Treatment

The best candidates for a genicular nerve block are those who have chronic knee pain but are not a candidate for surgery, have degenerative joint disease, lingering pain after a total or partial knee replacement, or have severe osteoarthritis in the knees.

This block is used to treat chronic knee pain, especially when other treatments have not provided sufficient relief. Conditions it helps include:

• Osteoarthritis of the knee
• Persistent knee pain after total knee replacement (TKR)
• Non-surgical candidates with chronic knee pain
• Pain following knee injuries or surgeries

Symptoms often include:

• Constant or activity-related knee pain
• Stiffness and aching
• Pain that limits walking, standing, or stair climbing

WHAT IS A GENICULAR NERVE BLOCK?

A genicular nerve block is a minimally invasive injection procedure that targets the genicular nerves, which transmit pain signals from the knee joint to the brain. This procedure involves injecting a local anesthetic, sometimes combined with a steroid, near these sensory nerves to block pain signals.

HOW WILL A GENICULAR NERVE BLOCK BENEFIT ME?

A genicular nerve block is a safe and effective option for managing chronic knee pain, especially when other treatments haven’t worked. It can provide both diagnostic insight and pain relief, helping improve your daily function and quality of life.

• Immediate pain relief from the local anesthetic
• Improved mobility and function
• Reduces reliance on oral medications
• Can help determine if you're a good candidate for genicular nerve ablation (a longer-lasting procedure)
• May help delay or avoid knee surgery

WHAT TO EXPECT?

The procedure is performed with the patient lying down. The injection site will be carefully cleaned, and a numbing agent (often bupivacaine) will be injected into the injection site. Using fluoroscopy or ultrasound, our doctors identify the genicular nerves to be targeted and inject a local anesthetic. Many patients feel immediate pain relief as the medications reach the nerves.

• The procedure typically takes 15–30 minutes.
• Performed under ultrasound guidance to ensure precise placement.
• No incisions are made — only small needle insertions.
• Mild discomfort may occur at the injection site.

After the procedure:

• You’ll be monitored briefly and can typically go home the same day.
• You may be asked to test your knee function (walking, climbing stairs) shortly after the injection to assess immediate results.

WHEN WILL I EXPERIENCE RELIEF?

• Immediate relief may be felt within minutes to hours due to the anesthetic.
• If a steroid is used, longer-lasting relief may begin within 2–7 days.
• Pain relief duration varies, often lasting from several weeks to a few months.
• If the block is successful, genicular nerve ablation (radiofrequency treatment) may be recommended for longer-term relief.

Intercostal nerve blocks are used to relieve sharp, burning, or radiating pain in the chest or upper abdomen caused by:

• Rib fractures or trauma
• Post-surgical pain (e.g., after thoracotomy, mastectomy, or chest tube placement)
• Postherpetic neuralgia (pain following shingles)
• Intercostal neuralgia
• Tumor-related chest wall pain
• Certain cases of chronic chest wall pain or inflammation

Symptoms may include:

• Shooting pain along the rib line
• Tingling or burning in the chest wall
• Pain that worsens with movement, coughing, or breathing

WHAT IS AN INTERCOSTAL NERVE BLOCK

An intercostal nerve block is a minimally invasive injection procedure that delivers local anesthetic, often with a steroid, around the intercostal nerves — the nerves located under each rib. These nerves carry pain signals from the chest and upper abdominal area.

The goal is to block or reduce pain signals coming from the rib cage, chest wall, or upper abdomen.

HOW WILL AN INTERCOSTAL NERVE BLOCK BENEFIT ME?

An intercostal nerve block is a safe, effective way to manage chest wall and upper abdominal pain, especially when it's nerve-related or following surgery or injury. It provides both diagnostic clarity and symptom relief, improving your ability to breathe, move, and heal comfortably.

• Immediate pain relief from local anesthetic
• Reduces inflammation if a steroid is used
• Improves breathing and mobility by decreasing pain
• May reduce the need for strong oral pain medications
• Helps identify if the intercostal nerves are the true source of pain

WHAT TO EXPECT?

An intercostal nerve block is simple to perform and useful for pain management, either as a primary intervention or as an adjunct.

