In this blog, we provide an overview of the most common injection therapies used to manage musculoskeletal pain, explaining how each method works, its benefits, risks, and the specific conditions it treats. For a deeper dive into any particular therapy, click on the titles below to explore each treatment in its own dedicated blog.
Muscle strain and pain can result from falls, accidents, work-related injuries, and more. One widely-used approach for managing such pain is through injections, such as epidural or trigger point injections. Each injection type has its unique mechanism, potential benefits, risks, and applications. What works for one type of pain may not be effective for another, and individuals with similar conditions may respond differently to the same treatment.
Whether you’re someone recovering from an injury or an attorney seeking to understand pain management options, this guide will help clarify the various types of injections and their role in treating musculoskeletal conditions.
Corticosteroid Injections
Corticosteroid injections use synthetic hormones to mitigate inflammation and pain at the injections site, particularly joints and soft tissues. They can be injected into various joints, including shoulders, knees, and hips, to treat a variety of conditions. Side effects may include elevated blood sugar levels and bruising, swelling, or pain at the injections site. Severe complications are rare but may include infections and hypertension. Repeated use can increase the risk of osteoporosis or loss of cartilage in the joint. Contraindications include active infections, uncontrolled diabetes, and glaucoma. Caution is advised for patients with bleeding disorders or those taking anticoagulants.
Epidural Steroid Injections
Epidural steroid injections are a nonsurgical treatment option for pain affecting the lower back and, less commonly, the neck. Corticosteroids are injected into the epidural space around the spinal cord, reducing inflammation and pain caused by compression and narrowing of the spinal canal. Although effective, pain relief is often temporary and requires multiple injections to maintain the same level of pain control. Complications, though rare, can occur due to the risks of administering medication into the spinal cord area and the steroid itself, including infection, hematoma, and nerve injuries. Contraindications include systemic infections, bleeding disorders, allergies, and uncontrolled diabetes.
Facet Joint Injections
Facet joint injections are used to diagnose and treat facet joint pain, which arises from the synovial joints between vertebrae in the spine. Medication is injected into the facet joint to reduce inflammation and pain. If significant pain relief is achieved, corticosteroid injections may be used for longer-lasting pain control. If nerve involvement is suspected, radiofrequency ablation may be the next step. Facet joint injections may be used to treat pain caused by degenerative osteoarthritis, menisci impingement, and trauma, among other conditions. If effective, patients may receive up to three injections per year. Though considered low risk, complications can include hematoma, septic arthritis, and nerve root irritation. Caution is advised for patients with infections, coagulation disorders, or allergies to the medications or contrast agents.
Trigger Point Injections
Trigger point injections use anesthetics, corticosteroids, botulinum toxin, or “dry needling” to release myofascial trigger points, localized “knots” in the muscles and surrounding connective tissue. Releasing these knots increases blood flow to the area, decreasing pain and stiffness and increasing range of motion in the area. Common muscle groups treated include muscles in the jaw, shoulder, hip, and neck. While generally considered safe, complications can occur such as pain, bleeding, infection, allergic reactions, and, rarely, pneumothorax. Trigger point injections are contraindicated for patients with active infections and open skull defects, among others.
Radiofrequency Ablation
Radiofrequency ablation (RFA) is a procedure designed to alleviate chronic pain by disrupting nerve signals in the spine. It involves inserting a hollow needle into a targeted nerve, where an electrode emits radiofrequency wave to create a heat-induced lesion, preventing pain signal transmission. RFA is particularly effective for conditions like facet joint pain, chronic neck or back pain, trigeminal neuralgia, and some forms of arthritis. While generally considered safe, potential complications include temporary discomfort at the site, infection, bleeding, and nerve damage. RFA is contraindicated for patients with increased intracranial pressure and infections at the injection site.
Platelet-Rich Plasma (PRP) Injections
Platelet-rich plasma is a regenerative medicine technique that involves injecting components of a person’s own blood into muscles or joints to relieve pain, reduce inflammation, and promote healing. It offers a low-risk option for pain control and tissue regeneration. PRP is unique from other injections because it uses the body’s own cells to stimulate tissue regeneration. It can be used to provide long lasting pain relief in conditions such as osteoarthritis, tendinopathy, and chronic back pain. The frequency of PRP injections varies based on the condition being treated and the patient’s response. While PRP therapy is generally well-tolerated, potential complications, such as tissue damage, nerve injuries, and infections have been reported. PRP is contraindicated in patients with active infections, blood clotting disorders, or platelet abnormalities.
Comparison of Common Pain Therapy Injections
| Corticosteroid Injections | Epidural Steroid Injections | Trigger Point Steroid Injections | Facet Joint Steroid Injections | Radiofrequency Ablation | Platelet-Rich Plasma (PRP) | |
| Used | Corticosteroid | Corticosteroids | *Anesthetics *Corticosteroid *Botulinum toxin *“Dry needling” | *Anesthetics *Cortico- steroids | Radiofrequency waves create a heat-induced lesion to block pain transmission | Platelets and growth factors from the blood |
| To Treat | Pain and Inflammation in joints and soft tissues | Pain and inflammation in the back and neck | Pain and stiffness | Back pain | *Facet joint pain *Chronic neck or back pain *Trigeminal neuralgia *Some forms of arthritis | Muscle and joint pain |
| Side Effects | *Pain *Bruising *Swelling *High blood sugar | *Pain *Bleeding *Swelling | *Pain *Bleeding *Infection | *Warmth at the site *Mood swings *Fluid retention | Temporary discomfort at the site | *Pain at the site *Bruising *Swelling |
| Complications | *Infections *Hyper-tension *Osteo-porosis *Loss of cartilage | *Hematoma *Nerve damage *Spinal infarction | *Hematoma *Blood vessel injury *Allergic reaction *Pneumo-thorax | *Hematoma *Septic arthritis *Nerve root irritation | *Infection *Bleeding *Nerve damage | *Tissue damage *Nerve Injury *Infections |
| Contraindications | *Bleeding disorders *Taking anticoagulant | *Systemic infection *Bleeding disorder *Uncontrolled diabetes | *Infection over the injection site *Open skull in the injection site | No contra-indications, but caution is advised for certain populations | *Increased intracranial pressure *Infections at the injection site | *Active infections *Blood clotting disorder *Platelet abnormalities |
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