Injections for Neck Pain: Types, Benefits, and Risks

If you suffer from debilitating neck pain, your doctor may recommend trying injections as part of your treatment plan. Injections can deliver medication directly into the spine to help reduce painful swelling and inflammation. Here’s an overview of the most common injection options used to treat neck pain, how they work, their effectiveness, and potential risks.

Cortisone Shots

Cortisone, a powerful anti-inflammatory steroid medication, is frequently used in injections to treat neck pain. The cortisone shot contains a local anesthetic as well to numb the area. The medication delivered directly to the painful site reduces swelling and irritation of compressed nerves and surrounding tissues.

Cortisone shots can provide substantial pain relief for several weeks or months. However, the effects are temporary and not a cure. Most patients need to continue with other treatments, plus cortisone injections are only recommended a few times per year due to side effects like weakened cartilage and bone loss. Still, for severe flare-ups of neck or cervical spine pain, a cortisone injection can offer fast relief when other therapies aren’t working.

Nerve Root Blocks

If a compressed or irritated spinal nerve in the neck is causing pain to radiate down the arm, a selective nerve root block may help provide relief. This involves injecting a local anesthetic and corticosteroid directly onto the affected nerve root. This immediately reduces inflammation on the compressed nerve, and the anesthetic offers temporary but substantial pain relief.

Nerve root blocks can confirm the source of pain and determine if surgery may help long-term. If they provide significant relief, it indicates that decompressing that particular nerve will likely ease the pain. Nerve root blocks tend to offer relief for a number of weeks or months before pain possibly returns. For severe nerve issues, they may be repeated up to 3 times per year.

Facet Joint Injections

Each vertebra has facet joints that connect it to the next vertebra. If these spinal joints become inflamed or damaged, they can cause significant neck, shoulder and arm pain. Facet joint injections deliver a corticosteroid and anesthetic directly into the painful joint to reduce inflammation and numb the area.

Relief varies but generally lasts several months, though studies show widely mixed results on their long-term effectiveness for neck pain. Most patients receive minimal benefit from facet joint injections, though they appear more effective for lumbar and thoracic spine pain. They may provide short-term relief and help confirm the joint as a pain source. However, given limited evidence for cervical facet joint injections, they are not usually the first option.

Radiofrequency Ablation

For severe neck pain that has not responded to other conservative treatments, radiofrequency ablation (RFA) may provide longer-term pain relief by deactivating nerves causing the pain. The procedure uses heat delivered via radiofrequency waves to essentially numb specific nerves for months at a time.

RFA can target painful facet joint nerves, the tiny occipital nerves in the upper neck, or specific dorsal root ganglia (nerve cell bundles that transmit pain signals). Pain relief often lasts 9 months up to 2 years before the nerves regenerate. While considered low risk, possible side effects include injections not working well if nerves are improperly targeted, infection, worsened pain, and neck stiffness or muscle spasms. Multiple RFA procedures may be necessary over time.

Epidural Steroid Injections

Similar to a cortisone shot but into a wider area, epidural steroid injections deliver anti-inflammatory corticosteroid medication into the epidural space surrounding the spinal cord and nerve roots. X-ray or ultrasound guidance ensures medication is injected directly into the most inflamed areas. The corticosteroid reduces swelling and irritation around compressed nerves.

Relief varies but on average last about 6 to 12 weeks, though multiple injections are usually given. Epidural injections appear to have only limited short-term benefit for neck pain, plus they come with risks like infection, bleeding, nerve damage, worsening arm weakness, headaches, and even paralysis, though rare. Potential benefits versus risks must be carefully weighed.

Trigger Point Injections

Muscle knots and trigger points in the neck and upper back can refer pain to surrounding areas. A trigger point injection delivers a local anesthetic and sometimes corticosteroid directly into the stiff, painful knot in the muscle to reduce inflammation and numb the area. Relief generally lasts for several weeks as it breaks the pain cycle caused by the contracted muscle fibers.

While considered low risk, potential side effects include bleeding, bruising, swelling, infection, and numbness. Trigger point injections can offer temporary relief for myofascial neck pain not alleviated by other measures. They may be combined with physical therapy, massage, and improving posture.

Potential Benefits of Neck Injections

  • Quick reduction in severe neck, shoulder and arm pain
  • Confirm an exact source of pain
  • Avoid surgery if injections relieve pain substantially
  • Enable physical therapy by decreasing pain prior
  • Temporary restoration of range of motion and function
  • Break the pain and inflammation cycle
  • Reduce need for oral medication or pain killers

Risks to Consider

  • Temporary pain flare up afterwards
  • Bleeding, swelling, bruising at injection site
  • Infection in surrounding tissues or joints
  • Nerve damage or worsened numbness and weakness
  • Paralysis, though very rare risk
  • Cartilage damage with overuse of steroids
  • Headaches, nausea, symptoms not improving
  • No long-term cure; pain usually returns eventually