What is infiltration therapy?
Infiltration therapy is a targeted injection procedure used in pain medicine. Medication – usually a local anaesthetic, often combined with an anti-inflammatory agent – is injected directly into the region of the suspected source of pain. The aim is to influence the pain at its origin rather than treating it systemically via the bloodstream.
Injection-based pain therapy is mainly used for symptoms arising from the spine, joints, tendon attachments or peripheral nerves. It forms part of a multimodal concept and generally does not replace exercise therapy or a thorough medical assessment.
When is infiltration therapy an option?
An infiltration may be useful when pain persists, can be clearly localised and other conservative measures – such as physiotherapy or oral pain medication – do not provide sufficient relief. Typical areas of application include:
- chronic back pain, for example caused by irritation of the small vertebral joints (facet joints)
- nerve root irritation, for instance with a disc herniation radiating into the leg or arm
- pain at the sacroiliac joint at the junction between spine and pelvis
- irritation of the shoulder, knee or hip joint
- tendon attachment problems such as tennis or golfer's elbow
- myofascial pain, i.e. symptoms originating from tense muscle areas
Spinal infiltration in particular plays an important role in the treatment of back and neck pain, as it enables targeted treatment of pain sources that are often difficult to distinguish.
What types of infiltration are there?
Depending on the location and depth of the symptoms, various techniques are distinguished:
Spinal infiltrations
- Facet joint infiltration: injection at the small vertebral joints, often used for load-related back pain.
- Periradicular therapy (PRT): targeted injection at the nerve root, usually under imaging guidance, for example with a disc herniation.
- Epidural infiltration: delivery of the medication into the area around the dura mater.
- Sacroiliac joint infiltration: injection at the sacroiliac joint.
Joint and soft-tissue infiltrations
- Intra-articular injections: directly into a joint, such as the shoulder or knee
- Bursa and tendon attachment infiltrations: for bursitis or tendon-related complaints
- Trigger point infiltrations: into particularly painful muscle areas
Which active substances are used?
A local anaesthetic is generally used, which briefly interrupts the transmission of pain. An anti-inflammatory glucocorticoid (corticosteroid) is often added to calm irritation for a longer period. In certain cases, saline solution or other substances are also used. The selection depends on the clinical picture, pre-existing conditions and individual tolerance, and is discussed with the patient before treatment.
How is an infiltration carried out?
Although the exact procedure varies depending on the technique, there is a typical basic pattern:
1. Initial consultation and examination: medical history, physical examination, review of existing imaging (e.g. MRI). Information about benefits, alternatives and possible risks.
2. Positioning: depending on the region, lying down, sitting or in a prone position.
3. Skin disinfection and sterile working conditions to avoid infections.
4. Puncture: with a fine needle, often under ultrasound, X-ray or CT guidance for precise placement.
5. Injection of the medication mixture in small amounts.
6. Observation: short rest period at the practice, monitoring of general condition and effect.
The injection itself usually takes only a few minutes. Many patients can leave the practice shortly afterwards, but should refrain from driving on the same day, depending on the procedure.
How quickly does an infiltration take effect?
The local anaesthetic can lead to noticeable pain relief within a few minutes. This initial effect wears off after a few hours. Any corticosteroid that has been co-injected usually develops its anti-inflammatory effect only after one to several days and may then last for weeks. Several sessions at defined intervals are often required to achieve more stable relief.
Possible risks and side effects
Like any medical intervention, infiltration therapy is not entirely without risk. With careful indication and execution, however, serious complications are rare. Possible side effects include:
- temporary increase in pain around the puncture site
- small bruises or local irritation
- rare allergic reactions to the substances used
- with spinal procedures: very rarely nerve irritation or infection
- possible effects of corticosteroids, such as short-term fluctuations in blood sugar, circulatory reactions or skin changes at the injection site
Patients taking blood-thinning medication or with a coagulation disorder, an infection or a relevant allergy should always inform the doctor before treatment.
Limits of infiltration therapy
As helpful as targeted injections can be – they are not a cure-all. A realistic view of the possibilities is important:
- An infiltration often treats the symptom, not the underlying cause.
- In the case of structural changes, such as advanced osteoarthritis or a disc herniation requiring surgery, it may relieve symptoms but cannot correct the underlying condition.
- The effect can vary from person to person and is limited in time.
- Frequent, uncritical repetitions – especially with corticosteroids – are not advisable.
- For pain that is purely psychological or partly caused by other illnesses, the benefit is limited.
Infiltration therapy is therefore usually part of an overall concept. Exercise and physiotherapy, adjustments to daily life, ergonomic measures, basic drug therapy where appropriate, and psychosocial support remain key components in the treatment of chronic pain.
What patients should bear in mind
Before injection-based pain therapy is planned, a detailed consultation is important. Useful questions include:
- What is the aim of the infiltration in my case?
- What alternatives are there?
- How many sessions are likely to be needed?
- What risks are relevant in my situation?
- What happens after the treatment – for example with physiotherapy?
Careful indication, sterile working conditions and – where necessary – imaging guidance contribute significantly to increasing the benefit and safety of infiltration therapy.
Conclusion
Infiltration therapy is an established procedure in modern pain medicine. When used appropriately, it can contribute to noticeable relief of spinal and joint pain, improve mobility and pave the way for active forms of therapy. However, it does not replace comprehensive diagnostics or a long-term treatment plan.
This article does not replace medical advice.