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Category: Injections

This leaflet is designed to give you information about meralgia paraesthetica injections and to answer some common questions you may have. Practice may vary slightly between centres. Your doctor will explain the procedure fully and discuss whether this treatment is appropriate for you.

What is meralgia paraesthetica?

Meralgia paraesthetica is a condition caused by irritation or compression of a nerve called the lateral femoral cutaneous nerve. This nerve supplies sensation to the outer part of the thigh.

Symptoms may include:

  • Burning, tingling or numbness on the outer thigh
  • Sharp or aching pain in the thigh
  • Increased sensitivity to touch or clothing

It does not affect muscle strength and does not cause weakness in the leg.

What is a lateral femoral cutaneous nerve injection for meralgia paraesthetica?

A meralgia paraesthetica injection involves injecting medication around the affected nerve. The injection usually contains a local anaesthetic, often combined with a small dose of steroid.

The aim of the injection is to:

  • Reduce inflammation around the nerve
  • Interrupt pain signals
  • Help confirm the diagnosis

Pain relief may be short-lived, but some people experience significant and longer-lasting improvement. The injection is not always a cure and is usually part of a wider treatment plan, which may include weight management, physiotherapy or activity modification.

What are the side effects of a steroid injection?

  • Allergic reaction/anaphylactic shock with local anaesthetic (extremely rare) – we take all precautions to minimise this risk and treat it should it occur.
  • Fainting
  • Bleeding/bruising
  • Infection – we use a sterile technique to minimise this risk
  • Temporary flare-up of pain or numbness, very occasionally palpitations or tremors
  • Short term deterioration of muscle tissue or joint surface. Possibly longer term if injections used repeatedly.

What should I do after the injection?

You may experience some soreness or aching at the injection site. Please keep the area of the injection dry for 24 hours following the procedure. Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular pain relief and medications as normal and this should settle down. If steroid was used, this can take up to 2-weeks to take effect on your pain. Following the injection, we advise that you have a day of relative rest, but you can continue with light work and daily activities during this time.

 

What follow-up will be arranged?

 

One of the Advanced Practice Physiotherapists in the pain team will call you 6-8 weeks after your injection to review your response. A member of the Pain Admin team will contact you to arrange this appointment after your injection. We will also send you a post-injection pain questionnaire via text or email to help us better understand the benefits the injection has had on your pain and quality of life.

 

 

If having read this information, and discussed any questions or concerns with your clinician, you would like to proceed with an injection, we will ask for your consent.  You are free to change your mind after this at any time.

 

The shoulder joint is a common area of pain and for some people who have tried rehabilitation, pain medication, shoulder injection and been assessed by an Orthopaedic Consultant and considered not for surgery, a suprascapular nerve block may be appropriate. This is an injection which blocks the nerve supplying the shoulder joint thereby aiming to give temporary pain relief. Like all injections, there is no guarantee of pain relief due to the complex nature of pain. Assessment by an Advanced Physiotherapy Practitioner is required to confirm suitability for this procedure.

 

Please click the link to find out more about the injection.

Cervical and thoracic facet joint injections video

What is a facet joint injection?

A cervical facet joint injection is an injection using a combination of local anaesthetic and steroid which is injected around the area of pain and inflammation at a specific facet joint in your neck or thoracic spine. X-ray or ultrasound guidance is often used to ensure the injection is in the right place.

Why have a facet joint injection?

The aim of this injection is to reduce the pain and inflammation at the facet joint which is contributing to your neck pain and stiffness.  This is to give you a window of opportunity to improve your quality of life e.g. by improving the movement in your neck / thoracic spine and increasing your general mobility. It may help you to reduce your pain medication.

How effective are facet joint injections?

Many people have good relief of their pain after the injection, meaning that they can get back to a more normal life.  However, the pain may return, and occasionally people do not find it effective.

Are facet joint injections safe?

Facet injections are generally a safe form of treatment.  However, they can cause side effects, and therefore we will need to know your health history so that, together with you, we can weigh up the risks against the benefits of you having this procedure.

