The epidural space is located outside the lining of the spinal cord. Medications such as corticosteroids and /or local anesthetics are injected in the epidural space by the way of a needle or catheter.
WHAT IS THE PURPOSE OF AN EPIDURAL STEROID INJECTION?
The corticosteroid injected reduces the inflammation and/or swelling of the nerves in the Epidural space. This may reduce the pain, tingling, numbness, and other symptoms caused by nerve inflammation and /or irritation and swelling.
WHAT TYPE OF CONDITIONS ARE EPIDURAL STEROID INJECTIONS USED TO TREAT PAIN?
Epidural steroid injections are used to treat conditions that affect the spine from the neck to the lower back. These conditions include herniated discs, protruding discs, degenerated disc, osteoarthritis of the spine, spinal stenosis, and scar tissue or other changes following neck or lower back surgery. Patient symptoms include pain in the neck, shoulder, middle or low back, arms, or legs. Patients may also have symptoms of numbness or weakness in the extremities.
HOW IS THE INJECTION PERFORMED?
Your procedure will be scheduled at a facility where the Physician will perform the procedure. After you have been checked in by the nurse and the paper work has been completed, the nurse will start an IV in your arm so the doctor can give you some sedating medication. The medications normally used for this procedure are called Versed and Fentanyl. They are short acting sedatives which will allow you to take a short nap. During the injection your blood pressure, pulse and breathing will be monitored by the nurse or anesthesiologist. The nurse will help you put on an oxygen cannula before being sedated to provide some supplemental oxygen while you are resting. This may smell like plastic and tickle your nose.
The procedure involves inserting a needle through the skin and deeper tissues so there is some discomfort from the placement of the needle, but the above medications will help with the pain.
WILL THE INJECTION(S) HURT?
There is minimal discomfort with the injection. You may experience an increase in your pain until the medication takes effect, usually within 24-72 hours after the injection. You will need to take your pain medication or an OTC medication for the discomfort for the first day. A small ice pack may help relieve the discomfort of the needle insertion site for the first 24 hours. It is not unusual for the tenderness to last 1-3 days following the injection. If the pain persists after 24 hours a heating pad may feel good to your back.
WHAT ARE THE SIDE EFFECTS AND RISKS ASSOCIATED WITH EPIDURAL INJECTIONS?
The risks involved include the following-infection, bleeding, bleeding inside the Epidural space with nerve damage and worsening of your symptoms. Diabetics may notice an increase in their blood sugars and should monitor this closely. Other side effect include water retention and general discomfort.
The procedure is performed under sterile conditions and the use of x-ray to guide the needle placement. However, it does have some risk due to the location of the needle placement and the medications used. The risks are low with this type of procedure.
HOW LONG DOES IT TAKE FOR THE INJECTION TO WORK?
If the physician uses a local anesthetic medication with the steroid, you may notice immediate relief or significantly diminished pain after the injection. However this local medication will wear off and the steroid will take 24-72 hours to start working. Your pain will return and you may have a “sore back” for a day or two. Some patients may take up to seven days to notice the full effect of the medication. Most patients do experience partial relief after the first injection. Subsequent injections are performed to increase the degree of pain relief.
HOW LONG DOES THE PAIN RELIEF LAST?
The injected steroids are fat-soluble and generally are active for about one month. Clinical relief depends on several factors. The most important is the nature of the patient’s condition. Healing after injury may take 6 months to one year. In other cases, the condition is chronic and injections may be needed on an intermittent basis (up to three times a year). You will be encouraged to go through physical therapy for strengthening exercises during the period of time when the pain has been reduced. You should continue these exercises on your own at home.
WHAT ABOUT PHYSICAL THERAPY?
Physical therapy and rehabilitation is essential in treating many patients with spinal conditions. By making the muscles around a spine into a “muscular corset” loads can be reduced on the nerves, disks, and joints of the spine. One of the major goals of the epidural steroid injection is to reduce pain and allow the patient to participate more effectively in physical therapy. Weight loss is also recommended to help reduce the natural stress on the body from an excessive amount of weight.
WHAT IF I DO NOT HAVE ANY RELIEF FROM THE EPIDURAL INJECTIONS?
If you do not receive any benefit from the epidural injection, other structures may be responsible for your pain. This could include the disk, joints, ligaments, or muscles surrounding the spine. You may require further imaging studies or other diagnostic injections to better identify and treat the source of your pain.