Injections & Nerve Blocks

Direct answers — no jargon.

If your question isn’t here, ask us at your consultation. We will give you the same answer in plain English.

• Will the steroid affect my blood sugar?
  Steroid injections can transiently elevate blood glucose for 2 to 7 days, particularly in patients with diabetes or pre-diabetes. We coordinate timing and dose accordingly. Most diabetic patients do well with appropriate planning; we adjust corticosteroid choice and dose based on your A1c and recent glucose patterns.
• How many injections can I have?
  We follow evidence-based limits — typically no more than three to four corticosteroid injections per region per year — and prefer to use injections strategically rather than as ongoing therapy. If you find yourself needing repeat injections every few months, that is a signal to consider a more durable option like RFA, Intracept, or spinal cord stimulation.
• Are these injections only diagnostic, or therapeutic?
  Both. The local anesthetic provides immediate diagnostic information about whether we have correctly identified the pain source. The corticosteroid provides anti-inflammatory therapy that can last weeks to months. We use both effects deliberately.
• What is the difference between fluoroscopy and ultrasound guidance?
  Fluoroscopy uses live X-ray to visualize bony anatomy and contrast — ideal for spinal injections and nerve blocks near bone. Ultrasound visualizes soft tissues and vessels in real time — preferred for peripheral joints, tendons, and certain nerve targets. We choose the right modality for each target.
• How quickly will I feel relief?
  The local anesthetic component provides relief within minutes and lasts a few hours. The corticosteroid effect typically builds over 3 to 7 days. Some patients feel transiently more sore for 24 to 48 hours before relief sets in — usually from needle irritation, not from anything wrong.
• Can I drive home afterward?
  If you receive sedation or a spinal injection, you will need a driver. Only minor, local-anesthetic-only procedures may allow you to drive yourself, and only per your provider's guidance. We confirm transportation arrangements when we schedule, so this is not a surprise.
• Why do I sometimes need a second 'confirmatory' block?
  For procedures like RFA, where we plan to ablate a nerve, we use a two-block paradigm — two separate diagnostic blocks on different days that both must provide meaningful relief. This is to reduce the rate of false positives and ensure we are ablating the right target.
• What about non-steroid injection options?
  We offer hyaluronic acid (viscosupplementation) for select knee osteoarthritis cases, and PRP for tendinopathy and select arthritis. These are biologic alternatives that avoid the metabolic and bone effects of repeated corticosteroids.
• Are sympathetic blocks different from joint injections?
  Yes — sympathetic blocks (stellate ganglion, lumbar sympathetic, celiac plexus, ganglion impar) target the autonomic nervous system rather than a joint or peripheral nerve. They are diagnostic and therapeutic for sympathetically-mediated pain syndromes like CRPS and certain visceral pains.
• What if my injection does not help?
  We use that as diagnostic information. If a well-targeted injection does not relieve your pain, we revisit the diagnosis — the pain source may be different from what imaging suggested. We do not just give you another injection of the same thing; we adjust the plan.