We would not usually offer you an injection if you have/are the following:

  • Bleeding disorder
  • An infection anywhere in your body
  • Previous allergic reaction to a local anaesthetic or injection
  • If you are immunosuppressed
  • Recent trauma or bruising to the area of the injection

If you are on anticoagulation medication, we will discuss this with you, and depending what you are taking and what it is for, you may need to stop this before the injection.

What are the side effects of a facet joint injection?

  • Allergic reaction/anaphylactic shock with local anaesthetic (extremely rare) – we take all precautions to minimise this risk and treat it should it occur.
  • Fainting
  • Bleeding/bruising
  • Infection – we use a sterile technique to minimise this risk
  • Temporary flare-up of pain or numbness, very occasionally palpitations or tremors
  • Short term deterioration of muscle tissue or joint surface. Possibly longer term if injections used repeatedly.

 

What should I do after the injection?

You may experience some soreness or aching at the injection site. Please keep the area of the injection dry for 24 hours following the procedure. Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular pain relief and medications as normal and this should settle down. If steroid was used, this can take up to 2-weeks to take effect on your pain. Following the injection, we advise that you have a day of relative rest, but you can continue with light work and daily activities during this time.

 

What follow-up will be arranged?

 

One of the Advanced Practice Physiotherapists in the pain team will call you 6-8 weeks after your injection to review your response. A member of the Pain Admin team will contact you to arrange this appointment after your injection. We will also send you a post-injection pain questionnaire via text or email to help us better understand the benefits the injection has had on your pain and quality of life.

 

 

If having read this information, and discussed any questions or concerns with your clinician, you would like to proceed with an injection, we will ask for your consent.  You are free to change your mind after this at any time.

What is a Transforaminal Epidural Injection?
Transforaminal epidural injections, sometimes called nerve root blocks, are used mainly for one sided localised radicular pain (long leg or arm pain), which is pain stemming from an inflamed nerve root due to impingement or compression, when simpler measures have not helped. A transforaminal epidural steroid injection involves injecting a mixture of local anaesthetic and steroid into the epidural space through the bony opening of the exiting nerve root, known as the foramen. Transforaminal epidural injections are done with a more diagonal approach than other epidural injections so that the affected nerve can be better targeted. They allow the medication to be placed nearer to the area where the nerve is being irritated. They only target one side of your spine. The local anaesthetic and steroid will bathe the nerve root which send pain signals to the brain. This is used when nerves in the spine are irritated due to a variety of conditions such as foraminal stenosis (an age-related narrowing of the bony opening where the nerve root exits), or a herniated disc. In addition to the mechanical irritation, there can also be a chemical irritation to the nerves from chemicals that can be released from a herniated disc. The injection is not a cure but aims to alleviate your symptoms by reducing the inflammation caused by both the mechanical and chemical irritation of the nerves. Pain relief can be short-lived, though some people can get significant and lasting pain relief from these injections.

How do we do it?
A transforaminal epidural injection is carried out as a day case procedure in an operating theatre. You will be carefully positioned and the skin around the injection site will be cleaned with an antiseptic solution or spray; this can feel very cold. You may feel a stinging sensation as local
anaesthetic is injected to numb the skin and surrounding tissues. The site of the injection is located via x-ray imaging. The Consultant will direct the injection to the nerve root suspected to be the source of pain and usually inject contrast (a solution that is visible under X-Ray) to ensure the needle is correctly positioned. When the injection is made, you may feel pressure, tightness or a pushing sensation in your back/neck or leg/arm.

What will happen to me after the injections?
After the injection you will be taken to a recovery area where nursing staff will monitor you. You will be advised when to get dressed and be given assistance to help to ensure that you can stand safely after the procedure. Depending on how long your consultant or nurse want you to stay for recovery, you will usually be able to return home soon after your injection, if all your observations are normal. Please ensure that you have made arrangements for someone to collect you after the procedure. If you don’t, your procedure may be cancelled. It is unsafe for you to drive home immediately after the procedure. If you do so your motor insurance will be invalid.

