“Epidural” refers to a particular space in the spinal cord and not a particular type of medication. Epidurals are familiar as a pain relief measure during labor, but the epidural Fish is referring to doesn't numb your lower body. In the case of low back pain, the physiatrist may inject a small dose of medication and steroid in the epidural space.
“If it’s a pinched nerve in the back or neck with pain going down the arm or leg, I might refer the patient for a specialized injection such as cortisone injections near the spine," says Fish. "That takes the pressure off the nerve and helps relieve the arm and leg pain.”
One of the most important treatments for chronic low back pain is physical therapy. Almost every back pain clinic or spine center will have a physical therapist on staff. Physical therapists are state-licensed health professionals whose primary focus is keeping people mobile and functioning using a variety of exercise and movement therapies.
Your physical therapist will design a program for you that combines core strengthening exercises, aerobic exercises, and “back school,” which builds your awareness of your posture and teaches you what you should -- and shouldn’t -- do to maintain a healthy back.
“They’re our eyes and ears,” says Fish. “They’re spending most of the time with the patient.” Usually, you will see a physical therapist approximately three times a week for three weeks, then ramp down to two times a week for the next three weeks, and once a week for the last three weeks. Nine weeks is the standard course of PT for back pain.
At many back and spine clinics, the physiatrist, anesthesiologist, or pain medicine specialist who administers the specialized pain-relieving spinal injections is also specifically trained as an “injectionist.”
You can become an injectionist via several paths, says Johnson. After completing physical medicine and rehabilitation training, a physiatrist may also undergo a pain management and injection training program that lasts another 1 to 3 years. A doctor may also start out in anesthesia and then do a fellowship in pain management, which offers more experience and training in complex injections.