• The procedure usually takes 15–30 minutes.
• Patient lies on their side with the affected area facing up
• Cleansing and sanitizing the skin around the injection site(s)
• An ultrasound or fluoroscopy (X-ray) may be used for precise needle placement.
• Injecting medication to numb the intercostal nerves
• You may feel a pinch or pressure during the injection.
• May be repeated at multiple locations for maximizing pain relief
• Afterward, you'll be monitored briefly and typically go home the same day.

WHEN WILL I EXPERIENCE RELIEF?

• Immediate relief may begin within minutes to hours due to the anesthetic.
• If a steroid is included, longer-term relief often begins within 2–5 days.
• Pain relief duration can vary — from days to several weeks or more, depending on the underlying cause.
• In some cases, repeat injections or additional treatments may be recommended.

WHAT IS A KNEE INJECTION?

Knee injections are a medical procedure where medications are injected directly into the knee joint to relieve inflammation and pain and/or improve function. They are often used for individuals who do not respond to traditional pain management methods or wish to avoid surgery.

Knee injections for pain can be a practical option for people who do not respond to pain management drugs and for people who want to treat knee pain without surgery. The injections can temporarily relieve symptoms and improve pain and joint function. A healthcare provider will give these injections directly into the affected joint.

While generally safe, injections can have side effects, such as temporary pain or swelling at the injection site. Corticosteroid injections may also have other potential side effects, such as increased blood sugar levels in people with diabetes. 

There are four basic portals of entry for injections into the knee: superolateral, superomedial, anterolateral, and anteromedial. The superior portals are at or just slightly above the kneecap on either side and are typically injected with the knee held in extension. The anterior portals are in the front, and just below the kneecap on either side. These portals are typically injected with the knee in flexion.

Knee joint injections are primarily used to alleviate pain caused by conditions like: 

• Osteoarthritis (OA) is a degenerative joint disease where cartilage breaks down, causing pain, stiffness, and reduced mobility
• Rheumatoid arthritis, another type of arthritis, is caused by inflammation of the joints and can affect the knee function
• Injuries to ligaments, tendons, or the meniscus (cartilage that cushions the joint) can cause localized pain and inflammation
• Conditions such as patellar tendinitis, bursitis, kneecap dislocation and bone fractures
• Excessive stress or overuse of the knee joint can lead to pain and inflammation

HOW WILL A KNEE INJECTION BENEFIT ME?

Knee injections can offer several benefits, including reduced pain and inflammation, improved joint lubrication, and potentially enhanced mobility and function. They can be a useful treatment option for conditions like osteoarthritis and can be particularly helpful for those who haven't found sufficient relief from other conservative treatments. 

Types of Knee Injections:

• Corticosteroid: Often referred to as steroid injections, these are used to reduce inflammation and pain in and around the knee joint. They can provide quick, temporary relief, especially during flare-ups. 
• Hyaluronic Acid: Also known as viscosupplementation, these injections aim to improve lubrication and cushioning within the knee joint. 
• Platelet-Rich Plasma (PRP) : PRP injections utilize a concentration of platelets from your own blood to potentially stimulate healing and reduce pain with conservative out-of-pocket costs.
• Stem Cell: These injections are a more experimental treatment that may encourage tissue repair and regeneration and can be quite expensive.

WHAT TO EXPECT?

Knee injections are frequently done as an office procedure. Your provider will clean the skin with alcohol or other solution. After the site has been prepared, your provider will numb the area with a local anesthetic prior to the knee injection. Based on your healthcare provider’s discretion, the injection site will depend on your knee’s range of motion, ability to fully extend and if applicable - the presence of fluid collection in the knee.

WHEN WILL I EXPERIENCE RELIEF?

Most people feel less pain after a knee injection.

• You may notice reduced pain 15 to 20 minutes after the injection.

• If you experience the uncommon phenomenon of post-injection flare (injection of fluid into the knee stretches the knee capsule and induces an initial inflammatory pain response that can last for about 24-hours), treat with (RICE) Rest, Ice, Compression, Elevation OTC anti-inflammatory medications such as ibuprofen or naproxen may help minimize the swelling. Steroid injections typically take two to seven days to start working to reduce pain and inflammation.
• While everyone responds differently, the effects of steroid injections usually last a few weeks or up to three months

Knee injections can be administered quickly and easily in an outpatient setting, making them a convenient option for pain management. While beneficial to many patients, knee injections may not be suitable for everyone, and the best treatment approach will depend on the individual's specific condition, symptoms, and medical history. Keep in mind knee injections are often a temporary solution and may not be a cure for the underlying condition, especially in cases of advanced osteoarthritis. Finally, knee injections are often most effective when combined with other treatments, such as physical therapy and exercises, to address the underlying cause of pain and improve joint function. 

