Pain can be difficult to pin point and treat.  It is not as simple as, “I hurt here, treat here.”  For instance, when a patient has a heart attack, it can cause pain that travels into the jaw or down the left arm, even though the heart is in the left chest.  This type of pain is called referred pain because the patient feels discomfort in an area (jaw/left arm) not where the actual source (heart) is located.  Treatment directed at the jaw or arm will completely miss the true source of the pain, the heart.  That is why a physician needs to try to identify the source of pain and direct treatment for that structure. 

It is also why simply doing an injection into the area that hurts is not so straightforward.  In regard to the spine, there can be multiple sources of pain, some of which are referred.  Unfortunately, there is no imaging study (MRI, CT scan) or blood work that can identify the exact source of pain, which is a common misconception among people.  Instead, the POTENTIAL source of your pain is determined based on many factors when looked at altogether, including your history, physical exam findings, and imaging studies.  With the latter, keep in mind they are anatomical studies that typically show age and life-related changes that are not always due to pain.

When spinal injections are recommended, also keep in mind that they are specific to a targeted area.  There is no one injection that helps with all pain.  Medication needs to be placed near the potential source of pain.  For example, an epidural steroid injection places medication near a disc or pinched nerve, while a lumbar facet joint injection places medication in the actual joint itself. Dr. Garala will typically explain the rationale for the injection or procedure that is recommended.  However, please let him know if you have any questions.  

A list of video animations explaining common injections/procedures are listed below.