Interventional Pain Management Options for Lower Back Chronic Pain

Neuropathic pain in the lower back can be debilitating, affecting all aspects of your life. Here are a few interventional pain management options to consider in helping you manage chronic lower back pain.

1. Epidural Steroid Injection

What Is It?

Epidural steroid injections work by injecting medication into the epidural space outside the sac containing the spinal nerves. This injection therapy relieves inflammation and reduces pain.

How Does It Work?

Corticosteroids reduce swelling and decrease pressure on nerves in affected areas, relieving pain. The procedure is minimally invasive and conducted by a licensed therapist or doctor.

Pros

• Near-immediate pain relief.

• Minimally invasive.

• May be repeated as needed.

Cons

• Temporary relief.

• Possible side effects, which could include infection or headaches.

• Not a permanent solution.

2. Facet Joint Injections 

What Are They?

Facet joint injections alleviate pain caused by spinal joints during the onset of arthritis, lumbar spondylosis, or zygapophyseal in seniors. It’s also useful for treating damage to the vertebrae by sports-related injuries.

How Do They Work?

A licensed practitioner injects a combination of Lidocaine, an anesthetic, and steroidal medications into the joints in the spine to lower inflammation and pain.

Pros

• Fast procedure.

• Near-immediate relief.

• Minimally invasive.

Cons

• Temporary results lasting a few months.

• Several injections could be needed in different areas of the spine.

• Potential adverse effects similar to other steroid injection therapies.

3. Radiofrequency Ablation

What Is It?

This therapy destroys nerve fibers carrying pain signals from the lower back to the brain by using heat generated from medium frequency alternating current (AC).

How Does it Work?

A medical practitioner introduces tiny needles near the problematic nerve endings. The radio frequency waves generate heat, disturbing nerve function to relieve pin symptoms.

Pros

• Permanent pain relief.

• Minimally invasive.

• Can be repeated if necessary.

Cons

• Requires precision.

• You may experience temporary numbness or weakness.

• Not suitable for everyone.

4. Spinal Cord Stimulation

What Is It?

Spinal cord stimulation involves implanting a device under the skin that sends electrical impulses to the spinal cord to disrupt pain signals.

How Does It Work?

A medical professional implants a small device delivering electrical stimulation to the spinal cord. This battery-powered device can last between two to five years before requiring replacement.

Pros

• Adjustable and reversible.

• Alternative to needles and opioid pain medication.

• Long-term pain management solution.

Cons

• Requires surgery.

• Battery eventually expires and requires a new implant.

• Regular follow-ups needed.

5. Intradiscal Electrothermal Therapy

What Is It?

IDET is a minimally invasive procedure in which the outer layer of the spinal disc (the annulus) is heated to reduce inflammation and pain.

How Does It Work?

A catheter containing a heating element is inserted into the affected disc, which subsequently contracts the collagen fibers of that disk and reduces inflammation.

Pros

• Minimally invasive.

• It decreases discogenic pain.

• Outpatient procedure.

Cons

• Is ineffective for all types of disc pain.

• Possible disc damage.

• Recovery time needed.

6. Trigger Point Injections

What Are They?

Trigger point injections are used for muscle knots or lower back muscle spasms.

How Do They Work?

A needle is inserted into the trigger point, and an anesthetic such as lidocaine or a saline solution is injected to relax the muscle.

Pros

• Rapid relief.

• Simple procedure.

• Can be done in a medical practitioner’s office.

Cons

• Temporary relief.

• May require multiple injections.

• Not effective for all types of back pain.

7. Vertebroplasty and Kyphoplasty

What Are They?

These procedures treat spinal fractures which are causing chronic lower back pain.

How Do They Work?

The practitioner injects a cement-like material in the fractured vertebra to stabilize it. Kyphoplasty requires “ballooning” of the injection site before injecting the cement to restore the vertebral height.

Pros

• Quick pain relief.

• Stabilizes the spine.

• Minimally invasive.

Cons

• Potential for complications.

• Not suitable for all fractures.

• Requires imaging guidance.

8. Sacroiliac Joint Injections

What Are They?

These injections treat the sacroiliac joint, which can cause lower back pain, since these joints connect the lumbar spine to the pelvis.

How Do They Work?

To reduce inflammation and pain, both a local anesthetic and a corticosteroid are injected into the sacroiliac joint.

Pros

• It can provide diagnostic and therapeutic benefits.

• Minimally invasive.

• Quick procedure.

Cons

• Temporary relief.

• Possible side effects such as infection.

• Not always effective.

9. Nerve Blocks

What Are They?

Nerve blocks target the direct injection of medication into plexus or ganglions, stopping the transmission of pain signals.

How Do They Work?

A medical practitioner injects a local anesthetic and anti-inflammatory medication near the affected nerve, stopping the passage of pain signals to the brain.

Pros

• Quick relief.

• Can be diagnostic.

• Minimally invasive.

Cons

• Temporary relief.

• Possible side effects.

• Not a long-term solution.

10. Disc Decompression

What Is It?

Disc decompression is a minimally invasive intervention that reduces the pressure exerted on the spinal nerves by herniated discs.

How Does It Work?

A needle is passed into the herniated disk, and part of the disk material is taken out to relieve the pressure on the nerves.

Pros

• Minimally invasive.

• Quick recovery.

• Helpful for disc pain.

Cons

• Not suitable for all disc issues.

• Possible recurrence of disc herniation.

• Requires imaging guidance.

11. Physical Therapy and Rehabilitation

What Is It?

In physical therapy and rehabilitation programs, the patient undergoes guided therapy, such as stretching. The goal is to build the musculature around the spine, strengthening the structure to reduce pain.

How Does It Work?

Physical therapy relieves pain and prevents new injuries through properly executed exercises, usually with specific stretches and massage therapy.

Pros

• Non-invasive.

• Improves overall lower back strength and flexibility.

• Long-term benefits.

Cons

• Requires commitment and time.

• May not provide immediate relief.

• Requires professional level of supervision.

12. Pain Pumps

What Are They?

Pain pumps or intrathecal drug delivery systems are installed with a pump to deliver the drug directly to the spinal cord. 

How Do They Work?

The pump continuously provides small doses of medication over time, providing sustained pain relief.

Pros 

• Effective for moderate to severe pain. 

• Reduces the need for oral medications. 

• Dosage is adjustable. 

Cons 

• Requires surgery. 

• Possibility of pump failure. 

• Follow-ups required. 

Consult with a Doctor About the Right Pain Management Strategy for Your Unique Situation & Physiology 

Relief from interventional pain management creates a better quality of life for patients affected by lumbar spinal pain caused by aging or injury. Discussing the treatments with your doctor can help you find the most effective pain management strategy.