What can I do after my procedure?
Ideally, you should arrange for someone to stay with you for 24-hours but, failing that, you should at least have access to a telephone. You should not drive, operate machinery, sign legal documents, provide childcare unsupervised or drink alcohol until fit to do so. If in doubt, please discuss these issues with your Consultant or Pain Practitioner for further advice.

Will I experience any side-effects?
As with any procedure, side-effects may occur. These are usually minor but there are risks with this procedure.
Side-effects may include;
• Mild local tenderness and/or bruising at the site of the injection. This usually settles over the first few days.
• The local anaesthetic may rarely spread causing some numbness and/or weakness in your leg (lumbar injections) or arm (cervical injections). Should this occur, the effect is temporary and will rapidly resolve over minutes or rarely hours.
• Infection. This is rare. You should seek medical help if there is local warmth or redness over the site of injection with tenderness and/or you feel hot and unwell. This may require antibiotic treatment.
• There are very important nerves in the spine, but serious nerve injury is extremely rare (less than 1 in 10,000 cases) and can occur when there is serious bleeding or infection abscess near the spinal cord, or even physical injury from the needle or injection itself. This is why the Consultant takes such great care in performing the injection. Persistent weakness of the legs and/or incontinence require further urgent investigation. These injections have very rarely caused severe harm. Very rarely cervical injections have caused severe harm or even death. These complications are so rare it is difficult to say how often they occur with certainty. Please speak to you Consultant to discuss this issue fully.
• Blood pressure may temporarily fall and rarely, people may occasionally feel faint
• Headache. On rare occasions the epidural needle may unintentionally reach spinal fluid (CSF). This is called a dural puncture and may lead to headache that requires further treatment. If a severe headache does develop following your injection, take some Paracetamol, drink plenty of water and lie flat. If the headache continues for more than 24- hours, please contact your GP or the Pain Clinic.
• Injection treatments are not always effective and may not help your pain.
• In rare circumstances, steroid use can damage your eyesight. You should report any new visual disturbance (such as blurred or distorted vision) to your doctor

What can I expect in the days afterwards?
You may experience some soreness or aching at the injection site. Please keep the area of the injection dry for 24-hours following the procedure. Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular pain relief and medications as normal and this should settle down. Steroid can take up to 2-weeks to take effect on your pain. Try to keep on the move about the house whilst avoiding anything too strenuous.

What follow-up will be arranged?
One of the Advanced Practitioners in the pain team will call you 6-8 weeks after your injection to review your response. A member of the Pain Admin team will contact you to arrange this appointment after your injection. We will also send you a post-injection pain questionnaire via text
or email to help us better understand the benefits the injection has had on your pain and quality of life.

If having read this information, and discussed any questions or concerns with your clinician, you would like to proceed with an injection, we will ask for your consent. You are free to change your mind after this at any time.

Patient Information – Sacroiliac Joint Injection

What is a sacroiliac joint injection?
A sacroiliac joint injection is an injection into a joint at the bottom of the spine where it joins the pelvis known as the sacroiliac joint. The sacroiliac joints allow movement and stabilise the spine. Age related changes, inflammation and injury may cause pain in some people. The injection contains local anaesthetic often with a small amount of steroid. The sacroiliac joint injections may be used to diagnose and treat certain types of back pain. It is used for localised pain where simpler measures have not helped enough. It may help your pain by reducing some of the pain signals from the joint. Pain relief is usually short-lived though some people can get significant and lasting pain relief from
these injections. It is not a cure. The injection is usually undertaken alongside other treatments such as physiotherapy.

How do we do it?
A sacroiliac joint injection is carried out as a day case procedure in an operating theatre. You will be carefully positioned and the skin around the injection site will be cleaned with an antiseptic solution or spray; this can feel very cold. You may feel a stinging sensation as local anaesthetic is injected to numb the skin and surrounding tissues. The site of the injection is located via x-ray or ultrasound imaging. The Consultant will direct the injection into the sacroiliac joint and usually inject contrast (a solution that is visible under X-Ray) to ensure the needle is correctly positioned. When the injection is made, you may feel pressure, tightness or a pushing sensation in your back.