What is a hip injection? How will a benefit me? What to expect from a hip injection? When will I experience relief from a hip injection?

WHAT IS A HIP INJECTION?

A hip joint injection is a shot of medicine into the hip joint. The medicine can help relieve pain and inflammation. It can also help your provider diagnose the source of hip pain. It may be used to treat hip pain from inflammation caused by osteoarthritis, disease, or injury.

Hip injections, often with corticosteroids, can provide pain relief and reduce inflammation for various hip conditions. They can be used to diagnose the source of pain or treat conditions like osteoarthritis, bursitis, and labral tears. While immediate pain relief from the anesthetic may be temporary, the steroid component can offer longer-term pain management. 

A hip joint injection is done to reduce hip pain caused by problems in the bones or cartilage of your hip joint. The hip pain is often caused by:

• Bursitis
• Arthritis
• Labral tear (a tear in the cartilage that is attached to the rim of the hip socket bone)
• Injury to the hip joint or surrounding area
• Overuse or strain from running or other activities

HOW WILL A HIP INJECTION BENEFIT ME?

Hip injections are very effective in treating pain from inflammation. Most often the medications used in hip injections are a combination of anesthetics and steroids, which reduce pain and inflammation. You may also feel relief from the release of fluid or pressure that may occur during the procedure. A hip injection is also useful for your doctor to determine from where your pain originates.

WHAT TO EXPECT?

Hip injections at US Pain Relief, PLLC, are typically performed with ultrasound imaging guidance to ensure accurate needle placement. A local anesthetic is used to minimize pain during the injection. 

Before your procedure, tell your provider about:

• Any health problems
• Any allergies 
• Medicines you take, including over-the-counter medicines
• Any blood thinner medicines, such as aspirin, warfarin (Coumadin), dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), or clopidogrel (Plavix)

Before the procedure, the risks, benefits, and alternatives should be discussed with the patient and informed consent should be obtained.

For the procedure:

• You will lie on the table with the affected hip facing upward, and your hip area will be cleaned.
• A numbing medicine will be injected into the site with a small needle.
• Once the area is numb after 3-5 minutes, another small needle will be guided into the joint area while the provider watches the placement on the ultrasound screen to ensure the medicine is placed correctly in the joint.
• Once the needle is in the right spot, the medicine (usually a combination of a local anesthetic and a steroid) is slowly injected into the joint.

After the injection, follow any specific instructions your provider gives you. These may include:

• Applying ice on your hip if you have swelling or pain (wrap the ice in a towel to protect your skin)
• Avoiding strenuous activity the day of the procedure
• Taking pain medicines as directed

You may resume most normal activities the next day.

WHEN WILL I EXPERIENCE RELIEF?

Most people feel less pain after a hip injection.

• You may notice reduced pain 15 to 20 minutes after the injection.
• Pain may return in 4 to 6 hours as the numbing medicine wears off.
• As the steroid medicine begins to take effect 2 to 7 days later, your hip joint should feel less painful.

As your pain subsides, your healthcare provider may advise you to engage in moderate exercise. While a hip injection is not a permanent solution, it will make your pain more manageable as your US Pain Relief, PLLC, provider develops a long-term treatment plan. If the shot does not relieve pain right after the injection of the numbing medicine or within a few days, then the hip joint may not be the source of hip pain, and your provider may perform additional diagnostic tests to determine the source of your hip pain.

References

American College of Rheumatology website. Joint injections (joint aspirations). rheumatology.org/patients/joint-injections-joint-aspirations. Updated March 2025. Accessed May 14, 2025.

Foye PM, Stitik TP, Shah VP, Sajid N, Gnana JS, Bachoura PJ. Hip osteoarthritis. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 55.

Naredo E, Möller I. Aspiration and injection of joints and periarticular tissue and intralesional therapy. In: Hochberg MC, Gravallese EM, Smolen JS, van der Heijde D, Weinblatt ME, Weisman MH, eds. Rheumatology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 31.

