Raj N. Sureja, MD
As an Interventional Pain Management Specialist, I regularly see patients who have pain, numbness, tingling or weakness in their arm or leg, which seems to follow a distinct neural path, caused by a problem originating near the spine. Most often, these patients have been treated by a physician for the pain, may have taken oral steroid medications or been prescribed Physical Therapy, which did not reduce the inflammation responsible for causing the pain. That is when they come to see me. A reliable and effective way to treat their pain is with a nerve root block.
Before you have your injection, it is important that you stop taking medications that can thin your blood, like Coumadin, or anti-inflammatory medications, like Aspirin, ibuprofen or naproxen. I usually want my patients off of these for about 10 days, so that the chance of bleeding is reduced during the procedure.
When you come for your appointment, you will be asked to change into a gown and lie on the treatment table on your stomach. My nurse will ensure that you are comfortable and then will clean the injection site with antiseptic. The area will be draped and kept sterile for the procedure. When I come into the room, I will explain the procedure and will check with you to see that you are ready to proceed. I will talk to you the whole time and tell you what is happening during the procedure. I want you to tell me if you are anxious and we will do everything that we can do to put your mind at ease.
Using a C-arm, which is an x-ray machine that allows me to see exactly where I am injecting the medication, I numb the area with an injection of lidocaine, which may sting a bit until the numbness takes effect. Then I inject a bit of dye into the area, so that I make sure I can visualize the nerve root that I want to treat. Then I inject steroid and numbing medication into the area near the spinal column where the nerve exits. I only treat the nerve that corresponds with your arm or leg pain. As I inject the medication, you may feel some pressure, but that is temporary. As there is also numbing medication in this injection, you should feel some pain relief immediately for a few hours after the injection. If so, that confirms that I have treated the nerve responsible for your limb pain.
After the injection, we put a band-aid on the injection site and sit you up on the table. We want to make sure that you are not dizzy or feeling faint. When you are okay to walk, you can get dressed. We will take you to the waiting room where we will ask you to wait for about 20 minutes to ensure that you are doing okay. Then we will release you with the person you brought to drive you home.
The numbing medication will wear off in a few hours, but the steroid medication should take effect in 2-3 days, reducing inflammation and pain. You should not bathe in a tub for 24 hours after the injection, but a shower is fine. You may feel sore at the injection site and ice can be applied to the area intermittently. Complications are rare but can include infection at the injection site, a dural puncture, headache, flushing or dizziness. If you experience severe pain or a fever greater than 101, call us immediately.
Although it may sound scary to get an injection near your spine, I perform nerve root blocks all the time for my patients and many of them experience significant pain relief. It is wonderful to be able to provide such an effective treatment for those who suffer with limb pain caused by nerve inflammation.