Epidural steroids have been safely and effectively used in the treatment of chronic neck and back pain for the last 40 years. Back and neck pain are usually treated conservatively with bed rest, physical therapy, non-steroidal anti-inflammatory drugs, back exercises and low dose narcotics. A majority of patients will improve on this regimen. However, when conservative therapy fails, epidural steroid injections are an effective next step in treatment.
Epidural steroid injections work by several mechanisms. They break the cycle of pain, followed by muscle spasm, followed by more pain which occurs in this disease. Pain relief afforded by epidural steroids may allow a larger and more pain free range of motion. This increases the effectiveness of physical therapy in preserving muscle strength and range of motion.
By administering a low dose, long acting medication, epidural steroids can effectively deliver the anti-inflammatory effect directly to the site of injury. This reduces the dose of medication necessary as well as increases its effectiveness.
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. They reduce inflammation, swelling and irritation of the nerves, thereby providing pain relief. Epidural steroids are simple and safe. The primary risk of the injection is headache which occurs in about 1 in 100 patients. Epidural steroids are safely performed by a pain specialist, usually an anesthesiologist.
Epidural Steroid Injections Frequently Asked Questions (FAQ’s)
NOTE:the following information is presented for educational purposes only. This informaiton is not Intended to represent medical advice. Please consult with your doctor if you have any questions or concerns regarding a medical condition or planned procedure.
1. What is an Epidural Steroid Injection?
An epidural steroid injection (ESI) is a simple, relatively painless procedure involving the injection of a steroid medication similar to cortisone into the epidural space, the place where nerve roots are located. Performed by an anesthesiologist or specialist in pain medicine, ESI is a very safe and non-invasive technique used to relieve a variety of painful conditions including chronic pain anywhere in the spine.
2. How is this injection done?
Although there are different techniques used for epidural injections, the most common technique is with X-ray guidance. The patient is placed on his/her stomach. The injection is done with local anesthesia and occasionally a mild intravenous sedative. The procedure takes about 5-10 minutes followed by a brief recovery before going home.
3. What types of conditions will respond to Epidural Steroids?
Epidural steroids are used to treat chronic neck and back pain. The most common conditions include herniated or bulging discs, spinal stenosis, and pain following back surgery. Some other painful conditions may respond to these injections such as post-herpetic neuralgia (shingles), lumbar thoracic or cervical radiculopathy, headache due to cervical disc disease, and neuralgia.
4. Does the injection hurt?
The injection of local anesthetic (numbing medication) at the beginning of the procedure may sting some, but ESI is an otherwise painless procedure that is extremely well tolerated by adult patients ranging in age from late teens to well over ninety years old. Upon request, a mild sedative can be given at the beginning of the procedure to reduce any anxiety and discomfort. The injection is performed in our state of the art facility in Coral Springs, Florida which is convenient to Fort Lauderdale, Margate, Pompano Beach, Lauderhill, Tamarac and anywhere in South Florida.
5. What should I do to prepare for my injection?
If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should discuss with your doctor whether to discontinue this medication prior to each injection. Examples of such medications include aspirin, plavix, coumadin, ticlid, lovenox and any other anti-inflammatory medications. The American Society of Regional Anesthesia has recently determined that it is safe for patients to continue taking normal doses of anti-inflammatory medications or low dose aspirin prior to epidural injections. However, you should discuss this with your doctor. On the day of your procedure, you should not have anything to eat or drink for four (4) hours prior to the scheduled time of the procedure. You will be required to have a driver to take you home after the injection.
6. What should I expect after the injection?
You may notice an immediate reduction in your pain for the first 1-2 hours after the injection due to the local anesthetic injected with the steroid. When the anesthetic wears off, your pain will likely return as it was before the procedure. Although no major improvement generally occurs for several days, you may notice a slight increase in your pain before you notice any improvement. Diabetic patients should be on the alert for a rise in blood sugar during the first few days after the injection.
7. What should I do after the injection?
Following discharge home, you should plan on some simple rest and relaxation. If you have pain at the injection site, apply an ice pack to this area as instructed by your doctor. If you received intravenous sedation, you should not drive for at least eight hours. You may return to work the following day and resume your normal activities. After the injection, you may continue with physical therapy, biofeedback, acupuncture or any other therapy the next day providing that your doctor agrees.
8. How many injections will I need during my treatment?
A typical injection series consists of three injections with an interval of one or two weeks between each injection. However, the number of injections that you will require will depend on your response. If you have no pain following one injection, your doctor may not recommend a second or third treatment. Alternatively, if you have absolutely no pain relief after two injections, your doctor may want to try a different type of procedure or may decide to discontinue treatment. It is important to note that some patients do not have any improvement until after the third injection. If you are not sure whether you should have a second or third injection or if you feel that a different type of injection should be considered, please contact your doctor at least two days before your next injection.
9. Could there be side effects or complications?
Minor side effects from the injected medications are not uncommon and can include nausea, itching, rash and sweating among other things. Headache can also occur on occasion, sometimes requiring further treatment. Fortunately, epidural steroid injections have an extremely good safety profile and serious complications are rare. Just like any other procedure, there are always potential complications and your doctor will discuss them with you before you decide to proceed.
10. What are the chances that this treatment might help my pain?
Most studies show that this treatment help relieve pain in at least half (50%) of the patients treated. The degree and duration of pain relief are variable and depend on many factors, including the underlying diagnosis or condition being treated, duration or symptoms before treatment, and whether previous back or neck surgery has been performed. Several conditions that may improve with epidurals include but are not limited to: chronic neck pain, chronic back pain, sciatica, pinched nerves, headache from cervical spine disease, bulging or herniated discs, failed back surgery, shingles or post-herpetic neuralgia, lumbar thoracic and cervical radiculopathy.
11. Can these injections be repeated if my pain returns?
Yes, this procedure can definitely be repeated if it was helpful to your pain in the past. Although there is some flexibility with a repeat injection series, your pain management specialist will probably wait for at least three to six months after your last series of injections to avoid undesirable side effects.