Nerve Blocks & Pain Injections — Epidurals, Facet & More

Pain blocks are injections of medication around nerves, into joints, or into muscles — used to relieve pain, to diagnose its source, or both. They are among the most useful tools in interventional pain medicine, because a well-placed injection can do something medications taken by mouth can't: deliver a powerful anti-inflammatory or numbing agent directly to the spot that's generating the pain. This page is an overview of the main types and the safety principles that apply to all of them; each procedure has its own detailed FAQ linked below.

The main types of pain blocks

Epidural steroid injections deliver a potent anti-inflammatory into the space around the spinal nerves — the workhorse procedure for back or neck pain that radiates into a leg or arm. They can relieve pain and sometimes postpone or eliminate the need for surgery. → See the Epidural Steroid Injection FAQ

Facet joint injections target the small paired joints along the back of the spine, which cause pain that worsens with twisting or bending backward. These injections are both diagnostic (numbing the joint tells us whether it's the pain source) and therapeutic. → See the Facet Joint Injection FAQ

Sacroiliac (SI) joint injections treat inflammation where the spine meets the pelvis — a common and frequently missed source of low back and buttock pain. Like facet injections, they both confirm the diagnosis and treat it. → See the SI Joint Injection FAQ

Trigger point injections treat the tender muscle "knots" that generate pain in fibromyalgia, tension headaches, and myofascial pain. See the section below.

Peripheral nerve blocks can both pinpoint and treat pain from specific nerves — useful for conditions as varied as certain headaches, nerve pain from surgical scars (neuromas), shingles pain (postherpetic neuralgia), and complex regional pain syndrome. Techniques and medications vary with the target.

Trigger point injections, in brief

If you can put a finger on a small, tender "knot" that seems to set off your pain, that's likely a trigger point — and it can be quieted with an injection. Typically a long-acting local anesthetic (bupivacaine or ropivacaine) is combined with a corticosteroid; interestingly, even "dry needling" (an acupuncture-like needle placement with no medication) can help. The needles are much smaller than the ones used to draw blood, and because relief is often immediate, these are among the injections patients come to welcome. Results last longer when the injected area is stretched daily afterward — the injection opens the window, and stretching keeps it open.

What are the risks?

Every injection carries risk in two categories, and honest discussion of both is part of good care:

• What the needle can do — bleeding, infection, or injury to structures the needle contacts.
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• What the medications can do — allergic reactions or drug side effects.

Because numbing medicine in a block can temporarily weaken a muscle or reflex, for most blocks we'll ask you to bring a driver, since a temporarily weakened reflex could leave you unprotected in an emergency.

"I heard cortisone is harmful — is that true?"

The anti-inflammatory steroids used in pain blocks are not the anabolic steroids weightlifters use — they're synthetic versions of anti-inflammatory hormones your body makes naturally. They're generally very safe, but honestly: they can cause temporary blood sugar elevations in diabetics, a few days of water retention, and — if given too frequently — temporary suppression of your body's own steroid production. This is exactly why we space injections appropriately rather than giving them on demand.

How to minimize your risk — what to look for

Your safety depends heavily on who does the procedure and where:

• Board-certified physician. Anesthesiologists are specifically trained in the science of pain relief and in the regional anesthetic techniques these blocks require.
• Proper backup and an accredited facility. The site should have full emergency equipment — defibrillator, emergency medications, suction, oxygen. You can be confident of this when the procedure is done in a facility accredited by a recognized review organization (such as Medicare/CMS, AAAHC, or the Joint Commission). Don't accept less; your safety is on the line.
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At Newport Pain Management, procedures are performed at the accredited Newport Center for Special Surgery, with Dr. Scott — a board-certified anesthesiologist — performing the blocks. To find out whether an injection is right for your pain, call (949) 759-8400.

This page is for general education and is not a substitute for individual medical advice.