What will happen to me after the injections?
After the injection you will be taken to a recovery area where nursing staff will monitor you. You will be advised when to get dressed and be given assistance to help to ensure that you can stand safely after the procedure. Depending on how long your consultant or nurse want you to stay for recovery, you will usually be able to return home soon after your injection, if all your observations are normal. Please ensure that you have made arrangements for someone to collect you after the procedure. If you don’t, your procedure may be cancelled. It is unsafe for you to drive home immediately after the procedure. If you do so your motor insurance will be invalid.

What can I do after my procedure?
Ideally, you should arrange for someone to stay with you for 24-hours but, failing that, you should at least have access to a telephone. You should not drive, operate machinery, sign legal documents, provide childcare unsupervised or drink alcohol until fit to do so. If in doubt, please discuss these issues with your Consultant or Pain Practitioner for further advice.

Will I experience any side-effects?
As with any procedure, side-effects may occur. These are usually minor but there are risks with this procedure.

Side-effects may include;
• Mild local tenderness and/or bruising at the site of the injection. This usually settles over the first few days.
• The local anaesthetic may spread causing some numbness and/or weakness in the lower limb. If this happens, the effect is temporary and will quickly get better over minutes or hours.
• The steroids can have varied effects ranging from flushing, menstrual disturbances, weight gain, increase in blood sugar levels and worsening of mental health issues. These effects are temporary and are more likely with repeated steroid injections.
• Infection. This is rare. You should seek medical help if there is local warmth or redness where you had the injection, or if you feel hot and unwell. This may need antibiotic treatment.
• There are important nerves in the spine, but serious nerve injury is very rare.
• Injection treatments do not always work and may not help your pain.
• In rare circumstances, steroid use can damage your eyesight. You should report any new vision problems (such as blurred or distorted vision) to your doctor.

What can I expect in the days afterwards?
You may experience some soreness or aching at the injection site. Please keep the area of the injection dry for 24-hours following the procedure. Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular pain relief and medications as normal and this should settle down. Steroid can take up to 2-weeks to take effect on your pain. Try to keep on the move about the house whilst avoiding anything too strenuous.

What follow-up will be arranged?
One of the Advanced Practitioners in the pain team will call you 6-8 weeks after your injection to review your response. A member of the Pain Admin team will contact you to arrange this appointment after your injection. We will also send you a post-injection pain questionnaire via text
or email to help us better understand the benefits the injection has had on your pain and quality of life.

If having read this information, and discussed any questions or concerns with your clinician, you would like to proceed with an injection, we will ask for your consent. You are free to change your mind after this at any time.

A medial branch block is a diagnostic test. Local anaesthetic is injected over the tiny medial branch nerve supplying a facet joint. The short-term numbing effect of this injection will provide information about whether pain is coming from your facet joint.

What is radiofrequency denervation?
Radio Frequency Denervation is undertaken only when the medial branch block has proven to produce significant pain relief for a short duration. It is a procedure where the medial branch nerve is destroyed by inserting a tiny probe to heat the nerve. Local anaesthetic and/ or steroid is also injected to reduce any discomfort. The aim is to try to produce more prolonged pain relief, lasting several months or even years.

Why have a medial branch block or radiofrequency denervation?
These injections are used for localised spinal pain coming from the facet joint, where other treatment, such as exercise and analgesia, have not helped. The facet joints are the small joints linking the bones of the spine together. Wear and tear, inflammation and injury to these joints may
cause pain in some people. By targeting the nerve to these joints, it may be possible to reduce some of the pain signals coming from the joint. The pain relief achieved is usually short-lived, but some people can get significant and more long-lasting pain relief from these injections.

Medial Branch Block Video

Are nerve blocks and RF denervation safe?
Nerve blocks and RF denervation are generally a safe form of treatment. However, they can cause side effects, and therefore we will need to know your health history so that, together with you, we can weigh up the risks against the benefits of you having this procedure. We would not usually offer you an injection if you have/are the following:
• Bleeding disorder
• An infection anywhere in your body
• Previous allergic reaction to a local anaesthetic or injection
• Immunosuppressed
• Recent trauma or bruising to the area of the injection

If you are on anticoagulation medication, we will discuss this with you, and depending what you are taking and what it is for, you may need to stop this before the injection.