When it comes to pain, many healthcare providers treat the condition with medications that reduce inflammation or discomfort, while others improve organ function or impact your neurotransmitters. But an unwanted consequence of these medications is interactions and, in some cases, medication dependence. At US Pain Relief, PLLC, with a location serving the Grand Rapids area, the team of healthcare professionals can address your pain and assist you with medication management.

Here at US Pain Relief, PLLC, we believe:

• All patients should receive treatment for pain that provides the greatest benefits relative to risks.
• Use of nonpharmacologic and nonopioid pharmacologic therapies should be maximized as appropriate because they do not carry the same risks as opioids.
• In agreement with the 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022 Clinical Practice Guideline) has expanded guidance on evidence-based nonopioid options for pain.

Medication management is a service provided by our practice to help patients reduce the number of drug interactions and lessen the risk of dependence on pain medication. One of the most important aspects of medication management is patient education. Your US Pain Relief, PLLC, provider spends time discussing your medications with you, as well as how they act on and affect your body.

Medication management also consists of providing a system to help you and the practice to monitor your prescriptions. This system, along with random drug tests and pill counts, provides a level of accountability with your prescription medications. These aspects of medication management help you take your pills as your healthcare provider recommends and allow you to watch for drug interactions.

A few medications have proven to be effective in chronic pain disorders and their use individually or in combination should improve the management of chronic pain. Especially for neuropathic pain, the medications recommended as first-line treatments include TCAs, SNRIs, calcium channel α₂-δ ligands, and lidocaine patch. Opioid analgesics and tramadol are recommended as second-line treatments that can be considered for first line use in selected clinical circumstances. A thorough understanding of pain mechanisms and good communication between physicians and patients are required to improve patient outcomes. Avoiding ineffective treatments and maximizing the treatments that have been proven beneficial in clinical trials (i.e., evidence-based treatments) are likely to produce better outcomes than have often been experienced by clinicians and patients in the management of chronic pain. Additionally, identifying and co-managing pain that is comorbid with psychiatric disorders have promise for improving both the physical and psychological outcomes. Furthermore, the multi-modality treatment of chronic pain incorporates not only this approach to pharmacological treatment, but also non-pharmacological strategies such as interventional pain management, physiotherapy, psychotherapy, and pain rehabilitation.

At US Pain Relief, PLLC, the practice uses various types of medication to help you manage your pain. Depending on the cause and severity of your pain, your healthcare provider may treat your chronic pain with:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Acetaminophen
• Antidepressants
• Anti-seizure medications
• Steroids

Although opioid medications, commonly called pain pills, can alleviate pain, the US Pain Relief, PLLC, practice uses these medications in addition to other pain-relieving treatments. Your healthcare provider may recommend using opioid medications and other narcotics only when your pain is unbearable.

At US Pain Relief, PLLC, your healthcare provider develops a system that works for you and your pain. As part of your medication management program, they may provide you with:

• Pill dispensers for organization
• Pre-packaged daily medications
• Drug testing to ensure you’re taking your medication as prescribed
• Pill counts for narcotic medications
• Therapy to help you find other ways to manage pain
• Alternatives to pain medication
• Neuromodulation treatments

By taking a multidisciplinary approach, the team at US Pain Relief, PLLC, works to alleviate your pain, not just through medication, but through a whole-person approach. In addition to medication, the practice may recommend other treatments like physical therapy, therapeutic massage or interventional procedures.

Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if expected benefits for pain and function are anticipated to outweigh risks to the patient.

Several nonopioid pharmacologic therapies can be used for subacute and chronic pain conditions. Some examples include:

• Topical and oral NSAIDs
• Acetaminophen
• Tricyclic and tetracyclic antidepressants
• Serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressants
• Anticonvulsants (e.g., pregabalin/gabapentin)
• Capsaicin and lidocaine patches

Nonopioid medications are associated with certain risks, particularly in older adults, pregnant women, and patients with certain comorbidities such as cardiovascular, renal, gastrointestinal, and liver disease.

