Epidural steroid injections, also known as epidural treatment for back pain, have been an important tool in the treatment of lower back pain since 1952. In some cases, epidural steroid injections alone are enough to provide relief from an acute episode of back pain. More often, the treatment is used in conjunction with a physical rehabilitation regimen to maximize the efficacy of the treatment. It is important to note that epidural treatment for back pain is not a long-term cure for back pain. The treatment is meant to provide short-term relief while the patient heals from injury, participates in a comprehensive rehabilitation program, or contemplates other surgical or non-surgical treatment options.
How do epidural steroid injections work?
Lower back pain can occur when spinal nerves are compressed by a herniated disc, bone spurs, or a narrowing of the spinal canal. The increased pressure causes the nerves to become irritated and inflamed. This can lead to pain, numbness, and weakness that can radiate to the lower extremities. An epidural steroid injection is not the same as the epidural anesthesia used during childbirth or surgical procedures. An epidural steroid injection involves using a powerful steroid in conjunction with a local anesthetic to relieve inflammation in the spinal nerves. The injection is made into the space surrounding the dural sac that covers the spinal cord. The steroid inhibits the body’s natural inflammatory and immune response, which can reduce pain.
Who is a candidate for epidural steroid injections?
Many instances of acute or chronic back pain resulting from nerve irritation can be treated with epidural steroid injections, including:
- Lumbar disc herniation – A herniated disc is a condition where the soft, inner nucleus of the disc protrudes through the outer fibrous ring, which places pressure on the spinal cord and nerves.
- Degenerative disc disease – DDD occurs when the spaces between the vertebrae narrow and impinge on the spinal nerves.
- Spinal stenosis – Lumbar stenosis occurs when the spinal canal narrows and places pressure on the spinal cord and nerves.
- Compression fractures – Spinal compression fractures occur when tiny, hairline fractures cause the vertebrae to collapse. These fractures may be the result of trauma or a weakening of the bone, such as with osteoporosis.
Most epidural steroid injections take between 15 and 30 minutes and use the following protocol:
- The patient normally changes into a hospital gown to allow easier access and visualization of the injection site
- The patient is positioned flat on a table with a pillow under their stomach to curve the back slightly.
- The injection site is cleaned and numbed using a local anesthetic.
- The needle with the steroid and anesthetic solution is inserted into the skin and carefully guided toward the epidural space. The doctor uses a type of live x-ray called fluoroscopy to ensure that the needle is positioned in the correct location. Once the doctor confirms that the needle is placed correctly, the solution is injected slowly. Most patients do not report feeling any pain during the procedure; however, it is possible to feel some pressure as the solution is injected.
- The patient is monitored for approximately 15 to 20 minutes following the procedure before they are discharged to ensure they do not have an adverse reaction.
Patients are advised to take it easy for the rest of the day following epidural steroid injections. Most patients are able to resume normal activities the next day. Any injection site tenderness can be treated by applying ice packs to the area for 10 to 15 minutes a couple of time an hour. It is possible to experience a temporary increase in localized pain following epidural steroid injections; however, this typically resolves within a few days.
The pain relief from epidural treatment for back pain usually lasts anywhere from a few weeks to several months. The success rate varies depending on the condition causing the pain and the amount of radicular leg pain associated with the condition.
Research studies show that approximately 80 percent of patients experiencing sciatica due to a herniated disc report symptom relief following epidural steroid injections. Patients suffering from spinal stenosis also experience symptom improvement in 75 percent of cases. Epidural steroid injections are most effective if they are given within the first few weeks following the onset of pain. Most physicians do limit the number of steroid injections to three per year to limit the potential for systemic side effects, such as bone weakening.
Are there potential risks of epidural steroid injections?
Just like any other invasive medical procedure, epidural steroid injections do carry potential risks; however, the procedure is considered safe and complications are rare. Possible complications of epidural steroid injections include:
- Some patients report dizziness, nausea, or headaches following the procedure. These symptoms are usually mild and resolve relatively quickly.
- Infection occurs in 0.01 to 0.1 percent of cases.
- Bleeding may occur in patients with an underlying bleeding disorder or who use blood thinners.
- A small percentage of patients experience an allergic reaction to the medication.
- Nerve damage can cause increased radicular pain in the leg.
Following the procedure, some patients report mild tenderness at the site of the injection, facial flushing, difficulty sleeping, feeling anxious, and an increase in blood sugar. These side effects are typically minor and resolve within a day or two.
Epidural steroid injections are considered a low-risk, effective, non-surgical method for treating back and radicular pain due to nerve inflammation. The most effective outcomes occur when epidural steroid injections treatment is started soon after the onset of pain and is used as part of a multi-faceted regimen.
Contact our office today to learn more about how epidural injections for back pain can help you find relief from your discomfort, as well as help you get back to your regular activities quickly. Feel free to ask us any questions that you might have about how the injection process works and what might make you a candidate. One of our back pain professionals will be able to meet with you for a consultation to help you learn more.