Radiofrequency Ablation (RFA) video

Will I experience any side effects of nerve blocks and RF denervation?
The nerve block usually uses a local anaesthetic. RF denervation heats the nerve to sever it. Side effects are very rare. They include:
• Allergic reaction/anaphylactic shock with local anaesthetic (extremely rare) – we take all precautions to minimise this risk and treat it should it occur.
• Fainting
• Bleeding/bruising
• Infection – we use a sterile technique to minimise this risk
• Temporary flare-up of pain or numbness, very occasionally palpitations or tremors
• Nerve pain caused by burning nerves (RF denervation only)
• Short term deterioration of muscle tissue or joint surface. Possibly longer term if injections used repeatedly.
• Pneumothorax (punctured lung) for injections over the rib cage (extremely rare).
• If the nerve supplies another structure as well as the painful one, then this other structure may be affected (see example below).

What should I do after the injection?
You may experience some soreness or aching at the injection site. Please keep the area of the injection dry for 24-hours following the procedure. Following the injection, we advise that you have a day of relative rest, but you can continue with light work and daily activities during this time.

What follow-up will be arranged?
One of the Advanced Practitioners in the pain team will call you 2 weeks after a MBB and 6-8 weeks after a RFD injection to review your response. A member of the Pain Admin team will contact you to arrange this appointment after your injection. We will also send you a post-injection pain questionnaire via text or email to help us better understand the benefits the injection has had on your pain and quality of life.

If having read this information, and discussed any questions or concerns with your clinician, you would like to proceed with an injection, we will ask for your consent. You are free to change your mind after this at any time.

What is a Genicular Nerve Block?
A nerve block injection blocks the signals that travel from a nerve supplying a certain part of your body. The genicular nerves supply the knee joint so a genicular nerve block is the nerve block used for knee pain. A nerve block switches off the nerve impulses travelling from your knee to your brain, and this stops your brain from giving you pain in this part of the body. The nerve is blocked temporarily using a local anaesthetic injection. The pain relieving effect of this is usually a few hours. However, sometimes the effect can last for much longer, for weeks or even months.

What is Radiofrequency (RFD) Denervation?
In some cases, it may be possible to do a second procedure to burn the nerve away. This is known as radiofrequency (RFD) denervation, sometimes called rhizotomy or nerve ablation. This may settle the pain for the period of time it takes for the nerve to grow back, which is up to 18 months. However because this is a more invasive procedure with more risks, it is only considered if a nerve block first relieves the pain.

Why have a Genicular Nerve Block or RF denervation?
The aim of a nerve block or RF denervation is to reduce your knee pain, and give you a window of opportunity to improve your quality of life e.g. enable you to increase your activity levels, stay at work, improve your sleep, or reduce your medication.

Are nerve blocks and RF denervation safe?
Nerve blocks and RF denervation are generally a safe form of treatment. However, they can cause side effects, and therefore we will need to know your health history so that, together with you, we can weigh up the risks against the benefits of you having this procedure. We would not usually offer you an injection if you have/are the following:
• Bleeding disorder
• An infection anywhere in your body
• Previous allergic reaction to a local anaesthetic or injection
• Immunosuppressed
• Recent trauma or bruising to the area of the injection
If you are on anticoagulation medication, we will discuss this with you, and depending what you are taking and what it is for, you may need to stop this before the injection.

What are the side effects of nerve blocks and RF denervation?
The nerve block usually uses a local anaesthetic. RF denervation heats the nerve to sever it. Side effects are very rare. They include:
• Allergic reaction/anaphylactic shock with local anaesthetic (extremely rare) – we take all precautions to minimise this risk and treat it should it occur.
• Fainting
• Bleeding/bruising
• Infection – we use a sterile technique to minimise this risk
• Temporary flare-up of pain or numbness, very occasionally palpitations or tremors
• Nerve pain caused by burning nerves (RF denervation only)
• Short term deterioration of muscle tissue or joint surface. Possibly longer term if
injections used repeatedly.
• Pneumothorax (punctured lung) for injections over the rib cage (extremely rare).
• If the nerve supplies another structure as well as the painful one, then this other structure may be affected (see example below).