In patients with neuropathic pain, both antidepressants and antiepileptic drugs represent the first-line treatment 

The American Pain Society suggests a multi-modal approach without a differentiation concerning the mechanisms of pain, that opioids (mainly taken via the oral route and with caution in opioid-naïve patients), gabapentin and pregabalin, NSAIDs, and paracetamol are possible options 

More recently, the Department of Health and Human Services’ best practices give further information, recommending non-opioid or non-pharmacologic therapeutic options in order to avoid chronic treatment with these compounds. For neuropathic pain, the first-line therapy should be chosen among anticonvulsants, SNRIs, amitriptyline, and topical analgesics (capsaicin and lidocaine). For non-neuropathic, non-cancer pain, NSAIDs and paracetamol are the first-line options. Based on patients’ responses, other medication classes include muscle relaxants may be medically appropriate.

Our goal at US Pain Relief, PLLC, is to provide medication management solutions (when medically appropriate) starting with the most conservative treatment pathways. Various treatment options are available to help manage and alleviate chronic pain effectively - you’ll learn what works best in managing your chronic pain with an emphasis on improving/maintaining functionality, and by working together get you back to your everyday life.

References

Stretanski MF, Kopitnik NL, Matha A, et al. Chronic Pain. [Updated 2025 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553030/

Alorfi NM. Pharmacological Methods of Pain Management: Narrative Review of Medication Used. Int J Gen Med. 2023 Jul 31;16:3247-3256. doi: 10.2147/IJGM.S419239. PMID: 37546242; PMCID: PMC10402723.

Queremel Milani DA, Davis DD. Pain Management Medications. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560692/

WHAT IS AN OCCIPITAL NERVE BLOCK

An occipital nerve block is a minimally invasive injection that targets the occipital nerves located at the base of your skull. It works by interrupting pain signals sent from the occipital nerves to the brain and is especially effective when the pain originates from irritation or inflammation of the greater or lesser occipital nerves.

The injection typically contains:

• A local anesthetic (to numb the area)
• A corticosteroid (to reduce inflammation and provide longer-lasting relief)

An occipital nerve block is commonly used to treat pain at the back of the head, neck, and upper scalp. This may include:

• Occipital neuralgia (sharp, shooting pain in the back of the head)
• Chronic migraines
• Tension-type headaches
• Cluster headaches
• Cervicogenic headaches (headaches caused by neck issues)
• Post-traumatic headaches

HOW WILL AN OCCIPITAL NERVE BLOCK BENEFIT ME

An occipital nerve block is a simple, safe, and effective way to relieve certain types of head and neck pain to help address:

• Pain Relief: Decrease or eliminate headache and upper neck pain
• Overall Quality of Life: May improve sleep, concentration and daily function
• Reduced Medication Use: Assists with lower reliance on oral pain meds
• Diagnostic Insight: May help determine whether pain is nerve-related
• Minimally Invasive: Quick procedure with little recovery time

WHAT TO EXPECT?

It offers both diagnostic insight and therapeutic benefits, with minimal downtime and quick results for many patients.

Before the occipital nerve block:

• No special preparation is needed.
• You can eat and take medications as usual unless advised otherwise.

During the occipital nerve block:

• Done in a clinic setting, usually while sitting or lying down.
• A small needle is used to inject local anesthetic near the base of the skull
• Once the injection site is numb, medication will be injected in the appropriate area

After the occipital nerve block:

• You may feel numbness, tingling, or pressure at the site.
• Mild soreness, bruising, or dizziness is possible.
• Most people return to normal activity within a day.

WHEN WILL I EXPERIENCE RELIEF?

• Immediate Relief: Usually within 15 to 30 minutes, due to the local anesthetic
• Delayed but Lasting Relief: If a steroid is included, full relief may take 2 to 7 days.
• Duration of Benefit: Relief may last from weeks to months.
• If successful, the block may be repeated periodically for ongoing management.

Piriformis injections are used to treat Piriformis Syndrome and related conditions, which may cause:

• Deep buttock pain
• Sciatica-like symptoms (burning, tingling, or numbness radiating down the leg)
• Pain when sitting for long periods
• Pain that worsens with walking, climbing stairs, or hip movement
• Discomfort that improves when lying down

WHAT IS A PIRIFORMIS INJECTION

A piriformis injection is a minimally invasive procedure in which a local anesthetic and often a steroid medication are injected into or around the piriformis muscle, located deep in the buttock. The goal is to reduce pain and inflammation and to relieve pressure on the sciatic nerve.

HOW WILL A PIRIFORMIS INJECTION BENEFIT ME?

