A costovertebral injection is a minimally invasive procedure to help relieve mid-back pain, stemming from inflammation or irritation of the costovertebral joints. Costovertebral joints are the small joints where the ribs join with the thoracic vertebrae. Patients receiving costovertebral injections normally have not responded to other conservative treatment such as oral anti-inflammatory medication, rest, chiropractic or physical therapy. These injections can provide relief from pain for day, years, or in some cases permanently.
Prior to the injection, you will be asked to sign a consent form. A nurse will check your vital signs, and ask what medications you are currently taking and if you are allergic to any medications. Patients may choose to remain awake for the entire process. Some physicians may offer the choice of an oral medication to relieve anxiety, while others offer IV sedation. The doctor performing the injections will review your medical history and talk with you prior to the procedure.
Lying face down on the table, in the procedure room, the area of injection will be cleansed with an antiseptic solution and the skin will be numbed.
With the assistance of a C-arm fluoroscopic unit (x-ray) the physician directs a needle to the costovertebral joint and the anesthetic and corticosteroid are delivered. A small amount of x-ray dye may be used to confirm the medicine only goes into the joint. The medications, a mixture of anesthetic and cortisone, help to reduce inflammation and relieve pain.
After the injection, you will return to the recovery room for 30 minutes of observation. The nurse will re-check your vital signs at this time. You will be given an ice pack to use for the remainder of the day to help keep the medication in place for maximum benefit and to relieve any soreness. You may resume normal activity the next day.
A form to periodically notate your pain levels post-injection will be given to you prior to discharge. Please bring this form with you to your follow-up appointment.
- Nothing to eat or drink 6 hours prior to injection.
- Discontinue all medications after midnight before your injection. If you are on routine medications for heart, blood pressure or diabetes, you can take your medication as usual the morning of your injection with a sip of water.
- Discontinue anti-inflammatory medication such as ibuprofen or naproxen three days prior to the injection.
- Discontinue aspirin products seven days prior to your injection.
- If on blood thinners such as Coumadin, Plavix or Pradaxa, contact the prescribing physician to stop the medication seven days prior to injection.
- You must have an adult driver with you
- Make and bring a list of all medications, both prescribed and over-the-counter with you to the injection along with your photo identification and insurance card(s).
- Plan to arrive one hour prior to your injection time to check-in and register at the facility.
Other than pain, associated symptoms may include weakness, numbness or tingling.
Fortunately, most forms of back pain get better on their own: approximately 50 percent of patients will experience back pain relief within two weeks and 90 percent within three months.
If the pain lasts for more than a few days, is getting worse, does not respond to back pain remedies such as a short period of rest, using ice or heat, lower back pain exercises and over-the-counter pain relievers, then it is usually advisable to see a back doctor.
- Advil,Ibuprofen, Nuprin, Motrin
- Naprosyn, Naprelan, Naproxyn, Alleve, anaprox
- Lodine, Etodolac
- Orudis, Oruvail, Ketoprofen
- Cataflam, Voltaren, Diclofenac, Arthrotec
- Feldene, Iroxicam
- Tolectin, Tomletin
- Nalfon, Fenoprofen
- Meclomen, Meclofenamate
- Daypro, Oxaprozin
- Clinoril, Sulindac
- Indocin, Indomethacin
- Relafen (Nabumetone)
- Dolobid, Difunisal
- Ponstel, Mefenamic Acid
- Toradol, Ketoralac
- Apsirin, Bufferin, Excedrin, Disalcid, Salsalate, Alka Seltzer Plus, Trisilate
- Anything that has “salicylic” or “salicylate” on the label
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