Interventional pain management

Where intervention fits

Most patients at Activa never need an injection. Structural correction and rehabilitation resolve the majority of mechanical spine and joint pain on their own.

Intervention is added when inflammation, rather than mechanics, has become the limiting factor, when a nerve root stays irritated despite good segmental correction, when a facet joint is confirmed as the pain generator, or when pain is severe enough that a patient cannot engage with rehabilitation at all. In that last case the injection is not the treatment; it is what makes the treatment possible.

Procedures we perform

Transforaminal epidural steroid injection

Anti-inflammatory medication delivered to the specific nerve root as it exits the foramen, rather than into the epidural space generally. Used for radicular pain from disc prolapse or foraminal stenosis. More precise than a caudal or interlaminar approach when a single level is implicated.

Selective nerve root block

Both diagnostic and therapeutic. Anaesthetising one root and observing the response confirms whether that level is genuinely responsible, particularly valuable where imaging shows changes at several levels and the clinical picture is ambiguous.

Medial branch block and radiofrequency ablation

For axial back or neck pain arising from the facet joints. The medial branch nerves carrying sensation from those joints are first blocked diagnostically. If blocks reproduce reliable relief, radiofrequency ablation interrupts those nerves for a longer period, typically months rather than weeks. Ablation is never performed without confirmatory blocks first.

Genicular nerve block and ablation

The knee equivalent, for patients with osteoarthritic pain who are not surgical candidates or who wish to defer arthroplasty.

Regenerative injection

Platelet-rich plasma for degenerative joints, covered separately on theregenerative therapy page.

What the day involves

1. Attend having followed the fasting and medication instructions given at booking, particularly regarding blood thinners.
2. Consent is taken by the performing physician, who will go through benefits and risks with you directly.
3. The area is cleaned and local anaesthetic given. Positioning is confirmed under imaging before anything is injected.
4. The procedure itself usually takes 15 to 30 minutes.
5. You are observed for a few hours, then discharged. Arrange for someone to accompany you home.

Bring a list of every medication you take. Anticoagulants, antiplatelet agents and poorly controlled diabetes all change the plan, and steroid injections can transiently raise blood glucose.

Risks, stated plainly

These are low-risk procedures in experienced hands and under image guidance, but they are not risk-free. Recognised risks include bleeding or bruising, infection, a transient increase in pain for a day or two, temporary numbness or weakness in the treated distribution, and, rarely, dural puncture with subsequent headache. Steroid preparations can cause facial flushing, transient hyperglycaemia and sleep disturbance.

Your physician will discuss these against your specific medical history before you consent. If you would rather not proceed, the rehabilitation pathway remains available.

What we will not do

We do not perform an injection because a patient requests one, we do not repeat injections indefinitely into a joint that is not responding, and we do not use interventional procedures as a substitute for the rehabilitation that produces durable change.