A piriformis injection is a safe, targeted treatment for buttock and leg pain caused by piriformis muscle irritation. It can provide both diagnostic insight and symptom relief, helping you return to normal activity with less discomfort.

• Reduces muscle inflammation and relieves pressure on the sciatic nerve
• Alleviates pain and improves mobility
• Confirms diagnosis of piriformis syndrome if symptoms improve after injection
• Supports physical therapy progress by reducing discomfort

WHAT TO EXPECT?

The procedure typically involves positioning the patient for access to the injection site, using imaging or ultrasound guidance for accurate needle placement, and injecting a mixture of corticosteroid and anesthetic directly into the muscle.

• The procedure typically takes 15–30 minutes.

• Is usually done using ultrasound or fluoroscopic guidance for accuracy.

• You may feel a brief sting or pressure during the injection.
• After the injection, you may rest briefly and can usually go home the same day.

WHEN WILL I EXPERIENCE RELIEF?

• Immediate relief (within hours) may occur from the anesthetic.
• Longer-term relief typically begins in 2–5 days as the steroid takes effect.
• Pain relief can last for weeks or months, depending on the cause and severity.

PRP is commonly used to treat chronic musculoskeletal pain, particularly in areas where tissue healing is slow or incomplete. PRP can help with:

• Tendon and ligament injuries
  • Tennis elbow, golfer’s elbow
  • Patellar tendonitis
  • Achilles tendonitis
  • Rotator cuff injuries (partial tears)
• Joint pain and degeneration
  • Knee osteoarthritis
  • Hip or shoulder arthritis
• Muscle strains and tears
• Plantar fasciitis
• Chronic pain from overuse injuries

WHAT IS PRP?

Platelet-Rich Plasma (PRP) is a treatment that uses a concentrated form of your own blood to promote healing. Your blood is drawn and processed to separate and concentrate platelets, which are then injected into an area of injury, inflammation, or degeneration. Platelets contain growth factors that help stimulate tissue repair and reduce inflammation.

HOW WILL PRP BENEFIT ME?

PRP is a safe, non-surgical treatment that uses your body’s own healing properties to relieve chronic pain, improve joint and tissue health, and restore function. It’s an excellent option for those seeking natural, regenerative therapy when other treatments have failed.

• Reduces pain and inflammation naturally
• Promotes tissue healing and regeneration
• Can delay or reduce the need for surgery
• Improves function and mobility of the affected area
• Uses your own blood — low risk of allergic reaction or rejection

WHAT TO EXPECT?

• Your blood will be drawn (like a routine lab test)
• The sample is processed to isolate the PRP
• The PRP is injected into the target area using imaging guidance (ultrasound or fluoroscopy)
• The procedure takes about 30–60 minutes
• Mild soreness or swelling at the injection site is common for a few days

Post-procedure:

• You may be advised to limit activity for a few days
• Full return to normal activity typically occurs within 1–2 weeks

WHEN WILL I EXPERIENCE RELIEF?

• PRP is not an instant fix — it stimulates your body’s natural healing process
• Initial improvement may be noticed in 2–4 weeks
• Full results often appear gradually over 6–12 weeks
• Some patients may need a series of injections for optimal benefit

SI joint injections treat pain caused by inflammation or dysfunction of the sacroiliac joints, which connect the spine to the pelvis.

Common symptoms include:

• Lower back pain, especially off to one side
• Buttock pain, sometimes radiating to the groin or thigh
• Pain when standing, walking, climbing stairs, or transitioning from sitting to standing
• Pain that worsens with prolonged sitting or standing
• Sometimes mistaken for sciatica or a herniated disc

SI joint pain can result from arthritis, injury, pregnancy-related changes, or altered gait.

WHAT IS AN SI JOINT INJECTION

An SI joint injection is a minimally invasive procedure in which medication is injected directly into the sacroiliac joint.

• Typically includes a local anesthetic (to numb the area) and a steroid (to reduce inflammation)
• Can be diagnostic (to confirm the SI joint is the source of pain) and/or therapeutic (to reduce pain)
• The injection is usually done under X-ray or ultrasound guidance for accuracy.

HOW WILL A SI JOINT INJECTION BENEFIT ME?

