Zion Pain Management

FREQUENTLY ASKED QUESTIONS

Question: If I am having an injection, what happens and how long does the whole process take?
Answer: Usually about an hour. First, we obtain a set of vitals, place an IV for sedation, have you sign a consent form, and answer any remaining questions you may have. Next, the procedure is done and that takes about ten minutes. During your recovery we take another set of vitals, remove the IV, offer you some juice, and then when you are stable we discharge you to your family or friends with some instructions and a follow-up appointment.

Question: Will the injection hurt?
Answer: No. You may feel some pressure, but it is not painful. We will offer you sedation through your IV to help you relax, and the doctor will numb the site of the injection with a local anesthetic.

Question: What will I be given to help me relax?
Answer: We will give you Versed to help you relax and Fentanyl to prevent any pain from the procedure.

Question: Do I have to have sedation?
Answer: No. You may choose not to have sedation, but in most cases the sedation makes the experience more pleasant.

Question: How soon following an injection can I drive?
Answer: Five hours if you choose to have sedation. If you had no sedation, you may drive as soon as the numbness from the injection has worn off.

Question: When can I eat with injections?
Answer: You should have nothing to eat or drink for at least four hours prior to your injection. After the injection you may resume your normal diet at any time.

Question: What medications should I stop taking before the injection?
Answer: You should stop taking all blood thinners four days prior to the injection. You should continue taking all blood pressure medications. If you are on an antibiotic, you must reschedule your appointment for after you have finished the antibiotic and the infection has completely cleared up.

Question: How soon after the injection may I return to my normal activities?
Answer: You may return to work the following day but you should limit your physical activity for several days to allow the steroid time to reduce the inflammation.

Question: How long does it take for the injection to work?
Answer: Allow up to 72 hours for the steroid to reduce the inflammation. Once it is reduced the pain will subside.

Question: Should I use heat or ice following my injection?
Answer: You may use ice for the first 24 hours after the injection and heat after that. Leave the ice or heat on the affected area for no more than 20 minutes at a time and then remove it for at least 20 minutes.

Question: How often can I have these injections?
Answer: You can have three injections within a six-month period at least two weeks apart.

Question: What if I just had surgery or am going to have surgery within the next two weeks?
Answer: We would need to reschedule your appointment six weeks out from your surgery and be certain that all incisions had healed completely.

Question: How will the steroid affect other wounds that I may have?
Answer: Steroid slows the healing process, lowers the immune system and makes the body more prone to infection. If the wounds are open or still have stitches, you will have to wait until they are healed completely before having a steroid injection.

Question: If I am diabetic, will the steroid affect my blood sugar?
Answer: Yes, the steroid will elevate your blood sugar for up to a month. You may need to contact your primary care physician to adjust your insulin or oral medications during that time.

Question: What would cause me to have muscle cramps following these injections?
Answer: Steroids can lower your potassium levels which results in muscle cramps. To treat this you need to increase your potassium intake by eating fresh fruits such as bananas, apricots, grapefruit, oranges and tomatoes. Dried fruits and fruit juices are also high in potassium.

Question: What can cause me to have weakness in my legs following an injection in my back?
Answer: We inject a local anesthetic along with the steroid into your back. Sometimes as the local anesthetic spreads it not only numbs the sensory nerve to give you pain relief but it can also numb a motor nerve as well. Numbing does not damage the motor nerve, but it may cause weakness that lasts about five hours after which the legs should return to normal strength.

Question: Why is it that my pain may be in one area but my injection is placed in another area?
Answer: Spinal nerves originate in the spine and spread to all the extremities. When the spinal nerves are injured the pain radiates along the nerve pathway and can manifest itself in other areas of the body. The injection is made at the source of the pain and not necessarily where you feel it.

Question: How will the doctor be able to know where the needle is placed if I don’t bring my MRI film to the appointment?
Answer: The doctor does the injection under fluoroscopic (live x-ray) guidance. This allows him to watch the needle as he advances it. Once the needle is in place, the doctor injects a contrast dye to verify the placement and then he injects the medication. By following this procedure the risks of complication are greatly reduced.

Question: What if I don’t get complete pain relief after my first injection?
Answer: It could mean several things. First, the inflammation may be so severe that several injections are required. Second, more than one pain source may be contributing to the pain that you feel. Third, the injury may require surgical repair in order to get full pain relief.

Question: I have noticed that when I have an injection sometimes the pain I feel in other parts of my body—like in my joints—is also reduced. Is that related to the injection?
Answer: Yes, the steroid is an anti-inflammatory, and although we place it near your spine it may be absorbed and have a systemic effect, which means that it may reduce inflammation elsewhere in the body.

Question: Why must I schedule a medication appointment every month if my meds are working fine and I’m having no problems?
Answer: By law we are required to see all patients once a month who are on opiates or opioids. If a patient has been on the same medication regimen for six months with no complications, we may consider seeing him or her every other month.