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 the need for ultrasound or x-ray guidance. Most injections are carried out with patients awake, but with generous 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 or rheumatological conditions).

Radiofrequency Procedures

These procedures are aimed at nerves. A needle with a probe through it is placed close to the desired nerve. A radiofrequency signal is then passed down the probe. Conventional radiofrequency will heat millimetres of surrounding tissue, and pulsed radiofrequency treatment relies more on the radiofrequency signal itself. These treatments 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).

BOTOX®

BOTOX® (botulinum toxin type-A) can be used to treat a number of painful conditions. This is highlighted by the recommendation for the use of BOTOX® in migraine by NICE (the National Institute for Health and Care Excellence). Resistant muscular pains are where BOTOX® is more often used. As with any treatment the use of BOTOX® has to be judged carefully for each patient and their particular individual circumstances.