One procedural option your Resolve Pain health practitioner may recommend to you isa nerve root sheathe injection. These procedures are often confusing to understand, so it is important that you understand what this procedure can and cannot do.
What is a nerve root sheathe injection? A nerve root sheathe injection is usually a local anaesthetic (a numbing liquid) and a steroid (a liquid to reduce inflammation) placed in a nerve root sheathe. Nerve roots are the starting places where nerves come out of your spine to go to different places, such as your fingers, arms, legs, neck etc. These nerve roots usually carry sensation information from these areas to tell your brain whether you are touching something, or your skin is too hot, cold,or injured.
This injection is placed in the bony hole where these nerves emerge (as shown below). For some people, these nerve ‘roots’ can be compressed by a piece of bone, ligament, disc bulge or other tissues. When these nerve roots are compressed and become inflamed, they often start ‘yelling’ messages of pain which you can feel along the whole nerve.
For example, if the nerve to your leg is compressed at your spine, you can get pain in the foot, ankle, shin, knee, thigh, or hip! Our brain is very poor at knowing exactly where the nerve is compressed – so just tell your brain, ‘It is somewhere along here!’
The nerve root sheathe injection aims to ‘open up’ the hole around the nerve and reduce any local inflammation in the area to try and stop the nerve from sending you pain signals when no damage is happening.
Will this procedure definitely work for me? Unfortunately, there are no guarantees. For many people, this injection can temporarily open the hole to relieve the pain, sometimes lasting 3-6 months. Some people may get longer relief as well, and while this is hoped for it is less common. The reason this is helpful, though,is that if your pain is reduced for 3-6 months, and you work on increasing your exercise level, getting stronger, improving flexibility in your back, and walking more, then there is a very good chance that as the medication wears off, your pain may not come back as much, or at all.
Why are these sometimes performed if I am considering surgery? If you are possibly going to have surgery to physically open up the hole around a compressed nerve, sometimes performing this nerve root sheathe injection can help to clarify whether thisis truly the area contributing to your pain, or whether your pain may be coming from somewhere else. Your health care provider can explain this is more detailif this is why you are having this procedure.
Will this procedure take away my lower back pain? No – this is very unlikely. This procedure is designed to help with pain directed AWAY from the back, such as sciatic paindown your leg, pain from your neck that goes to your shoulders or arms, or pain that goes to your head and causes headaches. It is not designed to help local pain in the middle part of your back. If this area is your primary area of trouble, then you should discuss this with your healthcare professional, as there may be more specific procedures to consider for that type of pain. Often, we will do both procedures for your neck/thoracic/back pain AS WELL as doing anerve root sheathe injection to help with the entrapped nerves.
Are there any risks with these procedures? Nerve root sheathe injections are performed daily all over the Sunshine Coast, and the majority are straightforward with no complications. Some more common possible side effects include a flare of pain from the injection (remember – we are putting more fluid in a tight space – so it can be a little sorer before it improves), reaction to the medication (which is quite unlikely) and bruising around the area where the needle is placed. Very rare risks include injury to larger blood vessels and/or nerves around the spine, causing nerve damage, which in most cases is reversible but exceedingly rarely may be permanent. You can also not have these procedures many times asthere is a small risk of fat developing around the nerves, which can compress the nerve (usually if you have >3/year).
If you have further questions, discuss this with your radiologist performing the procedure or your referring health practitioner.
If you would like any further information on these procedural options or would like to have a further appointment with our doctors, nurses or allied health practitioners, then please don’t hesitate to call, and we would like to help assist in strengthening your resolve and making your life less about pain.
Please note this video is provided by an external provider however the information is similar.