Frequently asked questions (FAQs)
Here are answers to some questions that we are commonly asked. Click on a question to reveal its answer. If you have questions that are not answered here or need further information, please contact us.
This is a psychological strategy for dealing with stress that is part of your pain problem. If you are suffering pain from any source and there are other sources of stress in your life, then coping becomes difficult. Often patients get to a point where they simply cannot think straight. They may develop inappropriate fears about their pain and what it means and what will happen in the long term. This results in anxiety and then secondary effects.
Firstly muscle tension and spasm can ensue. This can aggravate mechanical muscle spasm and escalate the pain. Secondly, body adrenaline increases and this increases traffic through pain pathways and amplifies the pain that you experience.
CBT offers a way of thinking logically to diffuse this cycle and give you a more appropriate and realistic way of viewing your problem. This reduces anxiety and stress and enables you to cope and move forward once more.
The majority of injections that we perform take place in an operating theatre. Not because you need a general anaesthetic, but because:
- It is a sterile environment
- Sedation can be given safely
- There is a real-time x-ray machine to guide safe needle placement
As a consequence the injection needs to be booked onto a planned theatre list which occurs Tuesday and Wednesday mornings and Thursday afternoon. We aim to organise this as soon as is convenient. Occasionally, simple ‘trigger point injections’ into soft tissues or muscles may be performed on the day in my room. Even then, sometimes we will need to organize a day when there is someone to escort you home safely.
If you wait for the pain to increase before taking the tablet you have a period when the pain medication to be absorbed and to start to work. In this time you may have to stop what you are doing and secondary effects such as your muscles tightening up may happen. This leads to enforced periods of inactivity, before you can get going again.
At the start of your treatment especially, it is important to keep on top of the pain so that you can exercise with out paying a price for it. This cycle of pain causing inactivity, then recovering, then increasing activity once more that causes more pain must be broken. In time the medications can be reduced and ultimately stopped once the initial problem has been dealt with.
It is never a good idea to stop pain-killers suddenly unless they cause bad side-effects. Medication types vary. Stopping over-the-counter medications suddenly is never usually a problem, unless of course your pain suddenly escalates. However, it is not a good idea to stop strong opioids like Morphine, as with-drawl effects can occur.
Whatever the medication being taken, it is always more sensible to slowly reduce the dose over days and weeks. If in any doubt, it is always good to contact the doctor or specialist who prescribed the medication and ask them what to do.
Steroid injections almost never cause a problem with weight gain from fatty tissue. In a small number of patients who usually are in the older age bracket, or who have other on-going medical problems, it may cause transient fluid retention often around the ankles.
Steroids taken by mouth for many months or years may have profound effects on the general body fat and muscle distribution and hence the desire to avoid this strategy if possible.
Often when having injections you will be given intravenous pain-killers and sedation. The purpose of sedation is not to make you sleep. The idea is that you do not feel pain, that you are relaxed and happy and that your muscles do not go into spasm with the needles. If this is the case and you are awake, then this is fine. Paradoxically, if you fall asleep then this is not a problem.
Some very anxious patients express the desire to be asleep and in the vast majority of cases this can be achieved safely.
You should not go to work on the day of your procedure. In an ideal world it would be nice not to have to go to work the next day. Better to rest and recover. If you have had intravenous sedation then you must not drive for 24 hours. If your pain was severe before the procedure then it would be very desirable to have a week off to recover, perform some stretch and strengthening exercises and address other components of your treatment plan.
6 hours. If your procedure is in the morning, then it may be wise to eat something later than usual, in the day prior to the procedure. If you are scheduled for an afternoon procedure, then get up early and have breakfast before 08.00? You may take small SIPS of water if necessary, especially if you need to take medications, including your usual pain-killers. You will be given something to eat after the procedure. If you are diabetic, bring your medications with you.
From your arrival at the hospital, to departure will be approximately 4 hours. Naturally, some people recover from sedation quicker than others and so it may be an hour sooner, or later than this.
There is no reason why you cannot remove the antiseptic plasters that cover the injection site and bathe the same day. There is no need to apply new plasters.
It is STRONGLY advised that you are escorted safely home. Even if you feel that the sedation has worn off, the after-effects can last for 24 hours. Your balance and movement may not be 100%. You may be at more risk of falling or having an accident, e.g. your judgment of traffic when crossing the road may not be at its best?
If an escort cannot be arranged, then a nominated friend or relative to meet you at home, or at least be ‘on-hand’, is acceptable. It is necessary to avoid public transport if you choose to take this option and to take a taxi door to door. Ask the taxi driver to watch you safely through your front door.
No. In fact you may need more pain-killers to start with, since you may be sore where the needles were inserted. This is more likely if you are having a ‘denervation procedure’. You should wait for 2 or 3 days after the procedure and see if it is possible to slowly reduce the number of tablets that you require.
Of course the ‘medical answer’ is to not go to work, to let things settle down after the procedure. If however you feel ‘good’ then there is no reason not too. About 10% of patients inform me that they did not feel up to going to work the next day, either from the sedation or soreness from the needle placement. So be prepared that you may not be able to go to work, especially if you have a long commute.
The steroid injections work by reducing inflammation and hence nerve sensitivity. To achieve this, the average time for the process to make an impact on your pain is about a week to ten days. Sometimes it is pleasingly sooner. The steroids are active, having a positive effect for about four weeks. It is at this point that I will usually review you in out-patient clinic. If no improvement has occurred by then, it is unlikely to.
This depends on how much limitation the pain was placing on you before the procedure. If the pain was severe, then I would not want you to exercise till you were able to sleep better at night and your ‘day-to day’ activities were easier. A marker for this may also be a reduction in your requirement for pain killing tablets.
If you were able to exercise to some degree, BEFORE the procedure, then you may return to stretching and strengthening after 48 hours. BUT start gently and build-up your activity levels slowly. Ideally this should be under the guidance of your physiotherapist.
Firstly, please make sure that you are booked in for your 4 week post procedure follow up appointment, when the following will be discussed in more detail, since the next step will vary from patient to patient:
- It may be appropriate to repeat the injections a second time.
- We may discuss additional pain-killers, or alternate exercise strategies, or explore other factors that may be provoking the pain.
- If the pain is severe and a specific structural problem has been demonstrated by radiological investigations, then you may be referred to a surgeon for an opinion.