Injections

Injury type: Acute/ Chronic

Category: Medical Options

Rating: No research

Our rating

What is it?

An injection is a means of putting liquid into the human body using a hollow syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body. There are different forms of injections and often relate to the role they intend to play. These include intradermal (within the skin), subcutaneous (just under the skin), intramuscular (into the muscle), intravenous (into the vein), intraosseous (into the bone marrow) and epidural (space between the spinal cord and sheath which covers it called the Duramater) injections.

How does it work?

The injection inserts the required amount of liquid into the host’s body. By doing so, the effect of the substance contained in the fluid travels all over the body and thus has a systemic effect. This is an effective and quick manner of administering chemical substances as the effect is not local but also generalised throughout the body.

A local anaesthetic is a drug that reversibly diminishes the feeling of pain by inhibiting pain signals travelling in through local nerves. A glucocorticoid is a form of steroid which, among other uses, has anti-inflammatory effects. Melatonin is a naturally occurring hormone found in our bodies and it is thought to play a role in biological clock, as an anti-oxidant, interact with the immune system and even affect dreaming.

Is it effective?

The evidence to support injections for whiplash is poor. A systematic review of existing whiplash related clinical practice guidelines¹ reported conflicting recommendations in relation to the use of pharmacological injections for the management of whiplash. In particular, two guidelines did not recommend its use, while another guideline found no evidence to support or refute its use. More recently, a narrative review² investigating invasive interventions for chronic whiplash found no relationship between pain duration and intravenous administration of morphine, lidocaine or ketamine. The conclusion was supported by one included study in this review.

On the other hand, there is some research on injections for the management of spinal pain or neck and upper extremity pain in general. One systematic review of randomised controlled trials³ compared saline, local anaesthetics and steroids in epidural and facet joint injections for spinal pain (including chronic neck pain). The findings suggest equal efficacy for local anaesthetic with steroids and stand-alone local anaesthetic injections in multiple spinal conditions except for disc herniation, where local anaesthetic with steroids appears to be more effective than local anaesthetic alone. Another systematic review⁴ investigating long-term effect of cervical epidural injections for the treatment of neck and upper extremity pain found some evidence to support the benefit of cervical interlaminar epidural injections.

Are there any disadvantages?

While there are some disadvantages to these injections, they were minor and transient. These include facial flushing, worsening of pain, dryness of mouth, dizziness, drowsiness, nausea, headache, malaise, vomiting, ulcer, allergic reaction, flu like symptoms, indigestion etc. Depending on the medicinal substance injected, there may be other side effects.

Injection itself may cause additional disadvantages. These include pain and redness of the skin at the site of injection.

Where do you get it?

Injections can only be provided by a registered health professional, most likely a Doctor or a specialist in this field.

Recommendations

Due to conflicting evidence, the use of pharmacological injections in the management of whiplash cannot be recommended. More research is required before concrete recommendations can be made.