Diagnosis
An alternative to relying only on the clinical evaluation and x-ray studies to diagnose the source of pain is diagnostic injections. These may be useful both in patients with nerve root pain and in patients with back or neck pain. At the time of a diagnostic injection we selectively inject individual structures of your spine with contrast dye and/or local anesthetic, and observe the effect this has on your pain. If you experience reproduction of your typical symptoms during an injection, that may be an indication that the structure being injected is the source of your pain. If your pain goes away, even for a short period of time, after we inject a specific structure with local anesthetic, that may also be an indication that the structure injected is the source of your pain.
Because the degree of pain relief that you experience immediately after a diagnostic injection is so important, following the injection you may be asked to perform certain maneuvers that usually increase your pain, to determine if that has changed. In addition to contrast dye and/or local anesthetic we often include a small amount of cortisone with diagnostic injections. The cortisone used may provide prolonged pain relief beginning one to two weeks after the injection. If you have such pain relief following a cortisone injection, that also may be important diagnostically. Examples of diagnostic injections include disc, facet, sacroiliac, sympathetic, and selective epidural or nerve root injections. Using injections, in conjunction with clinical information and imaging studies, we are able to diagnose the source of pain in approximately 75% of patients.