What should I do after the injection?
You may experience some soreness or aching at the injection site. Please keep the area of the injection dry for 24-hours following the procedure. Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular pain relief and medications as normal and this should settle down. If steroid was used, this can take up to 2-weeks to take effect on your pain. Following the injection, we advise that you have a day of relative rest, but you can continue with light work and daily activities during this time.

What follow-up will be arranged?
One of the Advanced Practitioners in the pain team will call you 6-8 weeks after your injection to review your response. A member of the Pain Admin team will contact you to arrange this appointment after your injection. We will also send you a post-injection pain questionnaire via text or email to help us better understand the benefits the injection has had on your pain and quality of life.

If having read this information, and discussed any questions or concerns with your clinician, you would like to proceed with an injection, we will ask for your consent. You are free to change your mind after this at any time.

What is a coccyx injection?
A coccyx injection is an injection using a combination of local anaesthetic and steroid which is injected around the area of pain and inflammation at the base of your coccyx. X-ray or ultrasound guidance is often used to ensure the injection is in the right place.

Why have a coccyx injection?
The aim of a coccyx injection is to reduce pain and inflammation at the base of the coccyx, sometimes known as coccydynia. This is to give you a window of opportunity to improve your quality of life e.g. by reducing the coccyx pain associated with sitting, and standing from sitting, so
that you can return to a more normal life.

How effective are coccyx injections?
Many people have good relief of their coccyx pain after the injection, meaning that they can get back to a normal life. However, the pain may return, and occasionally people do not find it effective.

Are coccyx injections safe?
Coccyx injections are generally a safe form of treatment. However, they can cause side effects, and therefore we will need to know your health history so that, together with you, we can weigh up the risks against the benefits of you having this procedure. We would not usually offer you an injection if you have/are the following:
• Bleeding disorder
• An infection anywhere in your body
• Previous allergic reaction to a local anaesthetic or injection
• Immunosuppressed
• Recent trauma or bruising to the area of the injection
If you are on anticoagulation medication, we will discuss this with you, and depending what you are taking and what it is for, you may need to stop this before the injection.

What are the side effects of a coccyx injection?
• Allergic reaction/anaphylactic shock with local anaesthetic (extremely rare) – we take all precautions to minimise this risk and treat it should it occur.
• Fainting
• Bleeding/bruising
• Infection – we use a sterile technique to minimise this risk
• Temporary flare-up of pain or numbness, very occasionally palpitations or tremors
• Short term deterioration of muscle tissue or joint surface. Possibly longer term if injections used repeatedly.

What should I do after the injection?
You may experience some soreness or aching at the injection site. Please keep the area of the injection dry for 24 hours following the procedure. Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular pain relief and medications as normal and this should settle down. If steroid was used, this can take up to 2-weeks to take effect on your pain. Following the injection, we advise that you have a day of relative rest, but you can continue with light work and daily activities during this time.

What follow-up will be arranged?
One of the Advanced Practitioners in the pain team will call you 6-8 weeks after your injection to review your response. A member of the Pain Admin team will contact you to arrange this appointment after your injection. We will also send you a post-injection pain questionnaire via text
or email to help us better understand the benefits the injection has had on your pain and quality of life.

If having read this information, and discussed any questions or concerns with your clinician, you would like to proceed with an injection, we will ask for your consent. You are free to change your mind after this at any time.

What is a caudal epidural steroid injection?
Caudal epidural injections are used mainly for radicular or claudicant leg pain, which is pain stemming from an inflamed nerve root or pain from reduced blood supply to the spinal nerves, when simpler measures have not helped. A caudal epidural steroid injection involves injecting a mixture of local anaesthetic and steroid into the epidural space of the lumbar spinal canal via the sacral hiatus, which is a small opening in the base of the spine just above the coccyx.

