Injections and other needle-based procedures.

For some painful conditions, injections can be helpful. Injections can be aimed into joints, around nerves, or into muscles. They can be performed under x-ray guidance, under ultrasound guidance, or for simple superficial injections without ultrasound or x-ray guidance. Most injections are carried out with patients awake, but with liberal amounts of anaesthetic. Some injections are carried out under sedation. The injections themselves usually consist of a longer acting local anaesthetic and a steroid. The steroid as a single one-off dose is not associated with long-term problems. Patients do worry about steroids and long-term effects. Those tend to occur when people have been taking steroids as tablets daily for long periods (for example for respiratory diseases).

Radiofrequency procedures

These procedures are aimed at nerves. A needle with a probe through it is placed close to the desired nerve. It is then heated. This can bring about longer-term pain relief than local anaesthetic and steroid injections. It can be performed for low back pain coming from facet joints or for some nerve pains (neuralgias).

Acupuncture

Acupuncture can be useful for painful conditions. It is generally most useful for conditions with a significant muscle pain component. Sometimes the usefulness can be limited by the need to repeat to procedure frequently, but that is not a problem unique to acupuncture.