Having Neck, Back Pain, or Sciatica? Injections a Spine Surgeon May Recommend

Sep 25

When patients come to me with persistent neck pain, back pain, or sciatica, one of the most common questions I get is:
“Are there injections that can help?” The answer is yes—but not all injections are the same. EVEN if you tried an injection that did not work, that does not mean there isn’t ANOTHER injection that can work. They are NOT all equal. Some are designed to relieve leg pain, others back pain, and others are diagnostic (helping us figure out the true source of your symptoms). Here’s a breakdown of the most common injections, organized by the type of pain they target.

🔹 Sciatica and Nerve Pain

If you have shooting pain down the arm or leg, often from a herniated disc or pinched nerve, the best option is usually an epidural steroid injection (ESI).

Transforaminal epidural: Medicine is placed precisely where the nerve exits the spine.
Interlaminar epidural: Medicine is placed into the spinal canal for broader coverage.

👉 Purpose: Reduce inflammation around irritated nerves and improve function.

🔹 Arthritis-Related Back Pain (Facet Joints)

The facet joints are small joints in the spine that can develop arthritis and cause chronic back or neck pain.

Step 1: Medial Branch Block (MBB): A small amount of numbing medicine is placed around the tiny nerves that supply the facet joints. Relief is short-lived, but it confirms the facet joints are the pain source.
Step 2: Radiofrequency Ablation (RFA): If the block works, RFA uses heat to “quiet” those nerves, often giving relief for 6–12 months or more.

👉 Purpose: Diagnose and treat arthritis-related facet pain.

🔹 Sacroiliac (SI) Joint Pain

The sacroiliac joints connect the base of your spine (sacrum) to the pelvis. They’re a common but overlooked cause of buttock and low back pain that can also radiate into the legs or groin.

SI joint injections can be diagnostic (numbing medicine such as lidocaine) and therapeutic (steroid to calm inflammation).

👉 Purpose: Confirm and relieve pain coming from the SI joints.

🔹 Modic Changes on MRI (Endplate Arthritis)

Some patients have chronic back pain linked to Modic changes—a specific type of arthritis-related change where the disc meets the bone.

The Intracept procedure targets the basivertebral nerve inside the vertebra that carries pain signals.
This minimally invasive treatment can provide long-lasting relief in properly selected patients.

👉 Purpose: Treat back pain that originates from vertebral endplate changes.

🔹 Muscle-Related Pain

Not all pain comes from joints or nerves—sometimes it’s the muscles themselves.

Trigger point injections deliver numbing medicine (sometimes with a small amount of steroid) directly into painful muscle knots.
Provides immediate relief and helps break the cycle of muscle spasm.

👉 Purpose: Relieve pain caused by tight, inflamed muscles.

Diagnostic vs. Therapeutic Injections

It’s important to remember: many injections serve two purposes.

Diagnostic – helping us pinpoint the true source of pain.
Therapeutic – calming inflammation and relieving symptoms, sometimes long-term.

✅ Takeaway

Neck pain, back pain, and sciatica don’t always require surgery. Injections can be a powerful part of the treatment plan, helping us both find the pain source and treat it directly—whether it’s nerve inflammation, facet arthritis, sacroiliac dysfunction, Modic changes, or muscle pain.

If you’re struggling with persistent pain, talk to your spine specialist about which injection option may be right for you.