Injections for Chronic Pain

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Key points

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    Even in the setting of chronic pain, various injections can still have a useful role in facilitating a rehabilitation program.

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    Spinal injections, such as epidural steroid injections and facet joint injections, are among the most commonly used procedures in most pain practices; but a growing number of practices are considering less common injections, such as trigger point injections, regenerative injections/prolotherapy, and injections using botulinum toxins.

Trigger point injections

Myofascial pain syndrome (MPS) is a common musculoskeletal pain syndrome characterized by a myofascial trigger point (MTrP) at muscle, fascia, or tendinous insertions. A MTrP is a hyperirritable tender spot, frequently associated with taut band that, on palpation, is firmer in consistency than adjacent muscle fibers. When compressed, an MTrP may cause patient vocalization or a visible withdrawal (which is known as the jump sign).

Stretching and exercise are the foundation of treatment and

Regenerative injections

Regenerative injection therapy (RIT) encompasses a spectrum of injection treatments designed to stimulate repair of damaged tissue. These injections range from prolotherapy (which provides a mild neurolytic effect followed by a complex restorative process with biochemically induced collagen regeneration), to platelet-rich plasma ([PRP], which uses autologous blood that has been spun down to separate out the platelets), to even stem cells (which can be autologous or banked).

In 1956, George

Botulinum toxin (BTx) injection

Injectable BTx is frequently used in both physiatric and pain practices. In general physiatry, it is commonly used to treat spasticity, such as that found after a stroke or spinal cord injury. Within pain practices, it is used for a variety of pain syndromes and is often used off-label. The mechanism of action and other theoretic aspects of these toxins are discussed earlier in this article as is their use for TPIs (which is also considered off-label). BTx comes in a variety of formulations,

Summary

Even in the setting of chronic pain, various injections can still have a useful role in facilitating a rehabilitation program. Spinal injections, such as epidural steroid injections and facet joint injections, are among the most commonly used procedures in pain practices; however a growing number of practices are considering less common injections, such as various TPIs, regenerative injections/prolotherapy, and injections using BTx.

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