The local anaesthetic and steroid will bathe the nerve roots which send pain signals to the brain. This is used when nerves in the lower back are irritated due to a variety of conditions such as spinal stenosis (an age-related narrowing of the spinal canal), or a herniated disc. In addition to the mechanical irritation, there can also be a chemical irritation to the nerves from chemicals that can be released from a herniated disc. The injection is not a cure but aims to alleviate your symptoms by reducing the inflammation caused by both the mechanical and chemical irritation of the nerves. Pain relief can be short-lived, though some people can get significant and lasting pain relief from these injections.

How do we do it?
A caudal epidural is carried out as a day case procedure in an operating theatre. You will be carefully positioned and the skin around the injection site will be cleaned with an antiseptic solution or spray; this can feel very cold. You may feel a stinging sensation as local anaesthetic is injected to numb the skin and surrounding tissues. The site of the injection is located via x-ray or ultrasound imaging. The Consultant will direct the injection to the epidural space close to the source of pain and usually inject contrast dye (a solution that is visible under imaging such as X-Ray) to ensure the needle is correctly positioned. When the injection is made, you may feel pressure, tightness or a pushing sensation in
your back or leg(s).

What will happen to me after the injections?
After the injection you will be taken to a recovery area where nursing staff will monitor you. You will be advised when to get dressed and be given assistance to help to ensure that you can stand safely after the procedure. Depending on how long your consultant or nurse want you to stay for recovery, you will usually be able to return home soon after your injection, if all your observations are normal. Please ensure that you have made arrangements for someone to collect you after the procedure. If you don’t, your procedure may be cancelled. It is unsafe for you to drive home immediately after the procedure. If you do so your motor insurance will be invalid.

What can I do after my procedure?
Ideally, you should arrange for someone to stay with you for 24-hours but, failing that, you should at least have access to a telephone. You should not drive, operate machinery, sign legal documents, provide childcare unsupervised or drink alcohol until fit to do so. If in doubt, please discuss these issues with your Consultant or Pain Practitioner for further advice.

Will I experience any side-effects?
As with any procedure, side-effects may occur. These are usually minor but there are risks with this procedure. Side-effects may include;
• Mild local tenderness and/or bruising at the site of the injection. This usually settles over the first few days.
• The local anaesthetic may rarely spread causing some numbness and/or weakness in your legs. Should this occur, the effect is temporary and will rapidly resolve over minutes or rarely hours.
• Infection. This is rare. You should seek medical help if there is local warmth or redness over the site of injection with tenderness and/or you feel hot and unwell. This may require antibiotic treatment.
• There are very important nerves in the spine, but serious nerve injury is extremely rare (less than 1 in 10,000 cases) and can occur when there is serious bleeding or infection abscess near the spinal cord, or even physical injury from the needle or injection itself. This is why the Consultant takes such great care in performing the injection. Persistent weakness of the legs and/or incontinence require further urgent investigation. These injections have very rarely caused severe harm. Please speak to you Consultant to discuss this issue fully.
• Blood pressure may temporarily fall and rarely, people may occasionally feel faint
• Headache. On rare occasions the epidural needle may unintentionally reach spinal fluid (CSF). This is called a dural puncture and may lead to headache that requires further treatment. If a severe headache does develop following your injection, take some Paracetamol, drink plenty of water and lie flat. If the headache continues for more than 24- hours, please contact your GP or the Pain Clinic.
• Injection treatments are not always effective and may not help your pain.
• In rare circumstances, steroid use can damage your eyesight. You should report any new visual disturbance (such as blurred or distorted vision) to your doctor

What can I expect in the days afterwards?
You may experience some soreness or aching at the injection site. Please keep the area of the injection dry for 24-hours following the procedure. Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular pain relief and medications as normal and this should settle down. Steroid can take up to 2-weeks to take effect on your pain. Try to keep on the move about the house whilst avoiding anything too strenuous.

What follow-up will be arranged?
One of the Advanced Practitioners in the pain team will call you 6-8 weeks after your injection to review your response. A member of the Pain Admin team will contact you to arrange this appointment after your injection. We will also send you a post-injection pain questionnaire via text or email to help us better understand the benefits the injection has had on your pain and quality of life.

If having read this information, and discussed any questions or concerns with your clinician, you would like to proceed with an injection, we will ask for your consent. You are free to change your mind after this at any time.

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