Types of Back Pain Injections: Complete Treatment Guide | Comprehensive Orthopedic & Spine Care

If you’ve been suffering from chronic back pain in Queens or Long Island, you’ve probably been hearing about injections as a form of treatment. But the terminology can be confusing. Epidurals, blocks, ablations—what's the difference? And more importantly, which one is best for your pain?

At Comprehensive Orthopedic & Spine Care, we feel that a well-informed patient is an empowered patient. These cutting-edge treatments are an everyday part of what Dr. Joseph E. Weinstein and Dr. Carlos Castro do to help their patients avoid surgery and get back to living actively again. This guide will take you through the most common injections for back pain, explaining how they work and who may or may not benefit.

Why Consider Injections?

Before we get into the kinds, let’s start with the purpose. The primary reasons for back pain injections are twofold:

• Diagnostic: They are one of the most direct ways to localize the exact place your pain is coming from. If you numb a particular nerve and the pain goes away, that’s a strong clue.
• Therapeutic: They can offer relief by reducing inflammation or interrupting pain signals, with effects that can last for weeks to months.

1. Epidural Steroid Injections (ESI)

This is one of the most well-known back pain injections.

What it is:

The medication used in an epidural injection is typically a mixture of corticosteroids (potent anti-inflammatories) and a local anesthetic, placed into the epidural space—the space around the spinal cord and nerve roots.

How it works:

When a nerve root is compressed by a herniated disc or spinal stenosis, it can become irritated and swollen. This inflammation can make pain radiate down your leg (sciatica) or arm. The medication flows around the nerve roots, easing inflammation and calming pain.

Best for:

• Radiating pain (sciatica, radiculopathy)
• Herniated or bulging discs
• Spinal stenosis
• Degenerative disc disease

The Experience:

It’s a short, outpatient procedure done under X-ray guidance. You may feel a little pressure, but it isn’t usually painful. Relief can start in a matter of days.

2. Facet Joint Injections

What it is:

The small stabilizing joints between and behind adjacent vertebrae are called "facet joints." They can get arthritis, just like your knees or hips. A facet joint injection places medication directly into the joint capsule.

How it works:

It targets inflammation within the joint itself. If you have “axial” back pain—meaning it stays in the back rather than radiating down your leg—the facet joints are often a culprit.

Best for:

• Arthritis of the back (Spondylosis)
• Long-lasting lower back pain that increases when standing or twisting
• Injuries due to whiplash (neck facet joints)

3. Medial Branch Blocks (MBB)

What it is:

This is primarily diagnostic. The medial branch nerves are small nerves that carry pain signals from the facet joints to the brain. With an MBB, a local anesthetic is placed near these nerves to temporarily block the signal.

How it works:

Think of it as a test drive. If the injection relieves your pain for as long as the anesthetic lasts (often a few hours), it’s good evidence that the facet joints are what’s causing your symptoms.

Best for:

• Diagnosis of facet joint arthritis
• Determining whether you are a candidate for Radiofrequency Ablation

4. Radiofrequency Ablation (RFA)

What it is:

More involved than an injection, RFA is a longer-lasting treatment that’s often done after medial branch blocks confirm the pain source.

How it works:

Using a specialized needle, radiofrequency heat energy targets the medial branch nerve. This creates a small heat lesion that helps stop the nerve from sending pain signals. It doesn’t interfere with muscle movement or normal sensation in your skin—mainly the pain coming from arthritic facet joints.

Best for:

• Lasting relief of facet joint pain (relief can last 6–12 months or longer)
• Patients who responded temporarily to facet injections or blocks

5. Sacroiliac (SI) Joint Injections

What it is:

The SI joints link the base of your spine (sacrum) to your hip bones (ilium). They are a common cause of lower back and buttock pain.

How it works:

Like a facet injection, steroids and anesthetics are placed into the SI joint to decrease inflammation.

Best for:

• Pain in the low back, buttocks, or groin
• Pain that worsens when getting up from sitting
• Back pain after pregnancy or childbirth (pregnancy can stress the SI joints)

6. Trigger Point Injections

What it is:

Sometimes, back pain is not in the spine at all—it’s in the muscles. A trigger point is a tight knot of muscle that refuses to relax.

How it works:

We inject a small amount of anesthetic (and sometimes steroid) directly into the muscle knot. This can help the muscle relax and receive more blood flow.

Best for:

• Myofascial pain syndrome
• Prolonged tension and muscle cramps
• Fibromyalgia