Not all pain is best treated with medications or surgeries. There are alternatives, including injection therapies. One of the more common is a treatment known as a transforaminal epidural steroid injection (TFESI). This minimally invasive procedure is often used to control pain and inflammation associated with nerve irritation.
The pain medicine doctors at Weatherford, Texas’ Lone Star Pain Medicine explain that TFESIs are not appropriate for all types of back pain. But if neck and back pain is specifically caused by irritation or inflammation of the spinal nerves, TFESI may be the best possible treatment. They say it is something to think about if back pain is radiating into the arms, legs, or neck.
Types of Injuries TFESI Is Recommended For
So, what types of injuries or diseases would TFESI be recommended for? Sciatica is one possibility. Sciatica is essentially a pinched or inflamed nerve in the lower back. Pain sensations from the inflamed nerve have a habit of traveling down the leg. Other conditions for which TFESI might be appropriate include:
- Degenerative disk disease
- Spinal stenosis
- Spondylolisthesis
- Bulging discs
Of course, a doctor would have to examine a patient and possibly run some tests to confirm a diagnosis. But if the diagnosis points to a condition TFESI can treat, the procedure itself is fairly simple. It involves injecting a medication that includes a combination of steroids and anesthesia. The anesthesia begins to relieve the pain while the steroids reduce inflammation.
When TFESI Is Normally Considered
Lone Star doctors say that TFESI isn’t necessarily recommended as a first line treatment. There are three circumstances under which TFESI is normally considered:
1. More Conservative Treatments Have Failed
The types of conditions that would warrant TFESI can be treated more conservatively first. Conservative treatments include pain medications and physical therapy. If such treatments don’t provide adequate relief, TFESI might be considered.
2. Pain Is Limiting the Patient
Doctors know the importance of maintaining function in treating painful conditions. So if a patient’s function is limited due to one of the injuries or diseases TFESI is normally prescribed for, then the chances of getting a TFESI recommendation are greater.
3. Imaging Tests Show Compression
TFESI is commonly considered when imaging tests show actual compression of a nerve. Pain medications are not going to prevent compression. Physical therapy isn’t likely to relieve the compression. But TFESI can reduce pain by keeping inflammation under control. In the meantime, doctors can begin working on a treatment to relieve the actual compression.
When TFESI Is Off the Table
Even when a patient is diagnosed with an appropriate condition and more conservative treatments have not worked, TFESI might still be off the table. There are certain things that doctors will look for, things that suggest that TFESI should be avoided. At the top of the list is an active infection.
Infection is always a risk with injections. Doctors prefer to minimize risk whenever possible, so TFESI may not be doable until after the active infection has been eliminated. Other potential qualifiers include:
- A bleeding disorder
- Known allergies to the medication
- More complicated conditions as diagnosed by a doctor
As with any medical treatment, TFESIs don’t work for every patient who tries them. But given that the injections are normally recommended only after more conservative treatments have failed, a failing TFESI would simply mean doctors have to keep looking for a solution.
When TFESIs do work, they tend to work quite well. They provide long term pain relief by controlling inflammation and keeping it under control over many weeks, and possibly months in some cases.
