What is an epidural injection?
Epidural injection can help reduce lower back, leg, neck or arm pain caused by sciatica, herniated discs, misaligned vertebrae or other back problems. A low dose, long acting steroid medication is injected into your back, into the area between your spine and spinal cord. This injection can effectively deliver the anti-inflammatory effect directly to the site of injury and can help reduce the inflammation and alleviate the pain.
Epidural steroids are effective in the treatment of discogenic pain (bulging or herniated discs) in the back and in the neck. Epidural injections can be used to treat other problems such as sciatica, spinal stenosis, cervicogenic headache, failed back surgery syndrome and pinched nerves among other problems.
How is an epidural injection done?
First, you may be given an intravenous medication to relax you, if this has been arranged between you and your doctor. Then, you’ll lie on your stomach on an x-ray table.
The doctor will numb an area of skin on your back with a local anesthetic. Then, guided by an x-ray, he or she will:
- Insert a thin needle into your back
- May inject dye to confirm that medication will go to the correct spot
- Inject a steroid (for longer term relief)
The medicines then spread around the spinal area, reducing nerve inflammation and pain. Usually, the procedure takes less than 15 minutes, and you can go home the same day.
How effective is an epidural injection?
Some patients report pain relief within 30 minutes after the injection, but pain may return a few hours later as the anesthetic wears off. Longer term relief usually begins in two to three days, once the steroid begins to work. How long the pain relief lasts and how much the pain is relieved is different for each patient. For some, the relief lasts several months or longer. If the treatment works for you, you can have periodic injections to stay pain-free. It is important to discuss with your physician your response to epidural steroids in order to plan future treatment options.
The most important success achieved with the use of epidural steroid injections is the rapid relief of symptoms that allows patients to experience enough relief to become active again. With this help patients may experience increased effectiveness of physical therapy and regain the ability to resume their normal daily activities.
The Department of Rehabilitation Medicine at the University of Washington conducted a study that compared the risks and efficacy between surgical alternatives versus Epidural Steroid Injections (ESIs). In their conclusion, “when weighing the surgical alternatives and associated risk, cost, and outcomes, lumbar epidural steroid injections are a reasonable non-surgical option in select patients.” (Young 2007)
What are the risks?
Although ESIs are considered safe and are one of the most commonly performed procedures in the world, there are risks associated with the procedure. Rarely, complications include spinal headache, nerve damage, and bleeding or infection at the injection site. Short term side effects can include: Numb or weak legs, dizziness, headache, and muscle spasms.
The other risks of the Epidural Steroid Injections may be directly related to the medications injected. Some of the potential side effects of steroids include elevated blood sugars, weight gain, arthritis, stomach ulcers, and transient decrease in immune system function. Patients should speak with their physician about risk assessment for the procedure in their individual situation.
Who should not have an epidural injection?
Patients with an allergy to any anesthetic, are on blood thinning medications, are diabetic, have an active infection, or are pregnant should consult with your pain physician before receiving the procedure. There may be special instructions for you or the procedure might need to be rescheduled.
What happens afterwards?
You can continue your regular diet and medications immediately. Do not drive or do any rigorous activity for 24 hours. Take it easy. You can return to your normal activities the next day.
It may take up to a week for the steroid to begin working. If you don’t feel better within 10 days, see your doctor for more evaluation and to discuss different treatment.
Is epidural injection right for you?
Epidural injection may be right for you if your back, leg, neck or arm pain has lasted longer than four weeks, is severe or has not improved with other treatments, such as physical therapy. Contact us to find out more.
At PrairieShore™ Pain Center, our goal is to relieve your pain and improve your quality of life. If your primary physician has advised you to see a specialist for your pain, turn to us for help. To schedule your appointment, please contact us here or give us a call at (847) 883-0077.
The use of lumbar epidural/transforaminal steroids for managing spinal disease. J Am Acad Orthop Surg. 2007 Apr;15(4):228-38 Young IA, Hyman GS, Packia-Raj LN, Cole AJ