Treatment starts with conservative care including physical therapy modalities and anti-inflammatory medications. Manipulative therapies have also been described. If these options fail, injections can not only provide diagnostic information but also therapeutic relief. Injection options include image guided SIJ intra-articular steroid injections that may address:

• Pain Relief: Helps reduce or eliminate SI joint-related pain

• Improved Mobility: Makes it easier to walk, sit, and move
• Better Function: Enhances daily activities and quality of life
• Reduced Need for Medications: May lessen the use of oral pain relievers
• Diagnostic Insight: Confirms whether the SI joint is the source of pain

WHAT TO EXPECT?

A sacroiliac joint injection is a safe and effective way to diagnose and relieve SI joint-related pain, especially for those with persistent lower back or buttock pain. The procedure is quick, with minimal recovery time and the potential for significant relief.

Before an SI joint injection:

• You may be asked to avoid food/drink for a few hours
• Inform your provider of any blood thinners or allergies

During an SI joint injection:

• The procedure is done in a sterile outpatient setting
• You'll lie on your stomach while the injection is guided into place using imaging
• The injection takes only a few minutes

After an SI joint injection:

• Mild soreness at the injection site is normal
• You may be observed briefly before going home
• Avoid strenuous activity for 24 hours

WHEN WILL I EXPERIENCE RELIEF?

• Immediate Relief: May occur within minutes to hours from the local anesthetic
• Longer-Term Relief: From the steroid, which may take 2–5 days to take full effect
• Duration: Relief may last weeks to several months
• If successful, injections can be repeated, or long-term management options (like physical therapy or radiofrequency ablation) may be discussed

WHAT IS A SHOULDER INJECTION?

A shoulder injection is a minimally invasive procedure aimed at interrupting the pain signals sent to the brain, where medication is injected into the shoulder joint or surrounding areas to relieve pain and reduce inflammation. It's a common treatment for various shoulder conditions, including arthritis, bursitis, and rotator cuff problems. The injection typically contains a combination of local anesthetic and corticosteroids, with the anesthetic providing immediate relief and the steroid reducing inflammation and pain over a longer period. 

Shoulder injections, often with corticosteroids, can provide pain relief and reduce inflammation for various shoulder conditions. They can be used to diagnose the source of pain or treat conditions like osteoarthritis, bursitis, and labral tears. While immediate pain relief from the anesthetic may be temporary, the steroid component can offer longer-term pain management. 

A shoulder joint injection is done to reduce shoulder pain caused by problems in the bones or cartilage of your shoulder joint. Shoulder injections can be used to treat a variety of conditions, including: 

• Osteoarthritis
• Rheumatoid arthritis
• Frozen shoulder (adhesive capsulitis)
• Bursitis
• Rotator cuff injuries
• Impingement syndrome
• Tendonitis
• Labral tears

HOW WILL A SHOULDER INJECTION BENEFIT ME?

A shoulder injection, typically containing a steroid like cortisone, can help reduce inflammation and pain in the shoulder joint, allowing for improved movement and function. This can be particularly helpful for conditions like arthritis, bursitis, tendinitis, and rotator cuff injuries. The injection can provide temporary pain relief and reduce swelling, allow for a greater range of motion in the shoulder, potentially enabling more effective physical therapy and rehabilitation. 

WHAT TO EXPECT?

Shoulder injections at US Pain Relief, PLLC, are typically performed with ultrasound imaging guidance to ensure accurate needle placement. A local anesthetic is used to minimize pain during the injection. 

Before your procedure, tell your provider about:

• Any health problems
• Any allergies 
• Medicines you take, including over-the-counter medicines
• Any blood thinner medicines, such as aspirin, warfarin (Coumadin), dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), or clopidogrel (Plavix)

There are 4 main areas in the shoulder that can be targeted for injection:

• Subacromial space around the rotator cuff
• Biceps tendon sheath
• Glenohumeral joint
• Acromioclavicular joint

Before the procedure, the risks, benefits, and alternatives should be discussed with the patient and informed consent should be obtained.

For the procedure:

• You will sit upright with the affected shoulder hanging loosely and relaxed by your side
• A numbing medicine will be injected into the site with a small needle.
• Once the area is numb after 3-5 minutes, another small needle will be guided into the joint area while the provider watches the placement on the ultrasound screen to ensure the medicine is placed correctly in the joint.
• Once the needle is in the right spot, the medicine (usually a combination of a local anesthetic and a steroid) is slowly injected into the joint.

