treatment for lumbar radiculopathy initially included bed rest, pain medications, and anti-inflammatory medication as well as physical therapy?
In cases where patients have persistent pain, early use of therapeutic injections may provide pain relief, a reduction in inflammation, and a means to facilitate physical therapy. The optimal method of steroid delivery is through the use of fluoroscopy and a contrast agent. the transforaminal approach may also prove to be more efficacious following the completion of current clinical studies. Anesthetic and also corticosteroids should be injected without too much dilutional effect from the extra normal saline agent while the optimal method of delivery is by the use of fluoroscopy and contrast agent.
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