Local Spinal Injections: Addressing Pain Concerns and Side Effects

Q: Local Spinal Injections: Addressing Pain Concerns and Side Effects

Let me clarify a few questions： 1. <br>Previously, what did the doctor say about the pain? What is the issue? Is it related to muscles, nerves, or joints? Is there any history of injury? How long has the pain lasted? 2. <br>What type of injection was administered—local anesthetic

Questions related to spinal local injections?

Could you please ask Dr.
Pan if local spinal injections could lead to the following symptoms: "Initially, my leg pain was only temporary, but about an hour after the injection, I noticed the pain became more pronounced, and it has now been 24 hours." I'm unsure if such a phenomenon could occur.
My family members who work in healthcare insist that the aforementioned issue is not possible, but my leg pain is indeed more uncomfortable than before the injection.
I have taken pain relievers and muscle relaxants, but the effect has been unsatisfactory.
I wonder if there might be other underlying issues?

gush, 20~29 year old female. Ask Date: 2005/08/02

Dr. Pan Yingda reply Rehabilitation

Let me clarify a few questions: 1.
Previously, what did the doctor say about the pain? What is the issue? Is it related to muscles, nerves, or joints? Is there any history of injury? How long has the pain lasted? 2.
What type of injection was administered—local anesthetic, corticosteroid, or something else, and where was it injected? If we do not discuss the above issues, there are several possibilities for increased pain after a local injection (this is possible!): 1.
The underlying issue may still be worsening, especially if the condition has developed recently, such as a herniated disc in a young person, or if there was exertion after the injection, or if poor posture was maintained for too long, such as during travel.
2.
In our experience with local injections, some patients report increased pain afterward (approximately 20% based on statistics), but this typically improves within 2-3 days.
There are two possible reasons for this: (1) Individual constitution—some patients may experience increased pain before improvement, which we refer to as "rebounding" (about 20%), and (2) When we inject medication or there is slight localized bleeding, even if the volume is only 2-3cc, it can create enough pressure to compress nearby tissues, especially near nerves (this phenomenon does not occur with larger muscles).
However, this should resolve within two to three days (I believe you may be experiencing this situation).
If the injection caused damage, you would likely feel something was wrong immediately after the injection, not an hour later.
Therefore, please remain calm and wait a couple of days to see if it improves; if discomfort persists, consult a physician nearby.
If you are in Taitung, you are welcome to come see me.
Due to the lack of clarity regarding your issue, I cannot provide a definitive answer.

Reply Date: 2005/08/02

More Info

Local spinal injections, such as epidural steroid injections or nerve blocks, are commonly used to manage pain associated with conditions like herniated discs, spinal stenosis, and other musculoskeletal issues. However, it is not uncommon for patients to experience an increase in pain following the injection, especially within the first few hours to days. This phenomenon can be concerning for patients, particularly if they are not adequately informed about what to expect post-procedure.

When a patient reports that their pain has worsened after a spinal injection, several factors could be at play. Firstly, it is essential to consider the nature of the underlying condition. If the condition was already in a state of progression, the injection might not immediately alleviate the pain and could even exacerbate it temporarily. This is particularly true if the injection was performed in the presence of inflammation or if the condition is still evolving.

One possible explanation for increased pain after an injection is the phenomenon known as "rebound pain." This occurs in approximately 20% of patients, where pain may temporarily worsen before it improves. This can be due to the body’s response to the injection, where inflammation may initially increase before the anti-inflammatory effects of the steroid take effect. Additionally, if there was any minor trauma to the surrounding tissues during the injection, it could lead to localized swelling or irritation, contributing to increased pain.

Another consideration is the possibility of a hematoma or localized bleeding at the injection site, which can occur if a blood vessel is inadvertently punctured during the procedure. This bleeding can create pressure on nearby nerves or tissues, leading to heightened pain. However, this type of complication typically resolves within a few days.

It is also important to note that the effectiveness of pain relief medications, such as muscle relaxants or analgesics, can vary significantly among individuals. If these medications are not providing relief, it may indicate that the underlying issue requires further evaluation or a different treatment approach.

In your case, since the pain has persisted for 24 hours and is more intense than before the injection, it is advisable to follow up with your healthcare provider. They can assess your symptoms, review the injection technique, and determine if any further imaging or interventions are necessary. It is crucial to communicate openly about your pain levels and any changes you experience post-injection.

In conclusion, while it is not uncommon to experience increased pain after a spinal injection, especially within the first few hours, persistent or worsening pain should be evaluated by a medical professional. Understanding the potential side effects and the body's response to such treatments can help manage expectations and guide further treatment options. Always consult with your healthcare provider to ensure that you receive the most appropriate care tailored to your specific situation.

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