After the injection, follow any specific instructions your provider gives you. These may include:

• Applying ice on your shoulder if you have swelling or pain (wrap the ice in a towel to protect your skin)
• Avoiding strenuous activity for several days after the procedure
• Taking pain medicines as directed

You may gradually resume most normal activities within 24-48 hours but be sure to rest the shoulder and avoid strenuous activities for the first 5-7 days. This allows the medication to settle and start working, and it minimizes the risk of irritation or injury. After the initial rest period, you can gradually return to light activities like household chores or gentle exercise and may be directed to resume physical therapy sessions.

WHEN WILL I EXPERIENCE RELIEF?

• You may notice reduced pain 15 to 20 minutes after the injection.
• Pain may return in 4 to 6 hours as the numbing medicine wears off.
• It's common to experience some soreness or bruising at the injection site. As the steroid medicine begins to take effect 2 to 7 days later, your shoulder joint should feel less painful.

As your pain subsides, your healthcare provider may advise you to engage in gentle exercise. While a shoulder injection is not a permanent solution especially if there is a structural problem in the shoulder, it will make your pain more manageable as your US Pain Relief, PLLC, provider develops a long-term treatment plan to include other treatments, like physical therapy or lifestyle modifications. The duration of pain relief varies depending on the type of injection and the individual's condition but can last for several weeks or months. 

WHAT IF MY SHOULDER INJECTION IS INITIALLY EFFECTIVE BUT DISSIPATES QUICKLY?

At this point, if you have had an injection and coupled this with either physical therapy or a home exercise program, Dr. Howlett's team will likely recommend an MRI to see what structure in the shoulder may be injured and hence why your pain is coming back.

References

Gill TJ. Shoulder diagnosis and decision-making. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine: Principles and Practice. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 37.

Martin SD, Thornhill TS. Shoulder pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 49.

WHAT IS A TRIGGER POINT INJECTION (TPI)

Trigger point injections (TPI) are a therapeutic modality to treat myofascial trigger points, especially in symptomatic patients, and have been demonstrated effectively to inactivate trigger points. The goal is to relax the muscle, relieve pain, and improve function.

Trigger Point Injections are a safe, effective, and quick treatment for muscle-related pain. They help release tight muscles, reduce pain, and restore mobility, especially when conservative methods like stretching or massage haven’t worked. Trigger Point Injections (TPIs) are used to treat painful “knots” in muscle tissue that don't relax on their own. 

These painful spots, called trigger points, can cause:

• Localized muscle pain or tenderness
• Referred pain (pain that radiates from the trigger point to other areas)
• Tension headaches
• Myofascial pain syndrome
• Fibromyalgia-related muscle pain
• Neck, shoulder, back, and hip pain
• Limited range of motion due to tight muscles

HOW WILL A TPI BENEFIT ME?

• Quick Pain Relief: Often within minutes to hours
• Improved Mobility: Helps restore movement in stiff or painful muscles
• Reduced Muscle Tension: Breaks the pain-spasm cycle
• Minimally Invasive: No surgery, short procedure time
• Can Be Repeated: If symptoms return, injections can be done again

WHAT TO EXPECT FROM A TPI?

Trigger Point Injections are a safe, effective, and quick treatment for muscle-related pain. They help release tight muscles, reduce pain, and restore mobility, especially when conservative methods like stretching or massage haven’t worked.

Before the TPI procedure:

• No special preparation is needed.
• Performed in a clinic setting.

During the TPI procedure:

• The injection site is cleaned.
• A small needle is inserted directly into the trigger point.
• You may feel a brief twitch or cramp during the injection.

After the TPI procedure:

• Some soreness or bruising may occur at the injection site.
• Most people can return to normal activity the same day.
• Stretching and physical therapy may be recommended afterward.

WHEN WILL I EXPERIENCE RELIEF?

• Immediate Relief: Often within a few minutes to a few hours.
• Full Relief: May take 1–2 days, especially if multiple areas are treated.
• Duration of Relief: Varies—may last days to weeks, depending on the cause of the trigger point and activity level.
• Multiple sessions may be needed for chronic conditions.

REFERENCE:

Hammi C, Schroeder JD, Yeung B. Trigger Point Injection. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542196/